Challenges In Health Care Discussed At Chautauqua’s Final Morning Lecture
CHAUTAUQUA The quality of health care most Americans receive has just as much to do with geographical location as social status, according to Susan Dentzer.
Dentzer, senior policy adviser of the Robert Wood Johnson Foundation, spoke about the varying issues associated with America’s current health care system during the last morning lecture of the 2013 Chautauqua Institution season Friday.
Entitled “Rising to Meet America’s Health and Health Care Changes,” Dentzer’s lecture centered around the nature of being an American. In this regard, she said economic status and location go hand-in-hand.
“(Being American) is not universal,” Dentzer said. “If you’re a poor person, it depends on what state you’re in. Your zip code, where you live, what your environment is and how high-income your community is will be as important a driver of your health status as any other factor – including genetics.”
She began with an allegory about a fictional country in which adverse elements of its health care system were among the leading causes of death amongst its citizens. Dentzer then revealed this country to be “The United States of Health Care.”
“This is our health care system,” Dentzer said. “And we will acknowledge (some of) the top 10 causes of death are adverse events in health care. Fifty million (people) are uninsured and many others are getting care but there’s no evidence that it works. We will acknowledge that this is a country that was ripe for change.
“Now, what did our country do,” she continued. “Did we call in Amnesty International? No. What we did, is we passed the Affordable Care Act of 2010.”
Dentzer provided statistics on the health of Americans as a collective unit. She reported two out of three U.S. adults as being overweight or obese – with upward of 80 percent on their way to being categorized as overweight by the year 2030 28 percent of adults as being inactive and a large share of the population under stress or toxic stress. She also discussed the impact of the aging phenomenon on the health care system.
This led into her presentation of data indicating that Americans have been dying at younger ages than people in nearly every other high-income country in the world.
“No matter what factor we look at- whether it’s chronic disease, intentional or unintentional injuries or traffic accidents – we are losing about twice as much lifespan before age 50 as the average of all the other high-income countries,” she said.
Dentzer argued, in most cases, the health care system isn’t as helpful as it could be in terms of prevention.
“We have some problems with our health care system. It’s not as safe as it could be, it’s not as effective as it could be, it’s certainly not that patient-centered, it’s not as timely as it should be, it’s not as efficient as it should be and it’s certainly not as ethical as it should be. Other than that, it is a great system,” she said jokingly.
She said the U.S. is No. 1 in two health care categories: spending and prices. She argued that this could be partly ameliorated by setting up a system whereby health care providers are paid by the value of the work they do, rather than the volume of appointments they take.
“We need to start paying for a package of care, and we need to start paying for the package to produce the best possible outcomes,” she said. “This is a phenomenon that was noted years ago. George Bernard Shaw wrote a play in the early 20th century where he said, in effect, ‘If you have a society that pays surgeons to chop off legs, you’re going to get a society of amputees.’ The only barrier to that not happening is a sense of professionalism among doctors.”
She concluded with a list of concepts being studied to help improve the health care system, such as: patient-centered medical homes, accountable care organizations and a comprehensive primary care initiative.
“We know that not all of these are going to work,” she said. “All of these experiments were set up by the Affordable Care Act to see whether we can figure out a better way to do this. It’s very hard to take a $2.7 trillion system and come up with one model we are confident is going to work. We have to try all of these different things.”