The U.S. is a powerhouse in technology, so it’s no surprise that the biggest success in the medical field has been technology based. Medicine in the U.S. is a powerful engine of creation, with more clinical trials and more medical start-ups than any other country. If you need a treatment for a rare disease, or heart transplant surgery, or cancer immunotherapy, the U.S. is the best place to be—it is the center of cutting-edge technologies and procedures.
But the trend towards faster, better and cheaper that characterizes the evolution of technology has not translated to health care, which each year seems to get more cumbersome, expensive and, especially considering the recent fall in life expectancy during the pandemic, worse in terms of outcomes.
Technology is not the culprit here, of course. What’s needed is a shift in the way technology is used and directed. Rather than training most of the nation’s technology on treating the sick, what’s needed is a shift in focus to keeping people as healthy and disease free as possible. That means developing technology and fostering start-up companies that can put in place a wellness infrastructure to implement the scientific wellness ideas being developed by Phenome Health.
The U.S. spends close to one-fifth of its GDP trying to help the sick, but this is not paying off in increased lifespan or increased health-span—the number of healthy, productive years a person can be expected to live. When you look at health-care spending worldwide, the U.S. is paying way more than other developed nations—in some cases, three times more per capita—and getting less in return. Although lifespan has increased dramatically for all developed countries in recent decades, the U.S. is lagging its peer group of developed nations. The average Japanese person now lives 85 years compared with 76 years for the average American. Citizens of the U.K., France, Italy, Chile, among other countries, all live longer than Americans on average. These nations spend half as much per capita on health care as the U.S.
A major difference between the U.S. and these other nations is how they prioritize and incentivize health-care decisions. The U.S. uses a fee-for-service model, in which patients pay for the procedures that doctors perform, not for the outcomes they achieve. This financing structure has led to a health-care system that has advanced, technological interventions for the very sick, but poor public-health infrastructure. Fee-for-service has distorted health-care priorities in favor of expensive treatments for people who are sick, rather than measures to keep them from getting sick in the first place. It has encouraged health-care spending on rare diseases; special-interest groups lobby Congress and the National Institutes of Health on behalf of small groups of people, sometimes at the expense of focusing on preventive measures that could improve the lives of more people.
The U.S. system may work well for people who are rich, but it is not geared to keeping 330 million people healthy over the long term for a reasonable price; the Medicare system, for instance, largely neglects people until they reach age 65 and their bodies are beginning to fall apart, at which point they can receive lavishly expensive interventions. From the standpoint of the nation’s overall health, this system almost guarantees overspending and underachieving. Keeping people healthy costs far less per capita than treating them when they have already developed preventable illnesses.
Things work differently in many other developed nations. In Britain, the taxpayer-funded National Health Service, which is imperfect in many ways, measures the effectiveness of everything it does in terms of disability adjusted life-years (which looks at years of life lost due to disability, poor health, and premature death). When the NHS budgets a medical intervention, whether it’s a pill or a transplant or nutritional advice, the operative question is: Will this increase the years of healthy life, unencumbered by disease and disability, for most individuals?
Relevance:
Despite growing awareness of preventative healthcare, the U.S. healthcare system remains heavily focused on treatment rather than prevention, leading to significant gaps in proactive care (Juan Enriquez, 2022). This underscores the importance of developing proactive approaches that prioritize early intervention and long-term well-being.
Reference:
Enriquez, J. (2022, December 7). In the U.S. healthcare industry, a slow shift toward prevention. Scientific American. https://www.scientificamerican.com/custom-media/the-new-science-of-wellness/in-the-u-s-healthcare-industry-a-slow-shift-toward-prevention/
