U.S. healthcare failing in cost, quality, safety; together we can cure what's ailing our system
The American healthcare system is headed toward a cliff, and the fall will be long and painful. Healthcare consumes 18% of our nation's gross domestic product, almost 50% more than the second highest-spending nation. High-deductible health plans are the new norm for one-third of insured patients. Out-of-pocket costs are increasingly unaffordable for many.
Healthcare accounts for 40% of tax revenue, and with 10,000 baby boomers becoming Medicare-eligible each day, American healthcare is heading for a financial free fall.
There are plenty of reasons for our country to fear these rising costs, but quality problems and personal inconvenience are just as worrisome for patients. Nearly a half-million Americans die unnecessarily each year from a combination of avoidable medical errors, failure to receive the recommended preventive services, and disparities in health outcomes because of race and other social determinants of health.
Meanwhile, few people can access the same technological conveniences in their medical care that they demand from the banking, travel and retail industries. Overall, U.S. healthcare scores in the bottom half on nearly all measures of quality when compared with the other 20 most-industrialized countries in the world.
To address these problems and help patients understand the impact on their health, I wrote Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong.
It begins with the story of my father, who died, in part, from medical error and the failure of his doctors to effectively communicate with one another.
After his death, whenever I spoke publicly about my father's mistreatment, people would line up to share similar experiences about the care of their loved ones. The combination of my desire to transform American medicine and my family's personal experience has led me to donate all profits from the book to charity to help provide access to those unable to obtain necessary care today.
As CEO of the nation's largest medical group and as the son of a man who died prematurely, I set out in
Mistreated to explore the strange division between the objective data on the quality of American medicine and the all-too-prevalent belief that American medicine is the best in the world, even if high-priced. By examining decades of psychological literature, behavioral economics and the most recent brain scan research, I came to understand why patients accept so much less from their healthcare than they demand in other areas of their lives. The answer resides in the power of perception.
Studies show that under the right circumstances, our brains undergo a neurobiological shift, causing us to perceive the world in ways that contradict objective reality. This subconscious distortion produces behaviors that prove problematic. Nowhere is this more evident than in the world of healthcare. We see intervention as more important than preven- tion, overlook omissions in preventive services and tolerate medical error. And fear makes most patients reluctant to question the recommendations of physicians, or even insist that they wash their hands between hospital rooms.
As healthcare edges closer to the proverbial cliff, patients and doctors are faced with a painful choice. Either we transform the U.S. system or watch it devolve into a two-tier system of care, divided between the rich and everyone else. To avoid this pitfall, Mistreated provides a road map for the future with real-life examples of what is achievable in healthcare with the proper structure, financing, technology and leadership. When medical care is integrated within and across specialties, capitated at the delivery system level, supported by the most modern technology and physician led, superior outcomes can be achieved.
My hope and belief is that if enough Americans understand the shortcomings of the current system and demand that all physicians and hospitals match the top performers today, our perceptions will change. We can then transform American medicine from the outdated cottage industry it resembles today. If we do, and if hundreds of thousands of lives are saved each year, then my father's death will have served a purpose.
Dr. Robert Pearl is executive director and CEO of the Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group.