When we make the mistake of talking about fixing our broken system, we tend to speak of driving costs down or of achieving greater efficiencies by stressing preventive care. There’s nothing wrong with efficiencies and prevention; that’s exactly what an (im)perfect system needs. But if that’s all we set out to do, we simply won’t have the same number of jobs that we do today. I’d argue that we can’t afford change at that price, not without shaking our economy to its foundation. It’s neither plausible nor realistic, and it’s certainly not desirable.
I think there is a way to preserve the jobs while creating a system that delivers higher value for the same spending. As a practical matter, that means holding the percentage of the gross domestic product devoted to healthcare at about the same level: 18%. As the economy grows, healthcare spending (in dollars) can grow with it. It’s not a question of how much we spend but really how we spend it. And it’s not a matter of eliminating jobs, because we want jobs. It’s a question of what those jobs are and how to teach people—who now fill jobs created only by inefficiencies—to do the jobs we need done today in a modernized system.
There was a time when the coming of the ATM was feared because tellers would lose their jobs. ATMs did enable banks to reduce the average number of tellers from 21 to 13 in each branch. But the net effect actually led to more jobs, because by reducing the cost of running a branch, banks were able to open more of them. The only difference was that some of the tellers needed to learn new jobs that required new skills, which paid higher salaries.
We can have a job-creating economic engine that also delivers affordable care at a higher quality. It will just take some deep questions, a willingness to change, and the vision to understand what aspects of the system are worth preserving and which need to be addressed.
We’ve created a booming sub-industry within healthcare dedicated to fixing the broken system. Everywhere you look, there are jobs and careers popping up around “fixing the problem.” The thing is, there’s a catch; it’s not really a broken system. It’s the perfect system—a system reacting perfectly to the market forces at play, human-made forces that are contributing to much of our nation’s economic stability. The problem with healthcare isn’t “fixing” the system. The problem is continuing to ensure that profits can be made and millions can be employed while outcomes and experiences improve. We won’t find the solution to that problem by embracing the solutions offered by either the right or the left. We have to build from the ground up, starting with a new foundation. I can’t wish away the political realities that stand in the way of such fundamental reform. But given all that’s at stake, I’m unwilling to accept anything less than this goal. Hopefully, you agree.