Below is text from the video. It has been edited to remove some extraneous words and may include grammatical errors that result from conversational speaking.
Everybody knows there are problems with the American health care system but nobody’s quite sure what to do about it. I have an idea and I’ve outlined my idea in my book Health Care: Meet the American Dream. I’m a health care strategy and operations consultant. I started in the industry in 1995. I’ve spent my career working for providers – so I work for hospitals, doctors, ambulatory surgery centers, clinics. I work at the point where health care is delivered to patients and I understand how patients access care. In my career one of the key takeaways that I’ve had – I’ve learned a lot – but one of the key takeaways is that how health care is delivered depends on who’s paying for it.
And when we think about the change that’s needed in health care. The change we need is not going to come from a gadget or from an app or from a new pharmaceutical. We need structural change that addresses the financial side of the business.
If you think about who’s paying for health care, the government spends about half of the dollars in health care. In 2016, it was 3.3 trillion dollars. Half of that was spent by the government. Medicare is the largest single payer in America so they wield tremendous power when it comes to dictating the terms of care. So they will outline rules and regulations about what’s covered, which doctors can do what, which patients can be seen, when, for how long. They have their own terms and conditions.
Then if you think about private insurers or insurance companies, they spend about a third of the dollars. But their reach is much bigger because they cover over half of Americans, so it’s very impactful to more people. They have the same sort of rules and regulations and there are so many insurance companies and all their rules and regs are different. So any solution that doesn’t address how care is being delivered and who is spending the money is never going to structurally change health care in America.
I decided that instead of looking at solutions that try to address this issue from the bottoms up, you know, trying to make it more efficient, provide navigators to help make it more clear, I thought we should come up with a totally new vision. Like a Blue Sky, if you were to start from scratch idea about how health care should be. And I’ve created this idea. It’s called the Dream Plan. And the idea is to have this vision and then work backward. Have this idea and come up with a road map to get from today to this vision. But you have to have a vision.
So this is my idea. It’s called The Dream Plan. There are two parts of it. There’s a public health component to it and then there’s what I call a Longitudinal Health Care Plan or LHCP. So I’ll talk mostly about that but I should say that in this visionary world you’d either have a Longitudinal Health Care Plan or you default into the public health system. So everybody would be covered. Nobody would be left behind.
The LHCP basically a decentralization of the payment system. Right now we pay into these third parties. We pay taxes. We pay insurance companies, we pay our deductibles, premiums, all that stuff. And we hope that what we put in is going to be enough to cover what we use. But we really have no idea. But in this model, you take that money and you put it into your own account. So it would be like a single-payer system except that the single-payer would be you or it would be me. And this plan is sort of like a combination of a financial investment model in conjunction with your own personal electronic medical record.
And it sort of goes like this. You would, or this company would, do sort of a work up on each of the customers. This LHCP is like a product. It’s something you’d access or buy like you access health insurance, or like you access a bank account. It would be offered on the open market. And you as the customer, we’d do a work up on you
and we’d say we’re going to look at all your genetics. We’re going to capture all the information about what your proclivity is to develop all the different types of diseases and conditions. So that’s a given. We have that technology now.
Then we take all the predictive analytics that are out there and address the behavioral attributes. So these are the things that really build or modify on what your genetic predispositions are, and pull in all these external determinants of health. Those are the real things that impact your health outcomes. It’s not whether you have health insurance or not. It’s the factors like whether you exercise, your socioeconomic background, where you live, what your education level is, if you smoke, if you exercise. All that sort of stuff would be put together with the genetics to come up with what I call a Conditions Timeline. And that is a longitudinal, lifelong projection of the diseases and conditions that you’d be expected to develop.
So when something like that happens, it sort of nullifies the need for health insurance as we know it today. Because the idea that you would insure yourself against cancer if you know you’re not going to get it just doesn’t financially make any sense. So all that sort of stuff goes off the table and takes a whole new view on what health insurance should be.
So in the LHCP, you’d have this Conditions Timeline. We would attach costs to treat and manage all those conditions. And then come up with an investment plan to help, to guide you, to save all the money you need through the course of your life to pay for each of these activities or each of these diseases and conditions as they arise.
That’s the sort of overview. The fascinating and empowering part about this is that it’s dynamic. So each year, this model would get updated. Each year, you’d go back to your primary care doctor because we as citizens can’t create our own personalized health care plan without the help of a professional. And we’d pull in all kinds of physicians to create these Clinical Protocols. But you’d work with your primary care doctor, go back each year and you’d get all your vitals, we’d put it back in the system and it would re-run.
And it would say, You’ve lost five pounds. And you’ve lowered your cholesterol level. You’ve made these changes in your life so as a result, you were protected to get a heart attack at 60. Now it’s pushed out into your 70s. It may not even come at all. But you still have a predisposition for diabetes. And so then it would give you all of this advice about how to address those issues. And depending on how the product was created, it may say to you, If you make these changes, you’re going to save X number of dollars. If you make these changes, then your longevity is going to change by X. You may not get Y disease. So it’s a very empowering, totally different way to look at health care, which I think is very American. It’s a personalized view of health care and it puts the accountability back on us and it puts the financial control back to Americans.
I hope you enjoy reading the book. I’m looking forward to the discussions that this topic will generate and I look forward to your feedback.