The holidays in my household are for spending time with family, reconnecting with loved ones…….and fierce political debate. Much to the chagrin of many members at the dinner table, opposing political philosophies tend to result in a heated discussion about “how to solve the world’s problems.” While probably not the most effective discussion, I do enjoy attempting to share my beliefs on specific topics - particularly healthcare (I know, you are shocked). In preparation for this year’s thunderdome, I wanted to put together a guide that could help you respond effectively if you experience a similar situation. Enjoy and happy holidays!

If someone at dinner says ...

We don’t need socialized medicine in this country. This is America not the Soviet Union!

Take it down a notch grandma. We already have socialized medicine in this country and it has benefitted millions of people for decades. On July 30th, 1965 President Lyndon Johnson signed Medicare into law - effectively launching one of the largest social welfare programs in American history.. With that said, we can definitely talk about the model of socialized medicine we have and how we can improve it. Medicare now constitutes nearly 40% of the mandatory component of the US budget, and this will need to grow as the population ages. Are you willing to give up Medicare or should we reform the system to take care of our sick?

I am tired of footing the healthcare bill for people who don’t work!

The unemployment rate is 3.7% grandpa, do you really think that is what drives up the cost of your bills? Ensuring that everyone has access to a baseline level of affordable care feels like a basic human right to me. If someone is sick in America, they should know they will get a foundation level of treatment that won’t put their entire family into debt. I may agree that not everyone should get that $1 million experimental treatment, but they shouldn’t have to choose between death and bankruptcy. Also, to be clear, the impact of these individuals on your medical bills is marginal in comparison to many systemic business model problems. Let’s focus on the areas where we can have the biggest impact, not a single blade of grass on a turf farm.

My doctor doesn’t even look at me anymore. All she does is type away on that damn computer!

Trust me, your physician hates them too. The doctor-patient relationship is certainly in jeopardy, and technology has become a contributor to this downfall. Electronic Medical Records systems were not designed for doctors, but, instead, to maximize reimbursement for the health system. As we have seen in other industries, technology can make our lives much easier if we build it for the right users. Fixing the problem of poorly designed medical records requires us to look long and hard at our current business models. (The Link between Provider Business Models and Physician Burnout).

My insurance premiums keep going up and I can barely afford them. Insurance companies are the worst!

Insurance companies have done a lot of harm to patients in the past, and they, justifiably, have destroyed their ability to garner patient trust. Some insurance companies continue to try to identify loopholes in order to make a profit - this is wrong. But, let’s think about how insurance companies operate.

The average insurance company profit margin is between 3% and 8%. The vast majority of their costs come from medical expenses, and they negotiate prices for these services with providers. In many major markets, providers have been buying up smaller practices in order to build a monopoly and increase their power in these negotiations.. As a result, they can charge astronomical prices and your insurer has no choice but to raise the cost to you. As medical technology continues to get better and the associated prices rise, this will only get worse unless we control utilization (deny some services) and/or increase provider competition to lower prices. Having the government negotiate prices in a Medicare for All scheme may lower them for some treatments, but are you willing to let the government deny covering a particular drug or service?

We had a great healthcare system before Obamacare. Why did we change it?

The healthcare system was incredible for people who were healthy and employed in benefit-bearing jobs. It was cheap and you could go to any doctor you wanted. However, if you had a pre-existing condition that barred you from coverage or you worked a part-time job with no benefits, you were royally screwed. And to be clear, there were millions of people who worked hard every day to support their families, but still could not afford or could not expect to be covered. That is not an America I am proud of.

Narrower networks of physicians you can visit and higher insurance premiums due to the flood of unhealthy people pouring into the market certainly led to increased cost for those doing fine in the previous system. But, that feels like an okay price to pay to know that we are drastically improving the security of a large portion of our population. Now, Obamacare did utterly fail in its quest to lower medical costs, but that is an entirely different discussion.

Pharmaceutical companies are just greedy, how can they expect anyone to pay these prices!

I hate “Pharma Bro” as much as the next person, but not all pharma companies are like him (or at least not all the time). Companies jacking up the prices for needed drugs because of a market failure is horrible - and we should definitely address those situations.

However, there is a broader issue we are facing now. You may have heard the term precision medicine. At a high level, this refers to a class of drugs designed to treat patients with a very specific genetic mutation. Because companies have developed these innovations for such small groups of people with those mutations, the cost of the drugs has to be massive in order to recoup the R&D costs and incentivize further innovation. This is not greed it is value creation. It is good for humanity that someone is discovering new ways to keep us healthier for longer, but that has an associated cost. Should we only provide access to these treatments for those that can afford them? Are you comfortable denying certain people life-saving treatment because of the cost?

We should just become a single-payer system - every other developed nation does it!

While I certainly appreciate the thought behind the Medicare for All movement, I don’t think that it is the best approach for America. There are many ways we can achieve universal coverage through a variety of public and private mechanisms that will require less disruption to the industry and enable millions of people to keep their jobs. (Read More from Vox).

Almost every major innovation in healthcare originated here in the US, and that was due in large part to the immense amount of money we put into it. Medicare for All will put a major resistor in the innovation current that I do not accept. Instead, I strongly support models like they have in Germany where there are many private payers working in concert with the government. (Healthcare in Germany). Let’s ensure no one goes bankrupt from medical bills again, but let’s also be realistic about what it means to switch to the complete opposite side of the single-payer spectrum.

How do we fix all these problems?

This is a multivariate problem that is just hard to understand without many years in the industry (just ask our President). I have been doing this for 10 years and I still have only scratched the surface. With that said, there are a couple things that I would prioritize above all else:

Decouple insurance from employers
Break-up monopolistic health systems and insurers while also preventing further consolidation
Incentivize the shift of Providers to value based care where they are paid for their ability to keep patients well rather than just for treating them when they are sick
Develop a plan for subsidizing new, high-cost technologies and drugs for those that need them
Reduce the ability for healthcare corporations to donate funds to political campaigns
Mandate interoperability of hospital records so that data may be shared across all Providers and increase funding for national health information exchanges

There are so many little market failures that happen every day, resulting in horrible experiences for patients. Let’s focus on where we can really make an impact rather than fighting all the little battles.