Every once in a while, I come across a book that has something positive or (more frequently) negative to say about the current state of the American health care system. These kinds of books are probably required reading for those of us in positions of leadership within the health care profession. They aren't always enjoyable to read, but they are important to read nevertheless. I recently came across an example of this kind of book by pure happenstance.
The holiday season is approaching, and there's a good chance that our family will be watching the 1990 film Home Alone again this coming December. It's a very entertaining movie that was filmed in a suburb of Chicago called Winnetka. You can actually drive by the house where the movie was filmed (and we have more than once). The house was recently sold, but it was owned by the John Abendshien family in 1989. John recently wrote a book that was published earlier this year, Home But Alone No More: A Memoir from the Owner of the House That Made Movie History. I've already placed a hold for the book at our local public library.
When I read more about the author, John Abendshien, I was surprised to learn that he had been working as a health care consultant for over 40 years and had written a book on the U.S. health care system. I checked that book out too - it's called Health Care in the Next Curve: Transforming a Dysfunctional Industry. It's a quick read and probably worth checking out.
Abendshien provides a nice overview of the current state of U.S. health care and doesn't pull any punches. We have major problems for sure, and he definitely covers all of the most important ones that we often hear about. One of his comments that most resonated with me though was a comment that I don't hear a lot being made by health care policy experts. Abendshien makes the true statement that Americans spend more on health care than any other country, which is true. And he also goes on to say that the U.S. health care system does worse than almost every other country in the Organisation for Economic Cooperation and Development (OECD) when it comes to commonly cited health care statistics, such as life expectancy, maternal mortality, and infant mortality, which is also true. None of this is new information, and I've posted about these statistics in the past (see, for example, my posts "The first step is to clearly state the problem...", "Measure What Matters", and "Invest Your Money Wisely"). But Abendshien takes the discussion in a direction that most do not when he acknowledges, "The less-than-stellar outcome measures of health care in the U.S. are not due so much to poor health care as they are due to poor health."
Bingo! As I have stated many times in the past (see the posts that I mentioned above), our health care delivery system is designed first and foremost to provide acute care for life-threatening diseases and medical conditions. We are getting better at re-designing the system to provide care for chronic diseases too, but we still have a long way to go. But there is a BIG difference between health and health care, as Abendshien points out. Americans aren't very healthy, that is true. Our flawed health care system certainly deserves part of the blame, but it definitely doesn't deserve all of the blame. Our health care system was never designed to address the social determinants of health (also called social influencers of health), which account for between 30-50% of all health care outcomes (see also my posts, "You give to get to give!" and "Our National Embarrassment"). It's nice to hear someone else calling these outcome statistics for what they are truly measuring - health.
Overall, Abendshien makes some good points, but I don't agree with him on every point. I want to "fact check" some of his comments and review some of his references before I comment further. What is clear - and where I do agree with Abendshien - is that the status quo is not acceptable. We need to do better. A lot better. The costs of health care are no longer sustainable for our economic future. Our problems are not easy, and it's going to take all of us to fix them.
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