By Michael Weitekamp, MD
“For every complex problem, there is a solution that is simple, neat, and wrong.”—H. L. Mencken
Mencken died in 1956, nearly a decade before the passage of Medicare and Medicaid (1965) and well before the modern era of generous employer-based health insurance. Medical costs were not yet a dominant concern in the rapidly expanding post-WW II economy. Medical science was primitive by today’s standards and treatment options were limited. Mencken’s wife died from an infectious disease that is curable today. Mencken himself suffered a stroke at age 68, with profound neurologic sequelae that may well have been prevented with modern care. He died in his sleep at age 76 — a blessing then, as it still is today.
The scientific advancement of modern medicine and the remarkable progress in public health, prevention, diagnosis, and treatment of illness since Mencken’s time has come at great financial cost. Arguably this has been, on balance, a good thing. We live longer, healthier, and more productive lives as a result. We set the pace for global advances in health science and medical workforce education.
But now we have a problem, and the problem has many facets beyond cost: value, sustainability, quality, safety, and equity, to name a few. The causes are legion: advances in technology, an aging demographic, an epidemic of chronic disease, obesity, socioeconomic disparities, medical illiteracy, a “medical-industrial complex,” misaligned payment incentives, aberrant pricing, poor personal choices, and on and on.
Therefore, as Mencken warned, if anyone claims to have a simple and neat solution to this complex problem, they are wrong. The free market cannot fix this. We spent $2.6 trillion on health care in 2010 and the vested interest in the status quo is formidable. Insuring everyone under a government mandate may help equity and access, but it won’t solve care fragmentation or the duplication of low-value services. High-deductible health plans linked to a “health savings account” may make most of us more cost-aware, but will do little to affect where most of the money is actually spent. “Personalized medicine,” derivative of cheaper and faster gene sequencing, is no magic bullet either. Showing people their genetic predisposition or even objective evidence of their clogged arteries will not make them eat a more plant-based diet, jump on a treadmill, stop texting while driving, and throw their smokes away!
No, the unfortunate truth is that complex problems call for complex solutions. Quality health care will always be expensive. It does not, however, have to cost as much as it currently does. As Einstein said, “We can’t solve problems by using the same kind of thinking we used when we created them.” We need new thinking.
We must first wrap our heads around the fact that poor health is primarily the result of socio-economic determinants and underinvestment in public health and education, rather than insufficient medical care. Then our “new thinking” might include how to shift some of that $2.6 trillion to address those key determinants of societal health; how better to link the financing and delivery of acute and chronic care in ways that reward quality outcomes over volume; how to train the next generation of health care workers for a more holistic view of population and individual health; and how to better leverage information technology and behavioral science to target those most in need of special attention.
If it were easy, everyone would do it. But, if we don’t do it, it will be done to us.
—Michael Weitekamp, MD, MHA, FACP is a Professor of Medicine at Penn State College 0f Medicine and a Robert G. Petersdorf Scholar at the Association of American Medical Colleges. He can be reached at firstname.lastname@example.org.