10 ways to save American healthcare!

Okay, nothing is going to save American healthcare. But maybe these will help.

First things first: One week to Father’s Day. I’ll have more to say about THE FATHERHOOD MANIFESTO soon. Your emails have been very supportive, and the great reviews keep pouring in on Amazon.

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American medicine is a $5 trillion mess that eats anyone who tries to fix it (the knives are now out for Robert F. Kennedy Jr.).

But our healthcare doesn’t have to be this bad. I woke up thinking of 10 ways to improve it. (Yes, this is actually what I woke up this Sunday morning thinking about. I know, I need more hobbies.)

The first two are probably the most popular politically — and the least likely ever to go anywhere. But even the simplest of these would face huge political and economic obstacles. Still, that doesn’t mean we shouldn’t try for them.

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So, without further ado, here are 10 changes I’d make to the healthcare leviathan if I were in charge:

1: Break up local health care monopolies and oligopolies, particularly the “nonprofit” regional and academic hospital systems that have grown spiderwebs around nearly every metro area. Set strict limits on local concentration, recognizing that nearly all health care is delivered locally.

2: Set windfall salary taxes on executives at those systems. These hospitals pay no taxes. They are supposed to serve the public interest, not their executives. If they want to receive the benefits of ordinary charities, they should run like charities.

3: Move to the Danish vaccine schedule for children. Most importantly, end the recommendation for universal Hepatitis B shots at birth. Vaccinations are not public health theater and shouldn’t be treated that way. If a child isn’t at reasonable risk for contracting an illness she shouldn’t have to be vaccinated against it because other children are.

4: Prevent pharmaceutical companies from profiting from any medicine sold under the Food and Drug Administration’s “accelerated approval” program — that is, without proof of clinical benefit. In general, I think accelerated approval is a mistake. “Surrogate endpoints” like changes in the amount of protein a cell produces may or may not actually help a patient feel better or live longer, the changes that actually matter.

But if we are going to allow accelerated approvals, we have to force drug companies to follow through by producing real data proving those benefits. And pharma companies have shown they will drag their feet as long as they are making money from a drug sold under the accelerated program.

5: Begin a long-term program of funding placebo-controlled clinical trials to determine if common minor surgeries are helpful compared to rehabilitation, rest, and waiting. It’s more than surgery for meniscal tears — many surgeries have much weaker clinical evidence than people realize.

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6: End all gain-of-function research designed to increase viral or bacteria transmissibility or dangerousness. Propose an international agreement making all such research a crime against humanity. Covid proved the risks of such research.

Beyond that, Covid revealed the fatal flaws in the theory (propounded by virologists, of course) that virologists need to run such research to determine the dangers of newly emerging viruses. After all, they didn’t predict Covid, or any of the evolutionary pathways it took. We cannot predict how pathogens will evolve in the wild, only respond to them when they do.

Setting a bright line on this issue is particularly important at a time when artificial intelligence tools may give private and non-state researchers a greater ability to pursue gain-of-function research.

If such research must be conducted at all, it should be run in a handful of government-run labs worldwide — no more than one in any country — that are internationally supervised.

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7: End insurance parity between mental health and physical health conditions (except for psychiatric drug treatments that have randomized controlled trial evidence supporting them). I know this one will be very controversial with many of you.

But we have next to no evidence that mental health care works, and the nebulousness of these conditions allows the creation of expensive honeypots like autism behavioral therapy.

8: At a minimum, sharply cut back on drug addiction rehab coverage, which is incredibly expensive, fails to reduce addiction or relapse when it is tested, and actually encourages unscrupulous operators and companies to recycle addicts through programs to survive. Insurance companies should be required to provide one 30- to 60-day rehab every five years; after that the addict or his family is responsible for covering the cost.

9: Allow insurance companies to create and sell inexpensive, high-deductible health insurance products — true catastrophic insurance. This would return health insurance to its roots and make it more like other insurance products; your home insurance covers serious damage to your house, not fixing a faucet.

10: End medical aid in dying programs. When a patient has days or weeks left with a terminal illness, the difference between pain control and hastening life’s end can be impossible to distinguish. (Even then, physicians should be cautious.) Outside of that boundary, doctors should not be in the euthanasia business. The experience of Canada, Belgium, and other countries shows these programs inevitably metastasize.

If people are too afraid to kill themselves to do so without a doctor’s help to make the process effortless and painless, they probably shouldn’t be killing themselves. And doctors — who are in the business of healing —- should not be helping them.

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(Whew! That was 10! Reward yourself for getting to the end with a subscription.)

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So. At least for today, Those are my Top 10 American Healthcare Fixes (TM).

Looking forward to hearing what you think of them — and your own suggestions.