Five Numbers That Could Reform Healthcare
so it was one of those uh
great saturday mornings uh you know the
type when you get a
sleep in and have a nice relaxing day
a young man rolls out of bed to get that
second cup of coffee
and as he’s coming back into the uh
bedroom
his wife is standing in the door of the
bathroom and says han come on in i want
to show you something
so he walks in the bathroom and there on
the counter
um of the sink is a positive pregnancy
strip they both yell and scream they hug
each other
they they jump back into bed and they
begin to talk about all the sort of
things that you would talk about when
you’re expecting a baby
um you know it’s going to be a boy or a
girl
doing do we need to quit our jobs do we
need a bigger house
uh when do we tell our parents boy this
is scary how are we going to be able to
afford a baby
how are we going to find child care all
the sort of things that a young couple
would would
talk about so on monday morning uh
as it rolled around they were able to
call the obese
office and make an appointment for later
that week
both took the day off went in to
see the obstetrician and did the sort of
things that you
would would typically do in a doctor’s
office filled out the forms
you know sat in the waiting room they
were brought back um
of course again just verifying some
information
did you know height and weight and blood
pressure
took some lab tests and also did a first
ultrasound
so as the staff person was sitting there
talking to the young couple
getting all that information validating
information asking them certain
questions
all of a sudden she became very very
quiet and
very noticeable to the young couple and
made them both very very nervous and
they sat there in silence as a young
woman said to them
the doctor will be in to see you in a
few minutes so
definitely a change in tone a few
minutes went by
seemed like hours to the young couple
and finally the ob gyn came
in and after some pleasantries and
congratulating the young couple
talking about this great part and their
life great moment in their life
began to talk a little bit about the
practice and then again
very quietly uh grabbed the stool pulled
it up
and she looked at them at the end and
the eyes and said you know i’m very very
concerned about your baby
very concerned about your baby’s
diagnosis
and the young couple looked at the
doctor and thought diagnosis
you know this is our first visit what do
you mean diagnosis and she said well
your baby is a 4-3-6-0-4
and the young woman said
4-3-6-0-4-4-3-6-7-4 that’s our zip code
and the physician looked them in the
eyes and said exactly
and what we found in our country is that
the
five most important numbers in your life
many times is your zip code
the zip code of where you were born who
your parents
were how you lived your life the social
and economic conditions of your life
and that alone that in genetics has more
to do
about your health and well-being than
anything we do in health care
any clinical thing we can do and again
as we’ve seen the events unfold over the
last few months
one of the things that people now hear
about are these social economic
factors something we call the social
determinants of health
in the united states if you go to our
major cities and rural areas across the
country
you can see a 10 a 20
a 30-year difference 30-year difference
in life expectancy
in the united states so so how in the
heck does that happen
how can you literally be blocks
a quarter of a mile away from each other
and have a life expectancy difference of
20 plus years
and why we talk more about it why has
that not been an issue
and a lot of these issues it’s just been
our indifference to these issues
it’s not that we haven’t known about
them it’s not that parts of our society
have worked to address these
we’ve just never integrated them into
the way that that we take care of people
in our lives
so right now we have a large industry
large health care industry
that really is on a path they’ve been on
a path
uh since the 1930s almost a hundred
years
path and if you look at how they’ve
consumed resources in this country
the amount of dollars spent on health
care just continues to climb
and probably the last dozen presidents
have all said the same thing we have a
major problem in our country in health
care spending is out of control
we said that when it was five percent of
the gdp we said it when it was 10
of the gdp and now in just a short
period of time it’ll be 20 percent of
our growth semester
product and there’s really nothing we
can do about it it’s demographic driven
it’s trend driven and yet we spend six
trillion dollars
on health care and you really have to
ask yourself is that really the right
thing to do
given how we think about health care
today
and you’ve seen these statistics along
the way
when we begin to look at what we get for
the six trillion it’s one thing to say
oh man we get
it’s like going to the four seasons it’s
the best everything is taken care of
but yet we have this huge difference in
life expectancy
costs which are a critical issue in our
country
the number one cause of personal
bankruptcy is related to health care
costs
seniors 85 year olds filing bankruptcy
at an all-time high why because of
health care costs
we have more preventable deaths we have
high instances of hospital-acquired
infections
uh deaths from medical errors and so you
begin to look at all these issues you
say well
uh your truly is this relationship how
