Last week, I attended the Bloomberg Business Summit, held at the Art Institute of Chicago, and it was quite the event.
Mostly catering to the traditional business sector, media giant Bloomberg put together a two-day symposium featuring some of the biggest names in the corporate world to talk about what's on tap for 2014. Healthcare, which represents about 18 percent of the entire U.S. economy, was the focus of exactly one session.
John Noseworthy, MD, president and CEO of Mayo Clinic in Rochester, Minn., and Paul Rothman, MD, dean and CEO of Johns Hopkins Medicine in Baltimore, sat on the healthcare panel. Dr. Noseworthy and Dr. Rothman are two of the leading names in healthcare, representing two of the most esteemed health systems in the country.
They are both clearly ahead of the curve. Dr. Noseworthy talked about how Mayo is investing in science and genomics, "all the things you'd expect an academic medical center to invest in," but Mayo is also investing heavily in the science of healthcare delivery, or how to reach better outcomes for more people at a lower cost. Similarly, Dr. Rothman said Johns Hopkins is doing more to use science and innovation to reinvent the healthcare system. Hospitals have been built on the paradigm of healing and treating illness, but "now we're moving to population health," Dr. Rothman said.
Mayo and Johns Hopkins have been on the cutting-edge of healthcare for several decades now. They and others, like Cleveland Clinic, routinely provide some of the greatest care for some of the most severe illnesses and conditions that plague the human condition. I often hear the U.S. healthcare system called the "best in the world." However, this accolade often comes from politicians who never define "best" — probably because it isn't true. While I believe the U.S. has amazing components within its health system, like Mayo and Johns Hopkins, the system overall is far from the best in terms of quality and cost — and it's a lie we have to stop perpetuating if we ever want our health system to improve.
Study after study after study from organizations like The Commonwealth Fund and the Journal of the American Medical Association have found that not only do we spend more per person on healthcare than any other industrialized country in the world, but our clinical outcomes are also really, really bad. Aaron Carroll, MD, is a professor of pediatrics and assistant dean for research mentoring at the Indiana University School of Medicine in Indianapolis. He's also one of the many authors of the blog "The Incidental Economist," and he's covered this topic of healthcare economics and clinical quality in-depth. (I highly recommend you follow Dr. Carroll and the work of the blog.)
Last week, Dr. Carroll posted a chart based off 2013 health data from the Organization for Economic Cooperation and Development. What he found was neither shocking nor surprising, but to see it in graph form speaks volumes of just how far behind our health system is. Essentially, the U.S. is outspending every major country in the world, but our life expectancy (admittedly, an imperfect metric) is worse than Japan, France and 22 other countries. While the U.S. performs well in cancer care, it is downright awful in preventing costly hospital admissions for chronic conditions like diabetes and asthma.
"We are spending so, so, so much more than everyone else. It's not an even spread," Dr. Carroll wrote. "I don't want to get into arguments about the fit of the line, or about the fact that there's a cutoff. It's that those countries — representing lots more people than the U.S., by the way — are all in a reasonable relationship of more spending correlated with more life, to a point. Then there's us. The difference is so large, it must be defended. It must be justified. What are we spending the money on, if not extending life?"
Dr. Noseworthy and Dr. Rothman run great institutions, and their mindset of investing in population health and managing the chronic conditions is finally becoming pervasive among healthcare leaders. But most care is delivered locally, in the community hospital and physician setting, where quality and safety measures continue to suffer. For the sake of improvement, let's never refer to the U.S. healthcare system as the "best in the world." The statement is not accurate, and empty rhetoric doesn't serve a purpose in any reforming system.