“The Current Model for Healthcare is Not Sustainable?” – Why Not?

I’ve heard this phrase over and over:

The Current Model for Healthcare is Not Sustainable?

It’s especially prominent on social media and at conferences. Sometimes they change the word model to costs or some other related word. The message is clear. Healthcare is screwed up and people are pissed that it costs so much. On that I agree with them in many respects. However, I don’t agree that the current model isn’t sustainable. In fact, today I saw it and asked them why it wasn’t sustainable.

No one could give me a good answer.

However, to be clear I clarified that I wasn’t suggesting that we shouldn’t try to change the current model and that we shouldn’t try to stop the crazy healthcare cost curve. I also didn’t argue with the dire consequences that will happen if we don’t change healthcare from its current model. We should do all of those things.

It’s one thing to argue that we could or should do something and quite another to say that the current trajectory is unsustainable.

Healthcare has been surprisingly good at sustaining all of its bad characteristics. In fact, in many ways the bad things in healthcare are actually incredibly profitable.

In response to my question about why the current model is not sustainable I got the following story:

I was behind a lady at CVS who decided not to get her meds because she needed to pay her electrical bill. This cannot be sustainable.

A sad story and no doubt there are hundreds more like it. It’s heartbreaking to read and something we should work to fix. However, don’t wait for the healthcare organizations to fix it. This gets a little twisted, but think it through. If that lady chooses not to take her meds, what happens? Does the doctor get paid less? No. Does the hospital get paid less? No. In fact, if she doesn’t get her meds and gets really sick, the hospital is going to make a ton of money. (Yes, I know about value based care and hospital readmissions, but that’s a small percentage of overall revenue).

I’m not suggesting that any healthcare provider goes around saying that patients shouldn’t be compliant with their medications because it would be good for their hospital business. Even I’m not that cynical. However, if we were in any industry that’s what we’d want people to do. However, in other industries if you chose not to get your medications you’d have a bad experience (ie. you’d get sicker) and then you’d want to use me less. Healthcare is the opposite. If you get sicker you use me more.

The reality is that healthcare is not a true market. Go and read Dan Munro’s book Casino Healthcare to see what I mean. Healthcare is complex and it hides its issues behind that complexity.

I’m sure that some people reading this are going to offer up some pockets and small examples where this isn’t true in healthcare. Great. We need more of that and soon. We need it because healthcare is costing our nation too much money. We need it because healthcare is costing businesses too much money. We need it because many people aren’t getting the care they need because they can’t afford it. We need it for a lot of reasons.

However, we don’t need these changes because healthcare is going to collapse if we don’t change. In fact, to paraphrase Dan Munro, most in healthcare are profiting from its dysfunction. That’s why it’s so hard to change. Sadly, I don’t see anything that tells me we’ll stop paying either. The current model is surprisingly resilient and sustainable.

Of course, that’s not to say outside forces couldn’t change things. They can and they should. Patients are paying way too much for healthcare and we should be pissed and push for change. Businesses are paying too much for healthcare and we should be pissed and push for change. Government pays more for healthcare than anyone else and they’are paying too much for it. They should be pissed and push for change.

Just don’t expect providers or even payers to disrupt themselves. They’re all enjoying a shockingly sustainable business model. IT can only do so much when it comes to solving the business model issues.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • It might be “sustainable” for the healthcare field and government, but it’s not working for American citizens, whether the big boys want to agree with that in public or not.

    First, the cost is too high. If you can’t afford the “good” plan, you get less coverage. Second, it was stated that people could keep their regular healthcare professionals. Many have not been able to.
    Then there’s the MEDICAID fiasco.

    I still have no insurance, no medical care at all. There are procedures I need, but can’t get. The plan doesn’t work for us. I hope it’s not sustainable. Then maybe someone will come in with a plan that provides EVERY American healthcare.

    One thing that would help….make it MANDATORY that MEDICAID be expanded and provided in EVERY state, for people who can’t afford to pay through the marketplace they thought was so perfect.

  • Two many people who contribute nothing to patient care make too much money for the nothing they do.
    Administrators contribute nothing to the patient outcome
    Medical Directors contribute nothing to the patient outcome
    Brokers contribute nothing to the patient outcome
    Third-Party Administrators contribute nothing to the patient outcome
    Reinsurers contribute nothing to the patient outcome
    Pharmacy Benefit Management Companies contribute nothing to the patient outcome
    HMOs contribute nothing to the patient outcome
    However these entities consume upwards of 30% of every dollar spent on healthcare in this country. What a waste!

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