Companies & Industries

Book Excerpt: Health Care Reform That Makes Sense


In an edited excerpt from his new book, Health Care Reform That Makes Sense, Universal Health Services CEO Alan B. Miller makes the case for the U.S. health care system—complicated and flawed, but still the best in the world

Give me six hours to chop down a tree and I will spend the first four sharpening the axe. —Abraham Lincoln There is no question that the current health care system has flaws. Essentially what we have is a vehicle that stalls periodically and has a rear tire slowly losing air. The idea is to address the engine trouble, perhaps a bad valve, and replace the tire, thus ensuring forward motion—a smoother ride with the American people in the driver's seat. Our current health care system isn't a clunker, far from it. Upwards of 80 percent of the population is happy with the care they receive and don't want to see it compromised. Yes, the cost of premiums remains a concern to some and certain recommendations will be provided later in the book to cut unnecessary fat from procedural costs. With that said, we have superior, world-class doctors, nurses and technicians who utilize state-of-the-art technologies in advanced hospitals. When one studies the medical care available in America with our capitalist system, it is fantastic—there is no parallel. Yes, there are inequities and there are inefficiencies, but these are the usual consequences associated with ventures of this magnitude. A system built by humans will be impacted by human nature—some good and some bad. That's life. An adult, rational stance must be taken when considering our overall health care system. America leads the world in the medical industry because our system is based on incentive, risk and reward, which speaks to the very foundation of our country: entrepreneurship and hard work. I celebrate what is right with our health care system and focus my energies toward fixing the inequities, which include insurance reform, tort reform, examining Medicare and Medicaid, analyzing the pervasive immigration issue and determining the actual number of uninsured Americans—a figure far less than the purported 45.7 million. The aforementioned topics will be covered in greater detail throughout the course of this book. This health care debate is welcomed. The last time it became the talk at the watercooler was in 1993 under the Clinton administration. The fact that Americans are spirited, curious and engaged in the outcome represents a unique opportunity. Sixteen years ago, the pharmaceutical industry was not behind the reform. Today, they are interested in playing ball as long as contingencies are met. Medical Marvels We need to put the brakes on and take a moment to focus on the most important aspects of our health care system: innovation and expertise. Not long ago, I heard a resident from one of the Caribbean islands say that if he has a headache, he takes an aspirin. If it is anything more severe, he calls his travel agent: he's heading to a hospital in Miami. He sounded like a smart man to me, and I'll tell you why. We have the finest medicine in the world, with the finest doctors and the finest schools. If you take a look at international medical tourism—people with means and the ability to be discerning—you'll see an influx of foreigners taking advantage of our world-class medical services. Heads of state from the Arab nations on down the line go to the Mayo Clinic, the Cleveland Clinic, Memorial-Sloan Kettering, George Washington University Hospital and the list goes on. I have operated hospitals in countries with socialized medicine, such as the United Kingdom and France. There is simply no comparison. This is not to say that there aren't excellent hospitals and doctors operating outside the United States. There are small pockets of reverse tourism in India and Singapore, for example, built largely on lowered prices, but overall, we remain the leaders. And for the most part, those doctors were educated in America. We train countless Pakistani and Indian doctors, and when the majority of them complete their residency, they stay here. Leading reasons for this stronghold are that 70 percent of Nobel Prize recipients for medicine are from the United States. In addition, 77 percent of pharmaceutical advances take place in the United States and are then exported to other countries. Refocus The Debate From the onset, the health care debate has gone down a number of distinct roads, the first of which was covering the uninsured. This concept was tied to the failing aspects of the economy. The rationale was that the cost of health care was an undue burden on the economy, and if these costs along with inflation couldn't be brought under control, then the economy could not be fixed. These combined issues didn't gain as much traction as expected, which gave rise to the insurance reform issue. As with all systems, there is truth in that flaws exist. People often say, "I like my doctor but not my insurance company." Essentially, insurance companies became an easy target, and like all industries they should be subject to reform if the model is proven to be suspect. As the various forms of the health care reform bill bounced around the House of Representatives and the U.S. Senate, it became unclear exactly which issue would be the selling point. A bill of this magnitude requires a handle for politicians to hold onto in order to support or reject it. Both sides of the aisle have made emotional arguments on behalf of their position, but more often than not there are factual inconsistencies that are reported in papers and magazines and then pushed through the mill, which is the 24-hour television and Internet news cycle. As a consequence, it becomes difficult for the American public to decipher what the facts are. This is the nature of the political machine that is Capitol Hill. Perhaps the only flaw in our democratic system is the fact that presidential term limits influence policy initiatives. Problems associated with health care have permeated the system for the last 40 or 50 years. And, theoretically, they should have been dealt with incrementally, issue by issue. Unfortunately, all too often the attitude is "not on my watch" and systemic problems are passed along. The same could be said for corporations and businesses with CEOs who concentrate on quarter-to-quarter results. This places pressure on companies to be short-term oriented and to not focus on long-term investment. These companies, some of which were once household names, have failed. There is no guarantee that government programs, however well-intentioned, are not subject to the same fate. Who is left holding the bag? The American taxpayer will be the unwilling recipient of runaway costs and compromised health care. This is the reason we must proceed with caution. There is no more time for an antiquated approach. In the beginning of 2009, when the health reform bills first were kicked around, Medicare was held up as a failing government program in need of change. By the end of the summer, it was being touted as a model for universal health care for all Americans. With misdirection and misinformation like this example, it is no wonder that people are confused. The reality is that most Medicare recipients are satisfied, and in most cases happy, with their coverage. The problem is that it is a program that has wildly escalating costs and, according to some forecasts, is less than a decade away from bankruptcy. This is due to the fact that the program simply pays claims without vigorously investigating for fraud and abuse. In 2008, for example, Medicare's annual spending exceeded tax revenues, forcing Medicare to spend its reserve funds. To replicate the Medicare model for the rest of the country, or those deemed uninsured, seems incongruous. I recently heard the story of a fine young doctor who went to work for the Veterans' Administration. He said he was pleased to be working with a group of people who were the most dedicated medical professionals he had yet to come across, that was, until four thirty in the afternoon. They punched the clock. They didn't stay a minute after their shift because they had zero incentive. To be successful in business you accommodate to your customers' needs. The health care industry should be no different. This approach breeds excellence. Without incentive, there is little reward. And without drive, innovation is lost. The cascading result of this premise would be that highly educated doctors eager to help people would feel thwarted, disenchanted. Their once entrepreneurial profession will be considered a liability, and they may well turn their focus elsewhere, to another profession. A greater shame I cannot underscore. The balance of this book will investigate what is wrong with our health care system and ways in which it can be improved: diagnosis and remedy. These are solutions I have discussed countless times over the years behind closed doors with peers, politicians, policymakers as well as the medical and insurance communities. It is now time to have the conversation with you, the American people who deserve to see the issues from the inside out. After all, health care represents 17 percent of our gross Domestic Product (GDP). We simply can't afford any miscalculations. The health of our economy, and that of our people, depends on due diligence and foresight. At this point everyone agrees that the "tree" should be trimmed, but as Abraham Lincoln said, let's spend more time sharpening the axe and less time chopping it down.


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