Make fundamental changes to your nutritional environment and incorporate even a modest degree of physical activity into your daily routine, as these behavioral shifts can significantly improve health span and reduce long-term healthcare costs related to chronic illness.
Advocate for and support efforts to address societal issues like infant mortality, drug abuse, violence, and chronic illness directly, as these factors significantly drive poor health outcomes and are not primarily solved by insurance or healthcare system changes alone.
To protect yourself from exorbitant ‘sticker prices’ for medical services and supplies, ensure you have health insurance, as it acts as a ‘discount card’ providing access to negotiated group rates that uninsured individuals do not receive.
Shift your perception of healthcare insurance from covering random, infrequent, and unpredictable events to viewing it as a ‘discount card’ for predictable, ongoing health needs, as this reflects its current function in the U.S. system.
Understand that the socialization of healthcare costs through insurance has made American consumers less sensitive to the actual price points of services, drugs, and hospitalizations, which can lead to increased consumption.
If your employer doesn’t offer insurance and you don’t qualify for Medicaid, explore options on the Affordable Care Act (ACA) exchanges, which are designed to provide more affordable group coverage by socializing risk.
During open enrollment, familiarize yourself with different insurance plan types like PPO (Preferred Provider Organization) for open network choice and HMO (Health Maintenance Organization) for narrowed choice with potential cost savings, to make an informed decision.
When selecting health insurance, understand that PPO plans offer more choice but often come at a higher cost, while HMOs restrict choice for theoretical cost savings; decide which priority aligns best with your needs.
Whenever medically appropriate, opt for procedures and care in lower-cost outpatient settings (like ambulatory surgery centers) rather than hospitals, as this can significantly reduce per-unit costs and improve convenience.
Support policies that allow government entities like Medicare to negotiate drug prices, as this could help curb rising pharmaceutical expenditures and align U.S. drug costs more closely with other developed nations.
Advocate for and support the use of large-scale purchasing power by major entities (like Medicare) to negotiate better prices for healthcare services and drugs, as this is a market-based approach that can drive efficiency and innovation.
Be aware that Pharmacy Benefit Managers (PBMs) operate as intermediaries in drug pricing, and their rebate structures can create incentives that may lead to higher drug prices, warranting scrutiny of their practices and advocating for transparency.
Explore and advocate for the responsible implementation of AI and automation in healthcare administration to reduce costs and improve efficiency in areas like claims processing, while ensuring appropriate controls and oversight.
When advocating for or implementing AI in healthcare, ensure robust controls are in place to prevent negative consequences such as over-coding or under-authorization of care, balancing efficiency gains with ethical considerations and patient needs.
Advocate for and support government-led initiatives aimed at improving national health objectives over a 10-year period, as such long-term investments are beyond the scope of individual or employer-funded programs but are crucial for societal health improvement.
Engage in discussions to establish clear national health objectives, as a defined goal is essential for guiding policy, funding, and interventions to effectively address the country’s health challenges.
Support and invest in engineering-based solutions and device therapies (e.g., neurostimulation) for neurocognitive decline and neurological diseases, as these innovations are crucial for managing an aging population’s care needs given the limitations of traditional drug discovery.
Advocate for and develop new models for custodial care that make it easier for families to provide care in the household, and support engineering solutions that enhance cognitive function to increase self-sufficiency for those with dementia, reducing reliance on expensive institutional care.
Recognize that discussions about the economy, inflation, and jobs are inherently discussions about healthcare, as it constitutes almost 20% of the U.S. economy, making it a critical factor in broader economic understanding.
Understand that seemingly unrelated societal issues, such as border policy, have direct implications for healthcare outcomes and costs, highlighting the interconnected nature of macroeconomic and social challenges with health.
Recognize that fundamental issues in the U.S. healthcare system require long-term planning and discussion, as quick fixes are unlikely to succeed, and proactive engagement is needed to avoid future crises.
For seniors seeking more product and benefit choices beyond traditional Medicare, investigate Medicare Advantage plans, which are designed to offer additional options and potentially better benefits.
Explore integrated care models like Kaiser Permanente, where you agree to stay within their network of providers and facilities, which aims to offer lower costs or better outcomes through care integration.
If cost control is a priority, consider managed care programs (like HMOs) offered by insurance companies, as they have demonstrated an ability to manage costs, albeit sometimes with trade-offs in choice and flexibility.
If considering managed care, be aware that for esoteric or rare medical problems, physicians typically have the ability to refer patients to out-of-network specialists, ensuring access to appropriate expertise.
Be aware that the ‘charge’ on a medical bill (e.g., $16 for gauze) is an artificial construct and does not reflect the actual cost or the negotiated price paid by insurers, which is typically much lower due to group discounts.
If considering GLP-1 agonists, especially for elderly individuals, be mindful of the potential for muscle loss, which can have significant health consequences like increased risk of hip fractures and mortality.
As a prescribing physician, acknowledge the lack of transparency regarding drug costs and consider advocating for or seeking information that would allow for more cost-conscious prescribing decisions.
Recognize the electronic medical record (EMR) as a foundational system of record, and focus on leveraging it with AI to build systems of engagement, improve clinical care, and enhance evidence-based medicine, rather than expecting EMRs alone to transform quality, access, or choice.
While acknowledging short-term hype, maintain a long-term optimistic perspective on the potential of AI to significantly improve clinical care and not just administrative costs in healthcare.
Acknowledge that while healthcare may be overregulated in some areas, government-mandated quality and safety standards (e.g., for sepsis care) have significantly improved the consistency and performance of the U.S. healthcare system.
Understand that the U.S. healthcare system relies on cross-subsidies, where healthy individuals and employer-sponsored insurance (paying higher rates) effectively subsidize care for the ill and those covered by government programs like Medicare and Medicaid.
When comparing healthcare systems, recognize that nationalized models often involve longer wait times and reduced choice for elective procedures, but generally maintain high quality for emergency and specialized care.
Recognize that industries operating in wide-parameter free markets, like pharmaceuticals, face a choice: proactively adjust practices (e.g., drug pricing) to stay within acceptable societal parameters or risk external intervention and regulation.
Anticipate that rising healthcare costs, particularly for new drugs, may force a re-evaluation of what services and treatments insurance models can cover, potentially leading to difficult decisions about coverage limits.
Understand that families in the U.S. bear a significant burden of long-term care for the elderly, which, while culturally positive, also represents lost wages and productivity in the economy.
From an economic perspective, consider prioritizing the application of GLP-1 drugs for working-age individuals to improve health status and economic productivity, rather than solely focusing on those over 65 where the long-term cost-benefit is less clear.
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