For episode seven of our podcast, we were joined by Niall Brennan, a nationally recognized expert in healthcare policy who works closely with policymakers, including the U.S. Congress on key issues. He discussed his experiences as the first Chief Data Officer for CMS, his current role as President and CEO of the Health Care Cost Institute, and why the healthcare industrial complex, insurance silos, and consolidation have made U.S. healthcare so unaffordable. Niall also gave his take on the issues of price transparency being pushed as a consumer only issue, and points out the current healthcare buzzwords that aren’t really “moving the needle.”
You can listen to the whole episode here or on Spotify, Apple Podcasts, or wherever else you listen to podcasts. If you’re short on time, we’ve included a few highlights from our conversation below:
Matt: “So one of the things that you’re touching on is a lot of stuff that we’re obviously incredibly interested in. Our core mission is to try to make healthcare easier to understand and easier to afford. What is the answer to why it’s so unaffordable and why it’s so confusing?”
Niall: “It’s a great question. Healthcare in the United States is expensive for a couple of reasons. Reason number one is that healthcare in the United States is a fundamentally private sector enterprise. Okay. Reason number two is that, and it’s not the only reason, but then reason number two is because healthcare in the United States is kind of split into a whole series of silos. Some people have no health insurance coverage. Some people have public health insurance coverage. Some people have bad private health insurance coverage. Some people have great private health insurance coverage. So all those things come together to sort of create a certain amount of inefficiency in the market. Then you have the fact that just about all healthcare providers are private sector in nature.
And they have become progressively more consolidated over time. If you ask most people now…so healthcare spending and healthcare prices have been a problem for a long time in the United States, and we’ve consistently failed to get a handle on it. If you ask people right now, what the biggest problem is, it’s that there used to be 20 hospitals in your town with separate ownership. And then there were 15 and then there were 10, and then there were five large hospital systems. So there’s still 20 hospitals, right, but they’re all kind of owned by a smaller and smaller group of people. When it’s a smaller and smaller group of people who sort of control the supply of healthcare, they can work to basically demand higher prices than they might otherwise get in a competitive market. And that’s just one reason.”
Matt: “Are there any things you think would really make a meaningful difference at making healthcare affordable and improving the quality? What are you supportive of when it comes to health policy?”
Niall: “I’ve been in this business since the mid-nineties and a lot of people way smarter than me have been in this business since long before. And the one constant is steadily increasing prices, even setting quality aside. We know that quality and outcomes in the United States is not where it should be in general. And definitely not where it should be for the amount of money that we spend on healthcare. I think that the healthcare industrial complex loves acronyms and buzzwords, like value-based care, and ACOs, and bundle payments, and different things like that. Very few of them have been shown to meaningfully impact the cost curve in any way. Maybe quality’s getting a little better. Literally every evaluation from the Center for Medicare and Medicaid innovation, which was included as part of the Affordable Care Act and had an explicit mandate to test different payment approaches over the last 10 years, just about every single evaluation has found that while these demonstrations may be like generically pretty good they’re barely moving the needle in terms of costs.
I really think that if we’re serious about addressing healthcare costs in the United States, there’s got to be some form of price regulation. I realize that’s probably not a popular view in some quarters, but if you just look at the fact that there are many providers who are charging 200, 300, 400, 500, 600% of Medicare to their clients who have employer-sponsored insurance something just seems dramatically out of whack for me. And so I think the problem is every dollar of reduced spending is a dollar of reduced income for somebody else in the healthcare industry. And the healthcare industry is just working out just fine for a lot of people. There are a lot of people making a lot of money off the healthcare system right now, and even beyond sort of those people, healthcare is almost becoming a little too big to fail or too big to shrink.”
This is just the tip of the iceberg of the many eyebrow-raising points Niall offered; if you want to hear them all make sure to listen to the full podcast here. You can also hear more from Niall by following him on Twitter and checking out The Health Care Cost Institute website.
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Dr. Bryan Vartabedian, a physician leader, joined us on this podcast episode to discuss technology.