How To Understand U.S. Healthcare? Follow The Money | Dr. Jonathan Burroughs | TEDxWolfeboro
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- เผยแพร่เมื่อ 13 พ.ค. 2024
- For those seeking to better understand the US healthcare system, national healthcare consultant Dr. Jonathan Burroughs suggests playing a game of "follow the money." He asserts that whenever healthcare appears illogical, following the money will make it all rational and clear. The U.S. spends 2x as much money as the rest of the industrialized world, yet its citizens do not live as long as they do in 36 other nations. Dr. Burroughs gives an overview on how to fix the system. Dr. Burroughs has worked with over 1,100 hospitals across the country to help healthcare leaders navigate the 21st century. He is a popular national speaker, who speaks to the impact of healthcare reform on hospitals, physicians and patients. Jonathan is a healthcare legal expert, who has participated in over 65 cases across the country. He is the winner of the James A Hamilton Award in 2016 awarded by the American College of Healthcare Executives titled "Redesign the Medical Staff Model". This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at www.ted.com/tedx
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This was a well-presented talk and a good perspective on the economization of the healthcare in the United States. The healthcare system in the United States is often criticized for being too expensive and inaccessible to many Americans, raising questions about the fairness and justice of the system. One of the key factors driving the high cost of healthcare in the United States is the for-profit nature of the healthcare industry. Unlike many other countries, healthcare in the United States is a commodity, bought and sold in a market-based system. This means that healthcare providers and insurers are motivated by profit, and the cost of healthcare services is often determined by supply and demand. From an ethical perspective, this raises concerns about the commodification of healthcare. Healthcare is a fundamental human right, and the market-based approach to healthcare in the United States may undermine the principle of justice. The for-profit nature of the healthcare industry can lead to inequities in access to care, as those who can afford to pay for healthcare are more likely to receive it. This can perpetuate social and economic inequalities and contribute to a lack of fairness in the healthcare system. The high cost of healthcare in the United States can lead to significant financial burdens for individuals and families. The cost of healthcare can be prohibitively expensive, leading some individuals to forgo necessary medical treatments or delay seeking medical care until their conditions worsen. This can lead to poorer health outcomes, increased healthcare costs, or, as mentioned in this talk, earlier age of mortality. From an ethical perspective, this raises concerns about the principle of beneficence, which truly should be the driver behind anyone’s desire to work in healthcare. The high cost of healthcare can make it difficult for patients to receive the medical care they need, potentially leading to harm and suffering. This can be particularly problematic for vulnerable populations, such as those who are uninsured or underinsured. The current healthcare system also has the risk of leading to significant disparities in healthcare access and outcomes. Health outcomes in the United States are closely tied to social and economic factors, such as income, education, and race. This means that individuals who are marginalized or disadvantaged in these areas are more likely to experience poor health outcomes and limited access to healthcare. From an ethical perspective, this raises concerns about the principle of justice, which refers to the duty to treat people fairly and equitably. The current healthcare system in the United States can perpetuate social and economic inequalities and contribute to disparities in healthcare access and outcomes. This can result in unfair and unjust treatment for certain individuals and populations. The economics of healthcare in the United States raise significant ethical concerns. The for-profit nature of the healthcare industry can undermine the principles of justice and fairness, while the high cost of healthcare can lead to significant financial burdens and disparities in healthcare access and outcomes. I believe that it is essential for healthcare to be considered a fundamental human right, rather than a commodity to be bought and sold in a market-based system. This would however require a rethinking of the current healthcare system and a renewed commitment to promoting fairness, justice, and the well-being of all patients.
This was a highly informative discussion on the backstory of the economics of healthcare in the United States. I think it is interesting that the United States has created a healthcare system that, at its core, seeks to meet business expectations and success parameters rather than markers of efficient, high quality, and affordable healthcare. I think the impact that this has on our healthcare system is catastrophic and threatens the very basic ethical principles of medicine. At the core of clinical medicine, medical physicians are tethered to the ethical principle to do no harm and that principle should extend to all individuals involved in healthcare and all levels of the healthcare system.
