Reimagining America’s Healthcare System

A New, Healthy Vision As American Healthcare Lays Dying

This post introduces several essays from Civic Way on America’s healthcare system. Despite spending far more on healthcare than other developed nations, the US suffers surprisingly poor health outcomes. Our healthcare system’s ills are not only acute, but immune to incremental reforms. Nothing short of transformational change will cure what ails our nation.

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Big Story

Since 2020, the US has suffered the biggest drop in longevity in decades.

The US’ recent decline in average longevity is alarming. Some attribute it to the pandemic. While Covid-19 clearly impacted our death rates, it was but one factor. Our average longevity also fell in relation to other developed nations. The real culprit is our inexplicably chaotic and wasteful healthcare system. 

Big Question

Why do we continue to tolerate a healthcare system that costs us so much and fails us so often?

We grudgingly accept a healthcare system that not only costs more than any other but delivers disappointing results. If any other industry served its customers like our healthcare system does, we would demand change.

Given our anger about so much else, our willingness to accept our overpriced, ineffectual healthcare system is nearly impossible to understand. Will we ever demand the changes we need?

Big Idea

Design and build an entirely new healthcare system, one that cures the inefficiencies and promotes healthy lifestyles.

The Democrats focus on insurance, split between upgrading ACA and enacting Medicare for All. The Republicans do little more than attack Democratic ideas. Instead of watching the two parties trade talking points, and accepting the status quo, let’s build the healthcare system we need—and deserve. A system that puts patients first, rewards prevention (and results), realigns resources, reforms healthcare financing (and insurance), maximizes competition and cuts costs.

Promising Initiatives

• Netherlands – offers managed competition system with innovative, collaborative and high-quality care, universal, private insurance, multiple health insurers, affordable insurance plans (individual mandate), low deductibles and drug costs, broad provider choice and extensive (and free) primary care access

• Costa Rica – enjoys longer life expectancy than US despite far lower per-capita income and healthcare costs; designed national health system to link public health and healthcare and target preventable deaths

• Singapore – provides top-ranked, most efficient healthcare system outside Europe with 1/3 costs of US; workers and employers contribute portion of wages to mandated savings accounts and providers offer low-cost basic care for everyone and deluxe care for premium payers

• United Kingdom – its District Nurse system empowers senior nurses to coordinate community-based care and in-home patient treatment including post-discharge follow-up services (e.g., supervise patient’s physicians, community specialists and other caregivers)

• North Carolina (Wake County) – WakeMed Key Community Care, an ACA accountable care entity, delivers high-quality, accessible and innovative care to needy patients including one-stop medical care at a homeless facility

• North Carolina (Caswell County) – Caswell Family Medical Center, using public health data, targets preventive services, screens social needs, links community resources and provides primary care to low-income patients (many uninsured)

• Virginia – improves maternal and child health outcomes via better collaboration among state agencies, community-based organizations, hospitals and other health providers and improving patient access to family support programs

Other Views

• Comparing Health Insurance Reform Options: From “Building on the ACA” to Single Payer, The Commonwealth Fund (10-16-19)

• Bridging Health and Health Care, Bipartisan Policy Center (9-30-21)

• A Vision for the Future, USC-Brookings Schaeffer Initiative for Health Policy (2-21)

• Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the US, American Academy of Family Physicians (AAFP)

• Confronting Rural America’s Health Care Crisis, Bipartisan Policy Center (4-20)

• Achieving an equitable national health system for America, Brookings (12-9-20)

• Rating the States on Telehealth Best Practices, Reason Foundation, Cicero Institute, Pioneer Institute (1-22)

• How American Health Care Killed My Father, Atlantic, David Goldhill (9-09)

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