US healthcare is defined by practices that in any other similar or related domain would be viewed as highly abnormal.
How did we get here? How do we get out of here?
Here are a ten examples of such practices.
There are countless more.
Lack of price and quality transparency. In any other arena of life, we would find the inability to easily know prospectively what something costs deeply unacceptable. The same could be said about the lack of any meaningful transparency around clinical quality. We exist in this state despite decades of efforts to drive greater price and quality transparency—starting as early as the 1990s and the Wisconsin Collaborative for Healthcare Quality.
Predatory billing and medical bankruptcy. It is not normal that one of the most common causes of debt and bankruptcy is healthcare. Countless people delay and forgo necessary medical treatment because of how we bill for medical services. Countless not-for-profit healthcare systems have aggressively sought payment for medical debt, sometimes leading to bankruptcy. Think about that. Organizations like RIP Medical Debt have raised the profile of this issue—but we are far from a world in which medical debt is no longer a leading cause of bankruptcy.
Profiteering middlemen. Most other industries are in some form of creative destruction through which non-value added middlemen are eliminated over time. Healthcare is overrun by incumbent middle-players who take their cut whose existence and perpetuation is almost hardwired in regulation. They are everywhere. And there are a growing number of them. We mostly have to strain our necks to buy their “value story.”
Redlining. Many so-called “quality” or “famed” organizations achieve that status by making implicit or explicit strategic decisions to not service complex patients and communities. They get their “status” by cherry-picking the kind of business that they want. And then they sit atop ratings of top organizations in their respective domains collecting and celebrating shiny tchotchkes along the way.
Waits and Delays. If in any other domain, a potentially life-and-death service was delayed days, weeks, or even months—we would have serious complaints, maybe even Congressional action. In US healthcare, we have normalized and accepted operational inefficiency and waits and delays as “just how things are”—even for people facing life threatening illnesses. The emergency room is where many people seek what would ordinarily be primary care. We have come to expect that you have to know someone who will fight for you to get access to necessary services.
Monopolies. Healthcare organizations often operate with unchallenged and/or growing monopolies. In healthcare, the promise has always has been that consolidation would lead to efficiencies and economies of scale that would lower costs. That efficiency has never come and monopolistic entities continue to scale. Usual tests of consolidation and monopoly power fail because most people consume healthcare hyper-locally.
Non value-added paperwork. We have normalized high volumes of paperwork and red tape and reporting that make little contribution to delivering on the end product for consumer. We employ armies of people to process that paperwork and fulfill reporting and or billing requirements. And the list of those requirements continues to grow unchallenged.
Strangers and anonymity. In healthcare, we normalize the constant incursion of strangers into our lives in our most intimate moments. These strangers (usually well-intentioned) often don’t know much about us and aren’t empowered with the luxury of time to build a relationship. Designed from first principles, healthcare would include more personalization and be grounded in long-standing connection.
Massive global pricing arbitrage. An Apple iPhone costs within 20%-30% of the same price in the US as it does in other countries. Pharmaceuticals? The difference could be as high as 10x or more. And we just accept this to be how we do business.
Inauthenticity. There is so much chatter about innovation, transformation, pick your favorite -ation. Pull back the covers and there’s not a lot going on. We have normalized hypocrisy and double speak and the “say-do” gap. And the normal forces that should challenge the hypocrisy often amplify it.
As with all of these other examples of “normalized” abnormal, I guess if you can’t beat them, join them.