Eliminating Waste and Huge Profits Key To Fixing Healthcare, Says Physician

While the quality of medical care available in the United States is the best in the world, says otolaryngologist Dr. Keat Jin Lee of the Yale School of Medicine, the system that delivers that healthcare is unacceptably expensive, disjointed and wasteful.

Lee, associate clinical professor of surgery, has some ideas about how to reform the system for the 46 million Americans who don’t have health insurance, and for those who do but still suffer from inequities in their care. He outlined 20 steps to better healthcare in an article in the June issue of the journal Otolaryngology-Head and Neck. (See below.) He spoke to the Yale Bulletin & Calendar recently about what he calls his “common sense” recommendations.

Why are healthcare and health insurance so expensive in the United States?

Healthcare and health insurance are profit enterprises. The interests of patients and the suppliers of healthcare — pharmaceuticals, doctors, hospitals, suppliers of medical instruments and devices, other paramedical supplies and above all the insurance companies - are not aligned. In addition, administrative paperwork eats up 19% to 31% of each healthcare dollar.

How does this expense affect healthcare?

It forces 46 million people not to have healthcare coverage. Many more millions are under-insured, and even those with health insurance coverage have difficulty getting tests certified for coverage, or claims for reimbursement for tests are arbitrarily denied. Every dollar insurance companies spend for healthcare is a dollar less profit. That is why they label payment for medical care a “medical loss ratio.” If you are running a company, it is natural for you to reduce the medical loss ratio by implementing as many strategies as you can.

How does this affect the United States’ ability to compete in the world economy?

We are now spending 16% to 17% of our GDP on healthcare. If things are left unchecked, we can be easily spending 20% to 25% in a few years — that is, more than four times the amount spent by other industrialized countries. We could price ourselves out of the market.

Will putting more money into the system solve the problem?

No, it will just escalate the problem. We must first give the public transparency on how each stakeholder is receiving and spending the healthcare dollars and how the dollars actually help the patients in a cost effective way.

What do you believe the guiding principles should be as we try to reform the system?

We need to eliminate waste and excessive profits. We need to balance the concepts that healthcare is a right, a commodity and a service. We need to give the practitioners and the overseeing bodies a tool to be able to confidentially, securely and efficiently make sure that medicine is practiced cost-effectively, according to acceptable evidence-based guidelines.

Currently there is a great deal of fragmented care and wide variation of care and costs of care for the same ailment. The tool to fix this is a confidential, secure, affordable web-based, user-friendly, interconnectable electronic health/medical record system. The technology is readily available and the time has come for this tool to be fully implemented among all providers.

What kinds of reform do you recommend?

The 20 steps I discussed in my article “Healthcare: Affordable Quality Coverage for All” (see below) are common-sense things that can produce healthcare reform without getting bogged down in partisan politics.

In addition, we need to tell Congress to stop bickering and do what is right for the people. A good politician takes care of the politics. A great politician takes care of the people. Let us demand that the U.S. president and our other leaders put politics aside and take care of the people. We are all patients, past, present or future. Members of Congress do not experience the difficulties we rank and file people have to go through to get healthcare, whether we have insurance or no insurance.

Lee’s suggestions for healthcare reform

Here are Dr. Keat Jin Lee’s “common sense” suggestions for reforming the nation’s healthcare system. He elaborates upon these points in his article “Healthcare: Affordable Quality Coverage for All” in the June issue of the journal Otolaryngology-Head and Neck.

• Improve transparency at all levels for all stakeholders.

• Simplify and standardize administration/paperwork.

• Expand Medicare.

• Implement a new compensation formula for providers that ensures quality and appropriate levels of utilization, outcome and patient satisfaction.

• Establish “homeroom/quarterback” provider to coordinate care.

• Deploy affordable, secured, confidential web-based, user-friendly electronic medical records with interconnectivity.

• Create a unique healthcare identifier number.

• Deploy more specialized advanced nurse practitioners and specialized physician assistants (mid-level providers).

• Implement a system of early intervention and disease management.

• Improve costly and inefficient emergency rooms.

•Promote public health education and establish Wellness Corps.

• Reduce the cost of pharmaceuticals.

• Eliminate pre-existing disease exclusions.

• Expand coverage through purchasing consortium, insurance exchange, Federal Employees Health Benefit Program (FEHBP), school based clinics and making coverage portable.

• Establish parity for all — rich and poor, young and old, working and unemployed, and of different ethnicities — including parity for mental health services.

• Establish sensible tort reform.

• Establish Health Corps to staff underserved areas.

• Deploy appropriate use of copayments.

• Establish sensible end of life care and living wills.

• Establish teaching ethics to medical and paramedical personnel.

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Media Contact

Helen Dodson: helen.dodson@yale.edu, 203-436-3984