After listening to this discussion, I wonder why hospital administration, shareholders, and other employees of the business model are not also held to this standard. I don’t know that healthcare in the United States will be able to exist without some business model but based on this speech, there is a balance that can be achieved. Unfortunately the medical system, starting with the abysmal price of medical education, has created a system that both has to and wants to value money. It is not difficult to understand or see where and why such greed abounds when there is an extensive amount of capital to be made. However, the principle of do no harm should extend beyond the boundaries of just clinical medical care and permeate all aspects of the medical model. It is difficult to hear that medical care is the main reason for bankruptcy in the United States. As a current medical student, I think about how every test I will order one day or test I may run will clarify the potential diagnosis and hopefully more rapidly get the patient back to a state of optimal health. However, it will simultaneously be filling the pockets of a company or individual who is essentially profiting from another individual's suffering and disease. Furthermore, once that patient leaves the hospital or clinic, they may be back to a state of “optimal” health, but the financial expense incurred from that experience may soon leave them financially broken and perhaps in a worse place than when they started. It is not difficult to see that providing high quality clinical medicine is only one-half of the do no harm imperative, if a patient goes home and is then forced into bankruptcy because of care that we provided them, how can we collectively as a medical profession claim that we did “no harm.”
this was great, very informative and eye opening, thank you doctor
Thanks for sharing such great information. It was really helpful to me. I always search for videos quality content and finally I found this in your post. keep it up!
Agree!!!🤩
Super informative!
Someone has to pay for that CEO to fly in the Insurance Company GV.
You got it!!! And we need to include THE FAMILY but too often they get dismissed and disrespected and looked down upon. They are experts of their own kind and need to be acknowledged-I’ve spent a lifetime being dismissed by health care professionals-making me entirely distrustful of the system and staying as far away from it as possible-especially all the polypharmacy!!!!
I'm 75 and 5 years after this talk. Nothing has changed. Nothing will change even if I live to be 90 years old. I will outlive my savings and get very poor health care in my final years. One thing I want is for Americans to be eligible for Medicare at age 70, Social Security, too. I've found that most people in their sixties are quite able to work and remain reasonably healthy. Most of all I want universal health care, Medicare for all. No more Medicaid or all these separate programs to piecemeal coverage. What to do about politician bribery I have no clue; it's the key to any change at all.
As of the most recent data available, there are 1,834 registered lobbyists working for pharmaceutical and health products. This means that the industry has more than three lobbyists for each member of Congress1. The pharmaceutical industry’s lobbying efforts play a significant role in shaping policies and legislation related to healthcare and drug pricing
hola soy de argentina son muy buenos sus vídeos
The healthcare is so expensive because of the profits on medicine, hospital machines , insurance ..
I’ve been saying this for years. If something ever doesn’t make sense, just follow the money and eventually it will.
He has layed out the solutions quute well but has not dealt with the big supplier that fund people in congress that make decisions...health care in america is run by hospital chains its a business first and foremost..
Absolutely! Furthermore, the biggest obstacle is the easy bribing of politicians.
Profit Projections:
Based on updated and expanded projections, it is estimated that healthcare profit pools will grow at a 4 percent CAGR from $654 billion in 2021 to $790 billion in 20261
Thankyou for this talk!
he is missing the point this is a moral issue look after your people and don't burden them
The fact that one can live 20-30 years if treated by doctor 1 and die tomorrow if treated by doctor 2 is criminal. There is no other argument needed to support healthcare reform.
I think that is more of a malpractice issue than a cost issue
good ides to incorporate in chaange management and medical eco systms
just loved it thanks for doing it
Although I agree with the points that there are always ways to improve the efficiency of a service to reduce costs. A system run for profit instead of for the benefit of the patient will always penalise the patient. And if you think that costs too much, I fail to see how Americans can pay more than they do currently.
Don't know your situation but wonder if you receive any health teaching abt your condition. Things like avoiding smoking, wt loss, exercise and other things Do Benefit the patient
@@jonipilaske9841 I hope your plan to teach the millions of Americans with cancer to just "not get sick" pays off
@@kagakai7729 I would tell them to avoid food laden with herbicides and pesticides, as well as to avoid contact with such things. Research shows these are contributors.
@@jonipilaske9841 True. But do doctors/medicare support this? Can one write gym fees or a meal plan off their taxes (the rich can write off golf but that is another issue)?
@@DrJohnnyJ what do you mean abt doctors and Medicare supporting?
