I attended the Yale New Haven Healthcare System annual board of trustee’s retreat last week. Yale New Haven Healthcare System is the largest hospital system in Connecticut with 20,000 employees, $4 billion in revenue, 6,300 physicians, over 109,000 inpatient discharges and 1.8 million outpatient visits. Like all healthcare systems, the debate in Washington on the next iteration of national healthcare policy is having a profound effect on everything hospitals do.
When I was a “practicing” healthcare economist, I was grounded in the principle that there are three dimensions of healthcare goals: access, quality and affordability. Healthcare economists knew then that a national healthcare system could achieve any two of these goals. So, we can have high quality care and control costs, but it would be at the expense of having less access to care. Or we could control costs and have great access, but quality would suffer. Or we could have great quality and great access, but it would very expensive. I learned from a briefing from a hospital lobbyist attending the meeting that these continue to be the choices we are faced with today. It is in this light that I look at the healthcare debate today.
The Obama administration choose to increase access and maintain quality. The downside of this choice is that it is very expensive, and somebody has to pay. The Republicans choose to maintain quality and control healthcare cost, at the expense of reduced access. The latest Congressional Budget Office estimate of the impact of the House bill passed two weeks ago, was that it would result in 23 million Americans losing their health insurance. There is no question, despite the denials, the House bill will reduce access.
Political winds are subject to change, but for now, the dominant political view is that access to care, particularly for the poor and the chronically ill will be reduced. I believe this effort will continue to meet strong resistance from advocates like myself and others. However, the dilemma of the three choices will not go away; or could they?
Economic disruption in any industry takes place when long held beliefs about the way the world works, and will always work, are shattered. The healthcare industry is ripe for economic disruption. And like most cases of economic disruption, it will most likely not come from within the industry. Some genius entrepreneur will figure out a way for consumers to access high quality care that will extend their life and increase the quality of their life at a fraction of the cost we now experience. It might be a new drug, but I suspect it will be something else.
Minority entrepreneurs are well poised to be the disrupters in healthcare. I say this because minorities currently suffer more from lack of access, lower quality care, and poorer health status than most Americans. Minorities suffer more in cases of diabetes, cancer, heart disease, hypertension, HIV, obesity and other major measures of health status. The motivation to heal members of our families is at least as strong as the motivation to generate entrepreneurial and monopolistic wealth.
Short of disruption, there are so many opportunities to solve real problems that bright minority entrepreneurs should spend some time looking at the unique problems effecting this industry. Healthcare represents almost 18 percent of the U.S. economy and is likely to grow in coming years, regardless of what Congress does. So now is a good time for minority entrepreneurs to think about these problems and these opportunities. You might be the disrupter that the doctor ordered.
In your service,