The Future of Health Care in the United States

Stephen F Hightower MD FACP

“Wherever the art of medicine is loved, there is also a love of humanity.” - Hippocrates

We have read and written about many opportunities for the health care system in the United States to be improved, to be more universal, to be more scientific with AI, to reach further and sooner to those in need, to always be available at all times and in all scenarios, to have lower cost or no cost, to provide always the most up to date information, medications, treatments, and to always have the very best outcomes regardless of what the patient does to assist in promoting that outcome. Is all that really feasible?

While there are currently several opportunities for the medical groups in the United States to be more proactive by adopting AI, improving access, expanding tele-health, focusing on follow up calls after hospitalization or recent office visits,  providing clinical Pharmacists for medication questions, and assuring the physicians knowledge base can be advanced with on line information about disease processes and medications, as well as awareness of ongoing clinical trials by disease, and new treatments occurring at the hospital down the block. Doesn’t all that investment validate our current Health Care System does not need restructuring?

All of the above have been available for months, and some for years. So why are we evaluating these opportunities again.  The answer is simply that every four years someone else comes into the White House with their concept of the best healthcare, and what the cost of health care for Americans should be, and thus the ideas change about how health care can be funded and provided.  Also, because physicians can be either independent or part of a group, their ideas and concepts will likely vary about their role, effort, compensation, and work life over the lifetime of their career.   

It is this reality of constant change, and its related potential insecurity that promotes hesitancy in invoking a definitive new plan of health care promoted by one Congress, which may change in 4 or so years by the next administration. In Medicine, 4 years may not be an adequate time for promoted changes in the health care system to really take hold or to be adequately validated.

What might be valuable is the Government providing assessments of all providers of health care with ratings coming from clients they have and the comparison of those ratings being published for all to review. Also, it would be especially valuable to see the personal comments section of the nurses reports and the perceived care the patient felt they received.   Insights of current heads of departments, and nurse practioners who visit patients  at home would be essential in really knowing what the patients were experiencing.

A reimbursement system based on outcomes may very well see the avoidance of care for those in most need, especially if they have poor underlying health or advanced age, when results are generally poorer.

Moving the majority of current inpatient care to home-based care would be a novel concept in many areas, but with our aging population could require significant numbers of home care providers that do not as yet exist.

The desire of a very advanced SYSTEM to provide health care is novel and if used would provide an access to affordable basic health care. However, the concept of finding who has and has not become a provider and what they provide would be similar to our current scenario of finding health care options that are affordable and actually provide some services for the premiums you have to pay.

I would be very happy to see the first iteration of a Medicare for all program.  If it were to come about, I anticipate a very large push back by all of the major insurers and companies that provide services at this time and likely from a significant segment of the physician population. The government will end up having to set prices for services, which will likely drive many physicians into small specialty groups with independent services and billing. Access could very well become an issue and there would be no ability to make the independent physicians take the cases of those physicians who have switched to the government insurance plan, even if those plans are overwhelmed with patients. It should be anticipated that the wealthy will go to their private doctors while all 23 million non-US citizens in the US, and all middle class and other citizens will be trying to receive care from the Medicare for all Plan.  It would be educational to have a CPA or other financial guru, try and evaluate what the financial scenario would be across the US if a Medicare for all who want it program, was started by the US Government. Even more valuable would be the concept of taking two states with large populations such as New York and Pennsylvania and compare their available access, treatments, outcomes, and cost, to two states with low populations like New Mexico and North Dakota.  We may find that lower populations do well with a Medicare for all program but that high population states struggle with access and quality.  Equally important will be the physician satisfaction reports which assess the potential for the program to continue.

A projection of the cost to the US Government, for Medicare for all, by the Mercatus Center at George Mason University is 32.6 Trillion over 10 years or essentially 3.2 trillion per year. The KFF has surveyed and found 62% of Americans support a national health plan but only 37% support Medicare for all, based on the potential for higher taxes and the elimination of private insurance. It has been suggested that a Public Agency run by a Regional Board would be able to promote higher job satisfaction for doctors, which will be critical to maintain appropriate access for patients.

The Future for Health Care in the United States can have a bright future.  If we test the theory with 4 states, use all of the new health care opportunities available, distribute the results of care, cost, access, and satisfaction of both patients and physicians, we can provide to our citizens what works best for all involved, reclaim our sense of pride in the health care we provide, and exult in the outcomes our patients have, and in the nation and profession we represent.

Respectfully submitted,

Stephen F. Hightower, MD, Fellow American College of Physicians

Dr. Hightower is a retired Internist and Geriatrician with experience in rural communities in New Mexico with the Public Health Service, in Major Universities like Baylor Scott and White in Texas, and in Community Hospitals like Presbyterian in Albuquerque, NM.  His focus on the elderly for over three decades remains steadfast as he continues to provide free testing for Mild Cognitive Impairment at his local Library in Rio Rancho, New Mexico under sponsorship of the Alzheimer's Association of  America. He also provides medical insights to the New Mexico Produced Water Research Consortium through the Risk and Toxicology and Public Outreach Committees. His current joys include encouraging the availability of health care for all our US citizens, making produced water from oil and gas useful, and taking his wife and all four grown children and their families on excursions to see the amazing wonders of our fabulous United States, and Occasionally the World.  He currently lives in Rio Rancho, New Mexico with his wife and 3 pups.