As Dr. Burroughs pointed out during this talk, the healthcare system in the United States has a large monetary focus compared to the rest of the industrialized world. Being a medical student in the in the United States you hear a lot of other students when discussing their medical specialty of interest mention the average income of individuals working in that specialty. Many are deterred by specialties like family practice and pediatrics because they are some of the lowest paid providers but instead want to work in higher paid specialties like orthopedic surgery or plastic surgery. This also brings up the fact that many of these higher paid specialties that involve surgery could be high because of a push for elective surgeries since the more surgeries a doctor does, the more they get paid. I think some people lose sight of what the medical field is truly about, taking care of the greater population. However, it can be understandable as the cost of medical school rises to the point where doctors that graduate from medical school are usually hundreds of thousands of dollars in debt and then have to work another 4+ years getting paid essentially minimum wage due to the long hours that are required of resident physicians. This vicious monetary cycle makes upholding the ethical tenets of medicine extremely difficult. For example, as Dr. Burroughs mentioned, receiving the proper healthcare can be extremely expensive especially for things like cancer treatment which can alone bankrupt a family. This violates the principle of justice which is supposed to ensure every individual can receive the same care no matter what. If someone is unable to afford the treatment they need and suffer because of it, this is unjust.
I thought the point Dr. Burrough made about the standardization of healthcare was extremely interesting. In medical school we are all taught the same protocols to follow for various conditions and diseases, however this may vary by school. We are then taught more applicable treatment processes when we go on rotations as compared to what is technically stated in textbooks. This is where more variation can happen since the way one doctor treats an upper respiratory infection or cystic fibrosis may be different than another even in the same hospital. These variations may cause significantly different outcomes as Dr. Burrough mentioned the 30 year difference in life expectancy of patients being treated for cystic fibrosis at different hospitals however, the problem arises with how that information can be delivered to doctors. I believe there is a lack of communication or sometimes initiative of physicians to continue to research new protocols or treatment regimes for the diseases they treat. This leads to a disparity of treatment and thus the patients inevitably suffer because of this which violates the principles of beneficence since they may not be getting the best treatment possible for their condition.
Good points to consider as well. Medical schools have a lot of changes to make, not the least being a change in approach and attitude towards students and teaching.
I completely agree with Dr. Burroughs’s viewpoint that healthcare in the United States has, unfortunately, begun to focus more on monetary rewards as opposed to patient health. Personally, I think the issue most often lies within the large corporations employing physicians. Since they are businesses, all they care about is making money. Therefore, they encourage anything that brings the hospital or clinic more money, even if that means pushing their physicians to compromise their ethical obligations to their patients. For example, I previously worked in a clinic that was constantly pushing its providers to see more patients each day even though every provider was already seeing 30-40 patients per eight-hour shift. This obviously led to frustrated patients due to poor patient care and minimal interaction with their physicians. We even had one provider who started instructing her medical assistants to knock on the door with an excuse for her to leave the room if she was in one patient’s room for too long. This provider did not employ this strategy because she didn’t want to spend time with her patients but because if she spent more than ten minutes with a patient then she would be running late to see every other patient for the rest of the day. The other issue that can arise from providers being pressured to cram so many patients into their schedule is they must delegate more tasks to others. This is okay if the provider is confident that they have competent medical staff, but if they delegate a task to someone who does not know exactly how to perform it, they run the risk of causing harm to the patient. Overall, it is frustrating to see our medical system structured more toward making money than patient care. Not only is it frustrating for patients due to the rising prices of healthcare with increasingly poor care, but it is also forcing providers to compromise their ethical obligations to prevent harm and promote good for their patients. Additionally, in some cases, providers may risk inflicting harm on patients if they neglect to properly oversee the actions of their medical staff due to time constraints. Every physician goes into medicine with the intent of helping people, so it is a shame that our healthcare system does not equally reflect that value. Hopefully, in the future, we can work toward getting our medical system to focus less on monetary rewards and more on the health of its patients.
Do physicians really decide the specific treatment tools or do insurance companies? Many physicians believe insurance companies limit their choices.
From the insurance perspective. One hopes that physicians are trying effective and cheaper procedures first; that proper medical practice is belong used rather than patient's requests; and that recognized procedures are being used according to modern medical research data. i have no doubt that medical costs would go up if the was no accountability, and that the insurances companies would pass this on to patients. Also, many procedures can be approved with the proper paperwork submitted. Something that doctors don't like to do. Do it right to start with, that's why they get paid the big bucks. They learned that discipline in your training.
