I have worked for 28 years in risk management and insurance with many employers who sincerely desire to provide the best health coverage possible to their employees. Over the past five years I have worked specifically with hospitals, physician practices and health systems. My experience has given me the opportunity to view our nation's healthcare system from different perspectives.
I've seen employers struggle to provide excellent healthcare benefits in an economic environment that is more and more global. I currently live in Michigan, which is suffering terribly now as a result, in part, of the global economic environment. The unmanaged cost drivers of our healthcare system have made us uncompetitive in the global economy. Each car that General Motors produces contains $1,700 in healthcare cost and our overseas competitors average less than $400. It doesn't take long to realize that the long-term implications for GM were not good even before the other mistakes that led to GM's bankruptcy.
I've also seen a system with little personal accountability generate an era of runaway costs. The temporary managed-care “marketplace fix” was to impose reimbursement caps or even capitation on the providers. That is just what the government has been doing, but for longer and at deeper discounts; so deep, that many sources agree it is below the cost of providing the care. Even at those rates, Medicare is still headed for bankruptcy. However, managed care had an impact and generates useful data for us to help understand physician and hospital practice patterns—stuff for real healthcare reform.
We do not have a healthcare “system.” What we have are pockets of dedicated healthcare workers in well-equipped facilities that are doing the best that they can with the information they have. There is no broad, national “system”: No consistent, electronic documentation, no flawless hand-offs from one care setting to another, no integrated mechanism to look after wellness and prevention for individuals. It's more like a sick-care system. You get sick and scramble to assemble the best and right resources to help you and your family through difficult times.