we should spend our six trillion dollars
and this graph is the countries we
typically compare our suit
compare ourselves to and the lighter
boxes
point out that you’re actually worse
than the other countries and as you see
the united states is very lower
so we have 30 million people that are
uninsured
in this country 30 million people and
yet when you begin to look at the
financial
impact on them and what we’re getting
for our dollars you have to really ask
yourselves
about the model so one in three people
say they can’t access health care
because of
cost one in three people say the biggest
worry
of their lives is health care costs one
in ten
one in ten americans in a gallup poll in
the last few months reported that they
knew someone
who died premature prematurely
because they couldn’t afford health care
so
as we think about our health care system
and we want to
celebrate our health care health care
system we really have to be concerned
that we really have the right model so
one of the things
that we have seen in the last couple
weeks unfold with covet and house covet
has
impacted certain racial and ethnic
minorities at a much much higher rate
and all of a sudden we’re talking about
social and economic conditions and what
many people would call the social
determinants of health
the who defines social determinants of
health
is really those things that kind of go
back to your zip code
where you grew up who your parents were
what kind of home you lived in what kind
of
resources what kind of opportunities you
have that
is more important to your health and
well-being than anything we do
clinically
in healthcare settings and as you look
at the chart here
twenty percent of health care twenty
percent of your health and well-being is
related to health care
and the other things are far more
important in your overall health and
wellbeing and it kind of makes sense
uh you don’t hang around hospitals every
day if you think about your health and
well-being you don’t run to a hospital
but but it’s those things that are
critically important
so about a decade ago i worked for a
healthcare organization
and we thought we would um you know
address
obesity and a lot of health systems
around this country do what they call
community needs assessments
and it was part of the affordable care
act it is something that we have
been most most health systems have done
for a long long time even before the
affordable care act and
you know we we looked at kind of what
came out of it we said well bc is a
problem let’s invest some dollars in
obesity so we created these great
learning maps
uh we hired uh you know um trainers
and we created maps for different sort
of ages and for their
for their parents and we put them into
the schools and the summer clubs and the
y’s and all those sort of things
so this goes on for a while we felt
pretty good about ourselves and
after four or five months the um the
trainers asked for a meeting and they
weren’t happy
and they they said this isn’t working
and
we said okay what do you mean it’s not
working these kids are hungry
and our response was no no no we didn’t
sign up for hunger
we signed up to teach them to eat
healthy and they go they can’t eat
healthy
because they can’t afford good food and
their obesity is
linked to the food and what we found out
is that food is a major health care
issue in our country pretty basic
healthy moms healthy babies
we just you know want to make it a
welfare issue in our country
and so we have this issue that food
is medicine hunger is a health issue 13
percent of households are food insecure
uh 19 of their children 33
of single moms and and children are food
insecure that means they miss
100 meals a month and the meals
they do have aren’t all that good
and yet we spend six trillion dollars
on all the stuff in health care and we
have people
uh in in our communities all over our
nation
that are struggling with food insecurity
and what this led
us to do is we’ve now screened for food
insecurity for
over 10 years we’ve done you know three
to four million screens
we provide short-term food needs baskets
of food
make food available we have food
pharmacies where doctors can write
scripts
and individuals can sit down with a
counselor a dietitian
and really plan out meals that they can
afford that are nutritious and
especially if they have some medical
conditions
we started an inner city grocery store
in a food desert because
no grocery store no grocery chain would
help us we’ve done farms mobile meals
and
and really this idea is how can we take
care of someone
clinically and yet not look to all these
social issues in life
and so what we’ve done over the last
decade
is now we’ve begun to screen for the 10
social determinants of health
and go back again we can spend all this
time and effort taking care of someone
clinically
but wouldn’t it make sense to you that
when you went into a doctor’s office
they asked you do you have access
to good food can you really take care of
yourself from a
nutrition standpoint do you have the
economics to take care of yourself
um you you live in a safe home uh do you
have money to afford the procedures i’m
going to ask you to do
and the the prescriptions i’m going to
give you
behave your health you have utilities on
you have transportation
do you have employment all those things
are critically important
but yet we look at a person physically
and yet we never look at these socially
determined health and if you think about
