An Upcoming Budget Crisis
Without a change in course, the US will face a health care crisis in less than one decade, like the financial crisis it is now experiencing.
The Problem
Health System Failure
Infrastructure Failure
Health care is like a pyramid with an unstable base. The three signs of structural failure are emergency services failure, growing uninsured, and eroding primary care.
The Uninsured
Mostly, the uninsured are the working poor. Eight in ten uninsured live in working families. Over half cannot afford to purchase insurance and their employers do not provide it. Twenty percent earn enough money to purchase insurance but choose not to do so. Twenty-five percent of the uninsured are eligible for public programs but are not enrolled.
Eroding Primary Care
Primary care physicians are pediatricians, family medicine doctors, and general internists. They specialize in preventing the development of chronic illnesses, managing chronic illnesses once they occur, and early recognition and treatment of acute illnesses. The two factors that are responsible for the erosion of primary care are: the fee for service payment system that underpays primary care and the disconnection of the public from a physician accountable for their care.
Emergency Services Failure
The United States once had one of the best emergency services systems in the world, if not the best. I doubt that is any longer true. The two steps to repairing the US emergency services system are to: 1) Cover the uninsured and 2) Resurrect primary care.
Patient Behaviors
Wasteful Patient behaviors
The consequences of smoking accounted for seven percent of health care costs and obesity nine percent of costs in the US in the mid-nineties.