Many say that healthcare is broken, but I disagree. In fact, I would say that healthcare is exceptional at doing what it is designed to do – what it is paid to do. And that is to save your life if you are sick. But if your goal is to stay healthy or improve your health, healthcare will fail you.
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We all know the US healthcare is fundamentally flawed. We have the most expensive healthcare system in the world by at least double, yet our health outcomes rank among the bottom of all developed nations.
On the other hand, the US healthcare system also leads the world in medical innovation. Much of the cutting edge, life-saving treatments being developed come from the US. Most of the leading medical journals, the leading medical scientists, the three highest-ranked hospitals all are in the US, and people come from all over the world to seek care here.
So, how do we explain this contradiction? How can the US healthcare system lead the world, yet also provide substandard and outrageously expensive care resulting in, conservatively, more than 2,000 premature deaths every day?
More importantly, how can you avoid being one of these people who die earlier than they should about every 43 seconds?
To understand how the US healthcare system can be both the best in the world, and one of the worst, you must understand the difference between acute and chronic disease.
Acute disease is when people get sick. Examples include when someone gets pneumonia, cancer, a heart attack, or stroke. Acute disease is where the US healthcare shines. While the system should be more efficient, less costly, and more widely and evenly distributed, the results are generally outstanding.
Chronic disease is the health problems that aren’t immediately life-threatening but lead to acute illness. Common examples include high blood pressure, diabetes, pre-diabetes, and obesity.
If you are acutely ill, being in a US healthcare system is likely going to give you the best chance of living through that illness. But what if you have a chronic disease? What if your goal is to stay healthy or get healthier after an acute illness? Chronic disease is where healthcare fails you. Healthcare has become so good at acute illness, keeping people alive, that now one of the biggest problems in healthcare is chronic disease.
How big of a problem? Chronic disease now affects the majority of us. Six out of ten adults in the US have at least one chronic disease, and 4 in 10 of us have two or more. And the CDC says that 86% of our over $3 trillion spent on healthcare is on those with chronic disease.
Even in the setting of a world-changing pandemic, chronic disease is still arguably the biggest problem in healthcare because who is most vulnerable to COVID-19? The elderly and those with chronic disease.
There are several reasons the US healthcare system is failing most of us. While payment reform and innovative care models are being developed, the vast majority of care is still free for service in an episodic care model that is not designed for those with chronic disease. However, I believe the most significant reason healthcare fails those with chronic disease because it does not provide the most effective treatment for most chronic diseases, which is healthier lifestyle choices.
According to the expert guidelines, the foundation – the place where all treatment starts – for the most common chronic diseases such as high blood pressure, diabetes, pre-diabetes, high cholesterol, heart disease, cancer survivors (the list goes on and on), is eating healthier food in the right amounts, being physically active, avoiding toxins, getting adequate sleep and effectively managing stress—in other words, changing your lifestyle. Yet, for the most part, healthcare does little to help people make the choices they need to live their healthiest – and best – life.
The healthcare system is exceptional at what it does and provides vital services, ones we all need, or will likely need in the future.
But keeping you healthy, or helping you get healthier, isn’t one of them.