You heard it here first: We need better care, at lower cost

A while back Dr. Ezekiel Emanuel described the state of American healthcare in the subtitle of a book: “Our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system”. It was more entertaining than the word ‘unsustainable’, though having a grossly problematic health care system is of course not amusing at all for anyone, with the notable exception of those profiting mightily amidst All This.

I don’t know a soul who disagrees with the description, but habits of thought persist, and many who ought to know better still resist the obvious: change is inevitable, and its begun. Some hospitals are already being financially penalized when patients return within 30 days of discharge and rewarded for reducing readmissions. This is just one way that the quality of care, as measured by outcomes, is becoming the focus after many decades in which fees were paid for services rendered. Re-admissions may seem like a narrow focus, but of course the estimated $41 billion dollars a year is not trivial. More to the point, supporting recovery and attending to the health of people after a hospital admission is an opportunity for many other providers to contribute to the cause.

This is not a big reach—but as behavioral economists and other social scientists keep demonstrating, we adopt terms like innovation and disruption readily but often have an tough time changing the way we think and behave. This gets in the way—to stress the gloriously obvious— when it comes to providing solutions to what has always been defined as another’s challenges. And there is often a cultural reticence in the non-profit world that prevents many with solutions from making them available.

When it comes to supporting recovery and preventing readmissions, many have a role to play. A disability organization with long experience in adapting environments for the mobility impaired, an eldercare agency that knows how to connect people who may be isolated, another with home health aides trained to spot depression and other behavioral health issues: each has skills needed in changing one significant piece of a dysfunctional system.

I’m not aware of anyone objecting to Emanuel’s lavishly insulting description of our health care system, and we now know what the current administration is proposing. While less health care for those who need it most is certainly heartless and immoral, it is also grossly impractical.

Its time to speak up about solutions and offer better care at lower cost.



by Danny Abelson