the future of us healthcare it's not surprising that every hospital and health institution in America is facing a substantial degree of uncertainty concerning the future of our nation's healthcare while the writing on the wall certainly includes accountable care organizations bundled payments insurance exchanges core measures H caps meaningful use and value-based purchasing the precise nature of that which will ultimately shape and enable our healthcare system to survive is at best uncertain the real question is how can we improve and sustain our healthcare for future generations highly politicized the Affordable Care Act is poorly understood and widely debated yet what appears to be universally agreed upon is a series of remarkably straightforward goals referred to as the Triple Aim improving the health of populations improving the experience of care and reducing per capita health care costs the pressure is building undoubtedly something has to give according to the Centers for Medicare and Medicaid national health expenditures grew to 2.5 trillion dollars in 2009 actually more than 8-thousand dollars per person or 17.6% of our gross domestic product CMS suggests national health care expenditures will balloon to four point four eight trillion in 2019 or 19.3% of GDP as a reference point contrast this with our total actual federal spending in 2009 equal to three point five trillion dollars yielding a resultant budget deficit of 1.5 trillion bottom line were no longer running on vapors the tank is empty we're out of funds beyond any reasonable doubt our deficit situation cannot persist despite all political bantering over health care reform or debt ceilings and while some have challenged the wh o–'s ranking of the u.s. in 37th place among the world's health systems just behind Dominica and Costa Rica it's a fact that health care spending as a percentage of GDP distinguishes the US as the world leader sodas are ranking as No one in the world for cheese production and not surprisingly obesity compared with a shamefully incomprehensible ranking of 47th in infant survival compound our challenge with more than 50 million uninsured Americans and an additional 25% underinsured and the nature of the ugly beast that rearing its head becomes apparent and if you believe that our present challenges are great just consider that there are more than 40 million Americans age 65 and over in the US and a projected 80 million seniors in 2040 while these staggering numbers could keep a building full of actuaries arguing for a year it's not surprising that most hospitals fear Medicare Medicaid and commercial insurance payment cuts neither political party is prepared to openly duel over the matter yet somehow most healthcare executives believe the axe is about to fall and funding cuts are going to decapitate the highly vulnerable organism we refer to as our ill-fated American health care system and while that fear is not unjustifiable the real question is whether or not our present challenges can be solved with a purely economic solution frankly I do not think so I also don't have a crystal ball to foretell the future yet I am convinced that each hospital and health care system in America can better prepare itself for weathering the storm regardless of the winds direction and we must not rely on a federal mandate to do so rather than fretting about future cuts or policy changes waiting for the sky to fall or contemplating early retirement we must now work together diligently toward the Triple Aim you might be surprised to learn how we can effectively reshape what we already have a broken system supported by the largest per capita health care spending in the world the real question is where do we begin the answer is a new vision our rapidly expanding fee for service system must give way to focusing on prevention eliminating wasted services and procedures and reducing costly admissions there's never been a better time to break down the healthcare silos and barriers that impede communication and coordination across disciplines this predictably results in devastating care gaps a new standard must be set to ensure that doctors hospitals and third-party payers work together cohesively for the well-being of our communities we must voluntarily and proactively develop and adopt an unprecedented level of coordination between physicians and caregivers Hospital departments community providers and healthcare institutions across town and across the nation sharing of medical records information evidence-based solutions and best practices must take precedence over competing at practically any cost fragmentation must give way to a reliable continuum of care within a comprehensive patient-centered community care network without walls that replaces the building once affectionately referred to as the hospital patients and families within this network must be encouraged to take an active and meaningful role in health care decision making and end-of-life care and when we finally focus on the fact that a mere five percent of our population utilizes 49 percent of our healthcare resources the prospect for developing an exemplary high quality sustainable US health care system becomes clearer an interdisciplinary health care approach orchestrated in a caring coordinated manner is doable and achievable within our grasp and ultimately within our budget through evidence-based interdisciplinary prevention strategies and true care coordination with an emphasis on improving outcomes along with the overall patient experience as a nation we will not only survive we will thrive as the best health care system in the world you

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Methew Wade

16 thoughts on “The Future of US Healthcare by Barry Bittman, MD”

  1. Exactly. Please tell me of a single "program" offered by the federal government that actually reduces expenses and improves quality. That's right, lets leave our healthcare to people who administer the postal system, federal highways/bridges (over 500 needing repair), office of motor vehicles, etc. Government rarely does anything better than the private sector b/c they don't have to worry about making a profit. They simply raise taxes and cover their inefficiencies/ineffectiveness.

  2. A clever explanation of our broken system, its inhumane and shameful results. But the recommendations at the end miss one key component: All the advanced nations that rank above us in outcomes operate under some form of single payer system. Call your Congressperson and urge support for HR 676, The Improved & Expanded Medicare for All Act. An estimated $400 billion annually now siphoned off by the administrative costs of private insurers, CEO salaries and profits–could be redirected to care.

  3. Most people agree with this video. However, it's when we finally get to debating the details or try to actually change how things work that reform breaks down. Also, there is a sizable group of political leaders (the GOP) who don't want reform period. What we need to do is look to those nations whose systems outperform ours and adopt them. We need single payer.

  4. I diffidently believe in all your views and the views of the video i would like it much connect with like minded individuals my facebook is………

  5. Nicely done! After 30+ years in healthcare financing, I'm convinced now more than ever that we need a strong public option, if only to force for-profit insurance companies into truly doing something about costs, rather than talking about it. Insurance carriers have been in THE best position to address inconsistent outcomes and unnecessary care, yet nothing has really changed. We simply can't rely on health ins reform 2 move us into the 21st century with respect to our health care system.

  6. A good introductory video about healthcare that is not steeped in politics or arguing over the economy–not that those issues are not important, but US healthcare has more problems than money and government involvement.

  7. Your point makes sense. However care can be centralized when a community hospital exists without walls. I suggest watching my second video on care coordination that outlines our actual program.

  8. I have one question, how? I mean it sounds great, but what exactly are you proposing? Centralized, command and control healthcare? I don't think that it will/can work like you think it will. At least not a radical change in human behavior. History shows this. I think this video ( illustrates my point that it is possible for there to be a market based solution, because we have seen this in other sectors of the economy.

  9. But it's simply untrue that only health care habits are major factor on your and everyone's health. For instance, if my family has a history of Cancer, should I pay more? Is that affair? That's clearly out of my control.

    The private insurance is model inherently broke (in a economic sense) because profits are increased by insuring people whom will never need health care and leaving people whom may get sick out of the game. Just by eliminating administrative expenditures the costs reduce 30%.

  10. The missing link I see here is requiring people to take personal responsibility for their lifestyle habits. If a person chooses to pursue risky lifestyle choices, they should understand the risks and it should not be the responsibility of all of the healthy people to pay the price for the ignorant and outright irresponsible. For example, a person who eats an unhealthy diet should plan on dying younger, not patched together on our dime.

  11. the interconnected network of providers is great. that's what the free market does to deliver goods & services at lower and lower costs each day. The more people are informed and empowered about their own health care decisions (or any purchase of any good or service), the more efficient the market.

  12. Well stated. Now we need leadership to catch the vision and organize the options into a workable living organism. From birth to death, every person is valuable and no person should be elevated above another with respect to health care.

  13. My intention was not to make this a political issue. Regardless of the side one takes or a political mandate, we must attempt to improve outcomes, provide better care experiences for patients and their families, and do so at a lower per capita cost.

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