Sunday, November 3, 2019

Reimagining healthcare: How about imagining if everyone could get it?

Several years ago, the University of Arizona Hospital was acquired by Banner Health, a large not-for-profit system with no previous presence in Tucson. Banner now employs the physicians for their clinical time. This arrangement is not unusual among academic health centers. An advertising campaign has been in place for several months which I hear mostly on the local NPR outlet, indicating that Banner and the University have joined together in a commitment to “reimagine healthcare”. I keep trying to imagine what this means, since, in itself, “reimagining healthcare” is at best meaningless and at worst ridiculous. It is clearly an advertising message, a slogan obviously thought up by a marketing firm (or possibly an employee in marketing), that is intended to grip the pubic, make them think that Banner/UA is doing great things, and, hopefully, abandon their current healthcare providers and rush over to where healthcare is being reimagined. I have no idea if it works; I guess the future will let us know if they continue with this tagline/slogan or come up with a new one. But I am deeply offended and upset that they are using this sort of content-free marketing tactic. Indeed, any marketing tactic, although I guess when they tout their excellence in specific services, there is at least content.

First, however, let me make clear that this is not particularly about Banner/UA, or meant to single them out as an egregious abuser of advertising slogans. I cite them because I live here in Tucson and hear it on the radio. I am sure that if I lived in another city, with another large health system, in collaboration with an academic medical center or not, I would hear similar ads. It is not just the specific ad, in all its vague and substanceless inanity, that is galling; it is the fact that there is marketing of healthcare services to the public as if it were make of car or brand of cereal. We are talking about healthcare, about people’s lives. The goal of a nation’s healthcare system should be solely to bring the greatest health possible to the most people. It should not be to market one system’s health services instead of another, Ipana® vs Gleem®, Bristol-Myers vs. Procter and Gamble. At least Bucky Beaver had big teeth, so somehow relevant to toothpaste (choosing those brands is just a nostalgia shoutout).

If there is a perfectly good cancer center/heart center/neurosciences center at one hospital in town, it makes no public health sense to build another and then advertise for it (Newer! Improved!) to draw people away from the first. It would make sense, from a public health point of view, to build a psychiatric or drug treatment facility if those are lacking in the community, or to build a facility to care for the people left out of access to the existing services because they are poor, uninsured, or – and this for sure happens – have an unprofitable-to-care-for disease. Or how about, here’s an idea, to build a facility in a smaller community where people have limited or no access to health care instead of having everyone competing in the major metropolitan markets? Those things would make public health sense.

Ah, but they do not make business sense! All of the things I have just cited as bad -- competing health systems and facilities in major marketplaces resulting in oversupply of some services, marketing to try to get people to come to your place instead of the other one – make perfect sense in a for-profit competitive business. And the things I said we need – provision of services that are currently in inadequate supply, provision of care to people who cannot access it, development of services for conditions with great need but generating little income, provision of services in less densely populated areas -- make little business sense. They are more likely to lose money than to make it – or certainly make less than something else the corporation could invest in. (I often find myself mis-typing “copro-ration”; maybe it is a Freudian slip?*)

The question is why we, as a society, allow healthcare to be a business, either directly for-profit or ostensibly not-for-profit (as most big health systems including academic health centers are) but operating by the same business principles (thus being essentially for-profits that don’t pay taxes, being the worst of both worlds!)? It is not the same as Ipana® vs Gleem®, or in current terms Crest® vs Aim®. It is not the same as Dodge vs Ford, or Burger King vs McDonalds, or Cheerios vs Kellogg’s Corn Flakes (or Cocoa Krispies vs. Count Chocula)! It is about your, and your family’s and friends’, health and lives. We accept it because some of us get, or think we will get if we need it, all the health care we need, and more. And this includes all the politicians, and pundits, and frankly news media – almost everyone in the upper- and upper-middle class. And the people who own stock in for-profits. And the politicians who benefit from the contributions of the non-profit as well as for-profit health care sector, and the power they wield as major employers in town. 

Of course, some of them will be surprised when they get sick, too. The people who can’t get care because they have no money or insurance, or crappy insurance, or have diseases the care for which are not well reimbursed, or maybe are just not our target market (let’s put our sports medicine clinic in the suburbs, and for goodness sake discourage old people with arthritis from coming in, we want the high school quarterback and his parents!). There are, of course, people who benefit. Rich people. Private equity companies and their investors, as described in the article by Gustafson, Seervai, and Blumenthal in “The Role of Private Equity in Driving up Health Care Prices”, in the Harvard Business Review.

It does not have to be this way. It is not this way in most countries, including most capitalist countries. (see, because I like it, One thing to NOT worry about: paying for health care -- in France, July 21, 2012).Those countries realize that the health of people is not a market commodity, but is a public service like roads and police and fire departments.

Maybe we’ll make the fire department for profit. Or the police. And they’ll only come if you have not only insurance, but the right kind of insurance, and have met your deductible (of course, in some neighborhoods it is kind of like that already…)

Or maybe, better yet, we can realize that our health is not something that should be dependent on a corporation making a profit.


1 comment:

Paul Mermin said...

Yes, Josh.
Again it's beyond sad that our public discourse contains so little recognition of these structural problems.
I'm waiting for Warren to decide she needs to talk about these issues as much more of a centerpiece of her efforts. I think the public understands it in their guts, but no-one they hear is helping them recognize how deeply the problem is based on the for-profit model. Hell, I'm waiting to see that Warren, or anyone else, has a forum in which there's an expectation that the possibility of structural reform is taken as seriously as the dismissive "yeahbutyoureallycan'tpayforit" and "people like their health care" (as opposed to people are terrified of losing the already-too-expensive fig leaf coverage they [the luckier ones] now have).

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