The Healthcare Conversation: Navigating the U.S. Health System

By Linh Doan Vo

The Healthcare Conversation is an inspiring read about understanding how to navigate the health system in order to become a smarter, better-informed patient-consumer. The main goal of this book is to empower readers to take their physical and financial well-being into their own hands.

This book strives to answer questions that have puzzled

• Language: English
• Publisher: New Degree Press
• Release date: Feb 25, 2020
• ISBN: 9781641373920

Book preview

THE HEALTHCARE CONVERSATION

Navigating the U.S. Health System

Linh Doan Vo

new degree press

copyright © 2020 Linh Doan Vo

All rights reserved.

THE HEALTHCARE CONVERSATION

Navigating the U.S. Health System

ISBN

978-1-64137-390-6 Paperback

978-1-64137-391-3 Kindle Ebook

978-1-64137-392-0 Digital Ebook

To my readers, who served as the inspiration for the creation of this book because all Americans deserve the right to demand more equitable, better-quality healthcare in their own nation.

This book is dedicated to the special ones bold enough to challenge the system and become the catalysts of change that our healthcare needs.

CONTENTS

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PART I

Chapter 1

MISSION STATEMENT

Chapter 2

UNITED STATES VERSUS THE WORLD

Chapter 3

HISTORICAL PROGRESSION

Chapter 4

REIMBURSEMENT SYSTEMS AND PAYMENT MODELS

Chapter 5

CHANGING A STAGNANT SYSTEM

Chapter 6

NEW AGE OF CONSUMERISM

PART II

Chapter 7

BREAKING DOWN EXPENSES

Chapter 8

THE GOVERNMENT IN PLAY

Chapter 9

HIDDEN FEES UNCOVERED

PART III

Chapter 10

CRY FOR PRICE TRANSPARENCY

Chapter 11

BRIDGING THE COMMUNICATION DISCONNECT

Chapter 12

Social determinants of health

Chapter 13

MEETING THE PATIENT WHERE THEY ARE AT

PART IV

Chapter 14

EMPOWERING THE PATIENT

Chapter 15

CALL TO ACTION

Chapter 16

OUR NEXT STEPS

APPENDIX

ACKNOWLEDGMENTS

PART I

CHAPTER 1

MISSION STATEMENT

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My medical history is not all that exciting. I am young and relatively healthy; healthcare was not something I thought about very often—or at all—growing up. That is, until I turned eighteen and my health insurance, Medi-Cal, completely changed before my eyes.

Suddenly, the whole process of visiting the doctor, receiving my prescriptions, and getting health checkups became incredibly convoluted. I constantly found myself surprised and underprepared for the administrative tasks I abruptly assumed responsibility for. I had to research what types of prescriptions were covered, why some dental or vision services were suddenly out-of-pocket costs, and how to seek out new treatments or referrals to specialists. 

What once seemed a guarantee now felt like something I had to fight for. At every turn and corner, I found myself confused and out of the loop about my own healthcare.

When did this process all become so complicated?

A JOURNEY TO SHARE

The U.S. healthcare system is a perplexing one that no one seems to quite understand, but why is that the case? What makes healthcare—its current status, its policies, its costs—so difficult to understand?

The healthcare industry initially struck me as incredibly daunting, with knowledge about it completely inaccessible to the general public. I felt alone in my healthcare journey, a feeling that all of us have experienced once, twice, or are still actively experiencing now.

In exploring the answer to this question, I unknowingly entered a realm of complexities that the current U.S. healthcare system encompasses. How does one define healthcare? Who are the influencers of healthcare policy and implementation? And how does one go about learning all this information? These questions I eventually received answers to spiraled into more questions, creating an endless cycle of perplexity.

The more questions I asked, the more I realized how much more I had to learn, causing me to embark on a journey of discovery and pursuit of knowledge. This book is my attempt to answer those questions and concisely formulate everything I have learned along the way.

One thing is for certain: Nothing in healthcare is certain. Healthcare is full of truths, non-truths, and half-truths coupled with many complex gray areas.

The idea of healthcare seems relatively simple. You enter a healthcare entity, receive treatment for your disease or illness, leave after completion of treatment, and pay the bills the institution sends afterward. However, the reality is the exact opposite, as the healthcare industry is covered in layers of complexity, making it arduous for consumers to understand its motives and incentives.

On the journey to understand more about this complicated system, I connected with numerous physicians, healthcare specialists and professionals, managers of innovative companies advocating for change within the system, along with patients and adults in their twenties and thirties. Many of the conclusions and proposals presented in this book are supplemented by copious amounts of research, published articles, and other credible sources that have reached the same or similar conclusions. 

I felt compelled to write a book because this bestowed knowledge was too important to remain unwritten and unseen to the public eye. The curiosity that drove me to understand the healthcare system is the same curiosity that drove the creation of this book, in the hopes that other people could enrich themselves with my discoveries too.

As a student learning and discovering new ideas about U.S. healthcare, I would like to humbly express that I’m here neither to criticize nor praise the healthcare system.

PURPOSE AND GOALS

My book aims to simplify the complexities for young Americans in their twenties and thirties, people who are just now being exposed to the idea of healthcare management, and to transform them into smarter consumers and better managers of their health.

I’m targeting this specific age group because the young generation is the most equipped to change the way patients have received healthcare for the last two centuries. This generation is the most technologically advanced one yet, and this advantage is what positions us to change healthcare history, giving us the tools we need to actively manage our healthcare.

