There are three questions I ask whenever I look at potential healthcare changes:
- How will it improve patient health outcomes?
- How will it contain or reduce the cost of healthcare?
- How will it increase access to healthcare for all Americans?
The first question focuses on the basic purpose of medicine: making or keeping us healthy. In general, it makes little sense to make a change that does not improve our wellbeing. I feel like this frequently gets lost in the conversation. Of course, treatments have costs along with benefits, so . . .
We should also ask, “What kind of value will we get for the money that we spend?” After all, it makes no sense to spend money on healthcare that doesn’t make us healthy or to pick an expensive option that is no better (medically) than a less costly one. Not every drug, procedure, or policy involves such a choice, but many do.
And finally, a variety of changes aim to move people onto insurance rolls or improve access to medication and services. These solutions ideally encourage wellness and move patients away from using the emergency room as a primary care option.
Personally, I think that we have been focusing almost exclusively on the second question: “How will this change reduce my insurance premiums and out-of-pocket costs?” And we rarely ever ask the last one: “How will this change improve the health of my relative, neighbor, coworker, or the guy I don’t know on the bus?” We seem to think that we’re not all in this together, that we’re autonomous healthcare consumers, that we can improve our own outcomes and costs without making changes at the societal level. (Ironically, if we improve everyone’s health, we should see lower overall costs. These questions/issues are all related.)
At least, that’s how I see it.
