A panel discussion at the Techonomy Health conference in mid-May tackled the daunting and politically-charged question of how to redesign the American healthcare system. Experts offered many ideas that look nothing like our current landscape: universal health coverage, outcomes-based care, even hospital systems that guarantee lower costs. They all called for major changes to the system and expressed hope that entrepreneurs and innovative technologies would help accomplish that.
The speakers agreed that one of the biggest obstacles to redesigning the healthcare system was the remarkably high level of resistance to change among leaders within it now. Steven Krein of StartUp Health, a coaching and networking service with 200 health startups in its portfolio, said that his companies’ discussions with hospitals, providers, and payers have shown that “the mindset of the leaders of these organizations are the biggest stumbling blocks.”
As a result, even the changes that have been effected are in many cases less significant than they appear. For example, Andrew Cohen of Cognizant, a consulting firm working in healthcare, noted that a shift to “value-based care” at many hospitals is in fact “sugar-coated fee-for-service.” When it comes to getting away from the fee-for-service model, widely acknowledged as an obstacle to improving healthcare, Cohen added, there is “intense pressure not to get there” from the system itself.
Dan Munro, author of a scathing 2016 indictment of the American system entitled Casino Healthcare, said too many efforts to change things are not focused on the heart of the problem. “We’re dancing sort of around the edges,” he said. “Meanwhile, every year, the cost goes up.” He cited a new report showing that the average cost for health insurance coverage for a family of four through an employer is now almost $28,000 per year. Ultimately, he predicted, the U.S. will have to embrace universal health coverage as all other industrialized countries have done. But he noted that such a system doesn’t necessitate a single-payer model, even though many American commentators think otherwise.
One promising sign of change, Cohen said, is that all parties are dissatisfied with the current state of affairs: providers, insurance companies, hospitals, and consumers. “All of the different stakeholders are absolutely frustrated,” he said, suggesting there may be no shortage of motivation to improve things. “All the pieces are there, we just have to figure out how to assemble them in the right way,” he added.
But Krein pointed out that one of the problems is that innovation and implementing change is being left to the healthcare system itself. In other industries that have been disrupted, change has usually come from outside—think Uber in the taxi market. He said collaboration with existing leaders and organizations will be important, but Krein put his bet on the contributions of entrepreneurs as the source of major change in this field.
The upshot, according to Krein, is that there is no clear path to building a better system. “Here’s the truth: nobody knows what’s going to work and what’s not going to work,” he said. “All you can do is experiment and try to figure it out.”