Sean Khozin, MD, MPH

This may come as no surprise to many, but our country’s Social Security and Medicare funds will vanish in the near future.

The annual Social Security and Medicare Trustees report officially called “The 2008 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance (OASDI) Trust Funds” was published yesterday. This report details the current and projected future financial status of the Social Security and Medicare funds and here are the highlights:

• The combined costs of these funds are projected to increase from $2,238 billion at the beginning of 2008 to $4,273 billion at the beginning of 2017
• Medicare funds will be exhausted by 2025
• For Social Security, trouble begins in 2017 as the annual cost exceeds tax income. All assets will be exhausted in 2041

So what is the solution? Fix the national deficit and our failing healthcare system or begin to channel resources into the development of technologies to colonize the moon.

More info: 2008 OASDI Trustees Report, U.S.National Debt, Colonization of the Moon

As part of the Open Letter Campaign reported here previously and after many weeks of debate, a large group of physicians have collectively identified 3 main factors behind rising healthcare costs and declining access to care in the United States:

1. The insurance industry’s undue authority and control over healthcare processes
2. Excessive and misguided government regulation
3. Practice of defensive medicine in response to a harmful legal environment

The negative influence of the above “axis of waste” relate directly to the figure below, which is from a recent McKinsey Quarterly report showing the flow of healthcare dollars in the United States and the areas of inefficiency (click to enlarge):

Although the areas of inefficiency highlighted in the McKinsey Quarterly report raise significant concerns about the sustainability of our current healthcare system, they also hint at opportunities that can lead to transformation and change. More specifically, “rapid innovation may lead to a restructuring of the value chain of healthcare payments and to a shift in the sector’s balance of power.” With providers moving towards embracing new technologies and methods of directly connecting to consumers, third party payers can expect losing the influence and monopoly they enjoy in the current system. If they play their cards right, providers can soon expect greater control over their affairs and the ability to better meet the needs of their patients “as fewer dollars are wasted on transaction-processing inefficiencies” and new channels of direct-to-consumer delivery of services are created.

All in all, the future looks promising for patients and physicians.

More info: Open Letter Campaign

If a simple ICU checklist can save lives and decrease the rates of catheter-related bloodstream infections up to 66%, then imagine what more sophisticated tools and technologies can do. We have a very robust and well-funded biomedical research enterprise in this country. Unfortunately, we don’t have anything equivalent to that on the delivery side. What we need is a healthcare delivery enterprise.

So how do we move in the direction of creating a healthcare delivery enterprise that provides evidence-based and high quality care in a cost efficient manner? The answer to this question is not simple but, to a large extent, it depends on formulating strategies to enhance the consumer experience. This raises another important question: who are the consumers in healthcare?

Traditionally, patients have been thought of as the primary consumers of healthcare services. Although this assumption makes sense, it is incomplete. Physicians are also part of the consumer equation. Without the direction and guidance of physicians, few of the healthcare goods and services could be “consumed” by patients. Physicians are the gate keepers. Ask my friend Jay Parkinson, MD, MPH and he will tell you why this is so crucial to understand.

So here’s another question: how do you enhance the consumer experience? I believe the best strategy would be to empower both patients and physicians.

We need to empower physicians to be able to freely make the best choices for their patients who rely heavily on their input for utilization of services. Physicians should have available to them novel models of practicing medicine, with minimal intrusion from third parties and other opportunistic entities. Physicians should adopt the use of innovative technologies to streamline work flow, documentation, and communication with patients. The bulk of the currently available EMRs and PMRs are far from being practical. We have to do better.

We need to empower patients to be able to choose from a menu of options for a particular service as recommended by their doctor. Giving patients more options should follow efforts to establish transparency for the cost and quality of services. The empowered patient and physician can work together to achieve the desired results.

ICU checklists are a good start. Hopefully, we will soon make the technology and imagination leap into the creation of more effective tools and an integrated healthcare delivery enterprise.