how healthcare has evolved in our
country
it’s really not made all that much sense
and the problem
um that we have is that for all the
right reasons we built hospitals across
america
and uh today we have some you know major
beautiful hospitals one of those
is an organization i work for uh you
have to have glass on your on your big
buildings today and really we have a
hospital-centric model
and it’s been that way since world war
ii when
because of the hill burton act we built
six seven thousand facilities in four
thousand communities
and guess what we still think of
hospitals as a central part of your
health
and my guess is you do not i do not uh
and really when we think about
care and the type of kind of care that
we want to deliver in the future
it’s really much more consumer based
it’s much more holistic
it has to take into account the social
determinants of health and other things
including life purpose
and really what we need to do is move
away from this hospital-centric model
what kovit has taught us is that
hospitals are critically important
absolutely
we do not need more hospital beds in
this country by the way what we need to
do
is invest in those services outside of
hospitals
and we have a broken health care system
we need to fix it and now is the time to
fix it
what we do have though are the best
caregivers in the world
no doubt about it but we’ve asked them
to work in a model that that really
doesn’t work
so really it’s time for a new model and
in it starts with reallocating our
spending
we are spending a lot of money we have
this massive healthcare industry
pharmaceutical companies hospitals
insurance companies medical device
manufacturers we’re spending tremendous
amounts of money
and it’s a major issue it’s a major
industry
it’s a major political force and either
we all need to spend
more money in order to address these
other things
taxes more or we really need to
reallocate health care spending
hard thing to think about hard thing to
do very very political
we need a national focus on the social
determinants of health
when we look at the impact of covet and
why
covet has impacted certain minorities uh
and and not others it’s because of those
social conditions
it’s because of their social and
economic health and we don’t have any
focus we should mandate
tomorrow that every health care facility
screens for the 10 social determinants
of health and oh by the way
we are now screening employees we screen
our employees
with the idea that that if you screen
employees you can
interact in their lives higher retention
higher recruitment lower health care
costs
higher productivity doing those things
for your employees for all the right
reasons
as well we need to invest in senior care
um kind of a travesty what’s happening
right now in senior care in this country
everyone
is throwing shots at senior care
governors media
lawyers and really what do we expect
it’s a bit of hypocrisy to complain
about senior care
when we reimburse senior care less than
we do a budget hotel
and for that we’re expected to provide
great clinical care
with with the with the best staff
beautiful facilities
three meals a day and all these
opportunities to you know
be involved in activities and mental
stimulation it just doesn’t work
it’s a highly heavily regulated industry
and yet we we think we care about
seniors but we don’t
and it’s this whole idea in our country
that we don’t value our seniors and
again one more time as we think about
investing
and where investment should be senior
care is one
and of course we’ve seen our problems in
public health huge problem in public
health in our country
as health care costs went up 50
um public health investments went down
25 percent
and over the last decade a reduction in
about 25
of their staffing and what we’ve seen is
we don’t have an integrated public
health system we’re not prepared it’s
not linked we not we don’t have the
right data
and we don’t have the right stockpiles
that needs to change rapidly
so how do we do that so for the last
several years
we’ve been in washington lobbying for a
national commission on health why a
national commission on health
because nothing’s going to change
otherwise the model is going to continue
we’re going to go from 19 to 20
to 25 percent of our gdp we have a long
history of national commissions
we’ve had over 125 national commissions
some of them very very successful
and the charge to a national commission
would be this this is a model that can’t
continue
we need to invest in these other issues
so either we need to increase taxes or
we need to find a new model
and we need to move money from some of
the things that we’ve put
invested in historically and move them
to some of those
other areas and we need to do that over
a period of time
a decade maybe two decades but at least
we would have
a new model so the question for all this
is this zip code going to be the most
five important most important numbers in
people’s lives
sitting here today a pessimist would say
oh absolutely this you know this two
will pass and nothing will change
and optimists would say no now is the
time
this is about america’s priorities this
is about america’s collective will
and a lot of things what we’ve learned
over the last few
uh weeks and months it’s about our
character it’s about the choices
we made and you know i think if you step
back and think about it
if there was ever a time we address
these issues
now is the time thank you very much