@@thomast3570doing fine without insurance companies treating our patients in Australia buddy.
I believe Dr. Jonathan Burroughs makes an excellent point regarding the financial status of healthcare in the United States. We are continuing to pay for sickness, procedures, and surgeries, and neglecting some of the most fundamental specialties in medicine. Primary care physicians and pediatricians are some of the lowest paying physicians, but some of the most crucial ones necessary for good health. Due to the rising costs of medical education, many students are opting to go into higher paying specialties, just to pay off the debt accumulated throughout school and residency. We are seeing less general family doctors and more highly specialized physicians, and the money reflects that. The question that comes into play is how many of these procedures and surgeries are absolutely necessary, and how many are being performed for the money? The concept of beneficence is the duty of a physician to do what is in the best interest for the patient. If we start adding financial compensation into the play, the guidelines of what is considered ‘good’ for the patient might be stretched. How can we ensure that surgeons are performing surgeries that are in the best interest for the patient, and not just so that they have a few extra zeros at the end of their paychecks? If money continues to be prioritized over what is best for the patients, the trust between a doctor and patient might be lost. It is disheartening to see something as valuable as healthcare be so highly monetized. Bankruptcy due to medical bills is another huge consequence from placing so much value and emphasis on money. A one-night stay in the hospital is not something every individual can afford, let alone all the additional labs, imaging, and procedures required during admission. How can we make a decision regarding a patient’s best interest, if it will potentially bankrupt them? Patients will continue to actively avoid receiving care just because they cannot afford it, until the economics of healthcare is further investigated.
I love your enthusiasm, your honesty, however the world is too selfish, to prejudice to judgemtal of who should recieve health care to accept your simple solution. Let continue to help the underserve population in hopes that as individual we can make a different in one person at a time.
the connecttions with community... its not one size fits all... it's just not... but lots of better
Yes this is all known and yet no one does anything about it!?!?
There is no way this three years old video with almost 40 k viewers has only 18 comments
The reality of tech and methodology... relationship and rights of people, providers and systems/communities.
people have to modulate the health care system by so many roles such as refusing online visiting by the same payment, and so many other tricks....
Went to doctor with my thyroid issues, rash ,heart pain,fatigue and radiation side effect.He was deaf but able to say you need a memmogram and colonoscopy
interoperable
There is no way a CT - scan should be $6000 . The same thing in india is $200 and its the same quality.
@@sbbperson - Nope, how much is the radiologist is getting paid in the United States versus India.
Costs a lot bc we pay it or insurancedoes it. Went to a walk in clinic. 70 bucks if I pay or 25o bucks if my insurance pays
@@americanbobtail1in Australia, radiologists get paid a relatively fair amount and CT scans cost is minimal.
los sigo desde el 2013
I didn't hear a solution. All I heard was how poorly doctors are diagnosing health problems. There's no such thing as competition driving down costs. The other problem is, how do you "shop around" when you need emergency care or you need a procedure? Where so people go who can't afford insurance?
it's more beyond the transactional relationship with financial ROI... but of course it is a large part of the equation. There are a lot of improvement spots. I am not a big fan of cynicism... there are so many very learned people involved in these very important issues.
You can't find a "better way" or the next evidence based best practice if you're mandated to stick with what you are mandated today. How the heck do you think medicine has evolved over time? It's evolved by providers taking their experience and tweaking care to find the "better way!"
In theory that is true. In modern practice, it is not so true. The reason is that even when improved techniques are found or when old techniques are shown to be ineffective, people are very slow to change. There is another doctor whose TH-cam channel I subscribe to who has a video that goes into detail about how slow doctors are to implement changes, even after they are provided evidence that the procedures they are currently applying are ineffective. He cited a study by an medical association for internal medicine that found that a very large percentage of doctors were still using procedures and methods that had been found to be ineffective many years in the past and had been removed from the association's database of recommended procedures. There was no requirement for the doctors to change, so cognitive dissonance and other logical fallacies drove the doctors' choices of which procedures they would use.
My wife already told me that she would make certain that I die at home.
Follow the money!
Health care should not be for profit. The ACA included a mandate that required everyone to get coverage or pay a small fine. Look up ‘shared risk pool’. Every ins company evaluates their shared risk pool from the actuarial to determine their risk. If america paid into a pool everything can be paid for. I could write much more but will stop…
How about preventing that dermatitis with a proper diet?
