Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

To fix health care, we need to be screwed

Peter Ubel, MD
Policy
October 3, 2012
Share
Tweet
Share

“We need to be screwed!”

Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs.

It was the last day of the semester, the last class discussion in my Intro to the U.S. Healthcare System course at Duke University.  We had spent a lot of time over the semester discussing the runaway cost of American healthcare.  We had explored the many failed attempts, by both the government and private industry, to reign in these costs—Medicare’s DRG program for example; the rise of managed care in the 80’s and 90’s too.

We had read about the many U.S. presidents who had tried and failed to reform the system—from Nixon through Clinton.  And of course, we had explored Obamacare in detail, and we had concluded (as have most experts) that even if the law withstands all challenges, even if it slowly unfolds as scheduled over the next few years, the law will still have little impact on healthcare costs.  The Obama reforms are much better at assuring people’s access to health insurance than they are at controlling the cost of that insurance, a fact that once again reveals its similarities to the “Romneycare plan” in Massachusetts, which has helped 98 percent of that state’s citizens obtain health insurance, but at a staggering cost which the state is now trying to cope with.

In short, we had come to a consensus that health reform would need to be an ongoing process, and that someone, somehow, needed to make the kind of changes that would “bend the cost curve,” as health policy wonks are want to say.

But how will we do that? Perhaps if one party controls the House, sixty Senate seats and the presidency, we can pass additional legislation. But even in that case, that party would need to take on powerful interest groups. Controlling healthcare costs, after all, means reducing the incomes of doctors, hospitals, pharmaceutical companies, device manufacturers and the like. It also means overcoming accusations of “healthcare rationing” from one’s political opponents.

How could any political party overcome that aggregation of forces? That was when my student threw out the idea of us needing to be “screwed.” “When everyone agrees our system is unworkable, that it is broken, then maybe we’ll be forced to work together,” she said.

This provocative comment generated lively debate. (Okay, almost every topic we discussed that semester generated lively debate; Duke students aren’t famous for their reticence.)

“Screwed ain’t going to be enough,” one student exclaimed. He went on to add something to the effect of “We’re already screwed. And yet we still can’t balance our budgets, and still haven’t found a way to keep people from being one major illness away from bankruptcy.” Several more minutes of back and forth debate ensued. The topic: whether the U.S. healthcare system was already screwed or was on the verge of being screwed.

And then another consensus formed: people agreed that we were already in deep trouble and that our political parties still hadn’t found a way to work together, nor had special interest groups ceased their lobbying for their interests over the good of the public. The room became downcast.

Then another student came to the rescue, with, I guess you could say, a glimmer of hope: “We will fix the problem, we will.  We just need to be super screwed!”

And that, my friends, is not only a promising title for my next book, but is also the way our semester ended.  With the awful hope that our healthcare system would become just enough worse to force us to fix it, hopefully before the damage to our nation becomes irreversible.

Shortly afterwards, my 50 or so students filed out of the classroom. Once again, their post-adolescent minds could return to the kind of, um, screwing that qualifies as super.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

ADVERTISEMENT

Prev

What is your doctor worth per hour in the open market?

October 3, 2012 Kevin 5
…
Next

Can the airline industry teach customer service lessons to medicine?

October 3, 2012 Kevin 4
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
What is your doctor worth per hour in the open market?
Next Post >
Can the airline industry teach customer service lessons to medicine?

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Policy

  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Health equity in Inland Southern California requires urgent action

    Vishruth Nagam
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The high cost of gender inequity in medicine

      Kolleen Dougherty, MD | Physician
    • Mpox isn’t over: A silent epidemic is growing

      Melvin Sanicas, MD | Conditions
    • How your family system secretly shapes your health

      Su Yeong Kim, PhD | Conditions
    • Women physicians: How can they survive and thrive in academic medicine?

      Elina Maymind, MD | Physician
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The high cost of gender inequity in medicine

      Kolleen Dougherty, MD | Physician
    • Mpox isn’t over: A silent epidemic is growing

      Melvin Sanicas, MD | Conditions
    • How your family system secretly shapes your health

      Su Yeong Kim, PhD | Conditions
    • Women physicians: How can they survive and thrive in academic medicine?

      Elina Maymind, MD | Physician
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

To fix health care, we need to be screwed
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...