However, I do not mean to limit my audience to this target group. My hope is that this book can resonate with all age groups, as I wrote it with the intention of reaching anyone who simply wants to learn more about the system in which they are active participants.

Rich Simmonds, a public figure and professional author, once said, Don’t look for ideas that will confirm your thinking; rather look for trends that will disrupt your thoughts.

In this book, we will address insufficiently discussed topics such as the trajectory of our healthcare system, whether healthcare is a right or commodity, ethics and morals obligations that come with business, and many more controversial ideas. For both the readers’ and this discussion’s benefit, this book attempts to bring both sides of the story into perspective, to facilitate and spark a conversation that does both sides justice in the matter. 

This book serves as a collection of stories and experiences from real people who have directly experienced the reality of the system. Their words shocked, puzzled, and inspired me, and I hope they can resonate with the same power and magnitude for you as they did for me.

BREAKDOWN OF PARTS AND CHAPTERS

In this book, I will outline the limitations of our healthcare system in its current condition, problems with our existing healthcare industry, discuss possible alternatives for our system, and propose viable solutions on how we can learn to better utilize this system as patient consumers.

This book is broken down into four parts revolving around four questions:

1.How did healthcare transform into this current state?

2.Why is obtaining care so expensive?

3.What are the main issues plaguing our system?

4.How can patient consumers initiate change?

Part [I] contains Chapter 1’s introduction explaining the origin of this book and the mission statement of what we can achieve through sharing this journey together. It also includes the introductory Chapters 2 to 6, where readers will learn about the historical progression of healthcare, its qualities compared to other developed countries’ healthcare, and the methodology we will use to approach our care.

Part [II] encompasses Chapters 7 to 9. After attaining a solid foundation on the status of healthcare, this part will address the financials of healthcare—i.e., the breakdown of healthcare expenses/fees and the allocation of total national spending on the industry—while giving insight on the government’s involvement in the system.

Part [III] comprises Chapters 10 to 13. These chapters acknowledge the major social problems of the healthcare system, such as the lack of transparency, inconvenience of accessing care, doctor-patient disconnect, and information asymmetry.

Part [IV] contains Chapters 14 to 16, which includes our next steps proceeding forward. This final part is about you, the patients of the U.S. healthcare system and consumers of its services. This section is a call to action for you as readers to become empowered and change how you manage your own healthcare.

Healthcare may be a daunting topic for those who do not specialize in it, so I hope to lessen that burden and fear by tackling the questions that everyone wants to know the answers to but are afraid to ask. I welcome you along for the crazy ride, hoping that this book offers you the answers you seek and the courage to seek the ones that remain unanswered.

CHAPTER 2

UNITED STATES VERSUS THE WORLD

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Our healthcare system is characterized by divisions. People with health insurance receive more care than the uninsured, who often cannot afford the care they need. Even among those with insurance, the healthy are divided from the sick, leaving the sick to shoulder large financial burdens. The burden of paying for healthcare divides people by income, with those at the lower income levels paying the largest share of income for healthcare.¹

This quote was beautifully spoken by Gail Shearer, the Consumers Union’s director of health policy analysis, regarding the healthcare divide that currently plagues our nation.

Americans debate many political and social issues, but healthcare should not be one of them. Our nation’s healthcare system affects each and every citizen, yet we remain divided and uncollected about this matter as our system remains in its stagnant state. 

PARADOX: INCREASED PRICES FOR LOWER QUALITY

A widely known fact among the American population is that our healthcare is in turmoil. Many have even come to accept this fact as a common burden of living, but this issue should not be accepted or normalized by the public. We will collectively come to comprehend this development when we dissect the healthcare crisis in a more comparative framework. 

To begin, in most healthcare system performance-ranking analyses, the United States often pales in comparison to other industrialized countries. Our healthcare system is twice as or even arguably three times more expensive than any of the other developed countries.²

For example, author Elizabeth Rosenthal discovered that the average hospital cost per day in the United States was $4,300 in 2013, more than three times the cost in Australia and about ten times the cost in Spain.³ And, as one might expect, the costs of hospital overnight stays have been continually rising since then. 

Allocating taxpayer money into the healthcare system would be perfectly reasonable if a positive correlation between higher spending and higher quality of care existed. However, research demonstrates that quite the opposite is happening in our case. In my interview with Joe Paduda, the principal of Health Strategy Associates and a nationally recognized expert strategist, he declared that we pay twice as much as the average country, to get results that are generally worse than average.⁴

In fact, healthcare spending has been gradually increasing about tenfold since 1980,⁵ with no evident increase in the quality of our healthcare alongside it. This disparity poses an inherently problematic situation as the United States keeps investing money into a system that does not properly reflect the efficiency and quality it should.

Having established that the United States spends significantly more on healthcare than other high-income countries, this predicament raises the question: how much more precisely are these investments? Well, in 2016, our gross domestic product (GDP) was 17.8 percent, while the average of other countries was only 11.5 percent.⁶ GDP is utilized as a common indicator used to track the health of a nation’s economy⁷ and calculated by adding together: personal and public consumption, public and private investment, [and] government spending.⁸

The 6.3 percent difference between the two GDPs may seem relatively small, but in terms of actual currency, that amount is astronomical. Unfortunately, this gap has also continued to widen every year since 1980, showing an uphill slope of U.S. taxpayer dollars.⁹ While investment into the nation’s health is a productive way to spend taxpayer money, the returns in healthcare performance and quality suggest that the money is going elsewhere and not being allocated toward improving patient wellness. 

Many researchers have offered an explanation for this paradox: Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall costs between the United States and other high-income countries.¹⁰ This