Follow The Money !
The most profound change comes from within. Let's understand what "We, the People" are paying for.
We, the people don't have the wealth to sufficiently bribe politicians, even collectively. It's hopeless. I appreciate that you want to try, but it seems impossible.
Universal healthcare just like Europe, there you go.
I understand it, a for profit scsm
Australia
Everything rún by money
Yes all good ideas. Hear me out though - do away with your insurance companies, scale back your absurd spending on military, redistribute this money and utilize taxation commensurate to each individuals income to actually cover the entirety of your countries constituents. Healthcare is a right and should be publicly funded the same way as firefighters, police, infrastructure etc. The rest of the developed World has this sorted. You need to eliminate the corporate drive for generating profit solely and eliminate shareholder demand and primarily the need for insurance companies. Look to the UK, Italy, Germany, Canada. It's time America.
Exa tly...look and explore Argentina health sistem...even if in appearance its "poor" its actually one of the best and all for free!!!the preparation for doctors are even higher than Europe and just a few see this because its just an"3er world country" that clasify has to be changed..
Entitlements got us into this mess it won't get us out of it
@@Luke-eo6kp I'm not sure you know the meaning of the word "entitlements". Just more cliches thrown around with no pertainness to the question at hand.
@Theo Russ Medicare, Medicaid social security, affordable cares act, government programs that are now in place that can't be cut because of entitlement. People "believe" they are entitled to these programs therefore we are unable to make the necessary changes to the system in order to correct past errors. It is a cliche, you are correct, yet I'm not going to waste my time elaborating on subjects you've never looked into. Do your own research.
@@Luke-eo6kp The definition of "entitlements " are payments "entitled" by law.Many people do not think SS and Medicare were mistakes. The laws pertaining to these have been changed in the past and can be changed in the future. It may be politically difficult to change the laws because people want these thing., but this is a democracy for the good of the people. The government is not a parent who decides what people get. "Entitlements" is often used to define benefits that were not earned, or on the other hand benefits that were earned. Some see it as welfare. It is a politically loaded word that doesn't help in objective conversations.Things can be discussed well without using it. We go off on political philosophies.
Now how did the clinician listen to your heart and lungs??? Is there a stethoscope you plug into your iPhone???
they have otoscope and stethoscope attachments for smart phones now.
follow the money, aetna. my money...as it goes to the prescription meds you aren't covering because you deny the pre-authorizations and appeals.
GREED happened!
Sorry, but single-payer is the most affordable, efficient and health-conscious way to deliver to your citizens. The problem is a profit-driven system.
Imagine actually thinking America is the best country in the world
Its vomiting what usa does to their own people. I would never live there even if they pay me. Speceally for the health care system. Criminals
We need to quit dispensing drugs for symptoms. Instead we should prevent disease.
Yeah. That will never happen. Diabetes alone brings in over 800 billion dollars. The medical industry makes money off treatment and managing diseases not curing. You cure sickness tons of investors are going to lose money. You have to retain customers. That’s with any business. They keep u coming back for treatments and pills. So sad.
@@Lovedandredeemed29 The diabetes drugs don't really extend life as well as a proper human diet (PHD). My grandmother died of a heart attack and she was a devout vegetarian. Some plant foods cause inflammation such as wheat, corn and soy which in turn causes CHD and Diabetes.
@@WA4OSH true. Soy, corn and wheat is heavily engineered too.
@@Lovedandredeemed29 It's not so much that these seeds were GMO but that they had been treated with glyphosate before being harvested. Futhermore, the seed oils are heavily cooked. refined and bleached before being bottled. Finally, Linoleic acid is the predominant n-6 polyunsaturated fatty acid (PUFA). Consuming PUFAs reduces the actions of n-3 fatty acids. Some people find PUFAs to be inflammatory.
@@WA4OSH that doesn’t sound good. Nothing surprises me. I guess it’s best to grow your own food if u can. I use farmer markets in my local area. This world is sad. Plant based diet has worked for me. It took me off medication. So that’s my route. I don’t digest dairy very well and never saw a point really of drinking a cows milk lol but whatever and meat made me sick a lot. I do get my blood levels checked by my provider to make sure I’m not lacking anywhere. Im not a fan of soy, corn or wheat and since u gave more info about it I definitely don’t want it.