Is our health care system fixable or dysfunctional beyond repair? At the Mayo Clinic’s Transform 2017 conference, Lown Institute vice president Shannon Brownlee and fellow health care experts engaged in a lively debate around this question. (In case you missed the live broadcast, you can watch the debate in its entirety in the video below or on the IQ2 website.)
Brownlee, along with former health care CEO and author Dr. Robert Pearl argued that American health care is indeed terminally broken, while oncologist and policy expert Dr. Ezekiel J. Emanuel and health care CEO Dr. David T. Feinberg held that incremental policy changes are enough for health care sustainability.
In her opening remarks, Brownlee pointed to three crucial problems that won’t change on their own: Lack of quality care for chronically ill and elderly, concentrated power in hospitals, and out-of-control costs. These problems are interconnected, Brownlee asserted – “We are starving primary care to pay for proton beam machines and more ICU beds and more specialty labor.”
While all the panelists agreed that we need to move beyond fee-for-service, emphasize primary care, and invest more in technology, they disagreed on how these changes would happen. Emanuel and Feinberg claimed that health care is moving toward reform on its own, and in time, all providers would have to adapt or die. “It is not just a few points of light,” said Emanuel, “It is tens of thousands.”
Brownlee and Pearl disagreed, arguing that it will take more than individual motivation to truly reform health care. Pearl noted that 92% of doctors still use fee-for-service and 78% don’t want to change. “The providers that have innovated will remain exceptions until we see fundamental changes in the way the system is paid for, regulated, and organized,” said Brownlee, “Most of these legacy players are not about to give up their power or their money without a fight.”
While Brownlee and Pearl narrowly lost the audience vote after the debate, viewer comments echoed their frustration with incremental change.
One commenter on the IQ2 discussion board wrote, “For all their talk of changes that are occurring, investment that’s happening, how much of that is directed toward the majority of people, those that struggle with any amount of healthcare cost? Not much, because most people cannot sufficiently incentivize the healthcare business with their income.” Another commenter agreed, writing, “A system designed to make people infinitely healthier cannot be infinitely profitable.”
Healthcare Informatics‘ David Raths also came out on Brownlee and Pearl’s side, noting that “as long as the [political] divide exists and Republicans control as many levers of government as they do, it seems unlikely to me that reform efforts that involve government oversight, payment or even participation have much chance of success.”
Although they did not agree on when or how it would happen, all the panelists believed that we need a people-powered movement in health care. “Health care reform starts in communities that are committed to the people that are living there… so that every patient gets care that’s compassionate, safe, dignified, and low cost,” said Feinberg.
Pearl took this point one step further. “Do you think industry will let significant change happen without a revolution in this country?” he said, “The revolution has got to come. It’s not going to happen on its own.”