Ep 28 – Health Value Consumerism and the American Dream, with Janis Powers

The American Dream is the hallowed ideology that any individual can advance his or her state of being through ambition and hard work. It defines the American psyche. Historian James Truslow Adams wrote, “The American Dream is that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.”

In today’s episode we explore a Dream Plan in health care – one that is based on consumerism accountability for health outcomes. Janis Powers is so intent on improving health care that she’s designed a completely new payment system. Her Dream Plan is to eliminate health insurance, enabling individuals to redirect their financial resources into personal accounts that fund their lifetime health care needs. Her ideas are outlined in her Amazon Bestselling book Health Care: Meet the American Dream. Powers founded the company Longitudinal Health Care to bring the ideas from her book to reality.

Janis hosts her own podcast, The Powers Report, where you can learn more. She argues that the health care system needs a solution that must include affordability for consumers in addition to incentives that appropriately align behaviors, both for care provider as well as consumers

Episode Bookmarks: 

1:43 “The American Dream is that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.”

2:34 Janis Powers’ mission to eliminate health insurance and her Amazon Bestselling book Health Care: Meet the American Dream

4:30 Do bundled payments really improve outcomes?

6:42 “It’s our job not just to critique what people do.  We must also come up with other solutions.”

7:13 Fixing Health Care by “starting from scratch” with a blue sky vision of decentralization and individualized consumerism

7:30 Why do we even need insurance since we have genetic information and predictive analytics?

7:55 “We don’t have health insurance…we have coverage. In designing it that way, we have created a one-size fits all system that creates tons of waste and administration.”

9:55 Disproportionate spending where the top 5% of most expensive patients spend 50% of the healthcare dollars, and the bottom 50% of the people spend 3% of the healthcare dollars!

10:45 The problems with government spending in healthcare (e.g. lack of consumerism, looming Medicare insolvency, rejection of single payer, low Medicaid reimbursement rates)

12:50 Rationing Care – Is this the only way to prevent Medicare insolvency?

13:10 Inappropriate treatment at the end-of-life and patient unwillingness to challenge doctors

14:05 “The goal of the government is to regulate – not manage — health care.”

14:30 Should Medicare patients be allowed to opt-out the federal program and get the capitated rate directly from the government?

15:15 Should the government make Annual Wellness Visits mandatory?

15:55 Does the ACA requiring coverage for preexisting conditions cause a moral hazard?

16:42 Should the Medicaid program be partially funded by states since it poses standardization challenges by creating a different health system in every state?

17:44 9% of the enrollees in Medicaid are elderly (i.e. dual eligible) yet they spend 21% of the dollars. 14% of the enrollees in Medicaid are disabled yet they spend 40% of the dollars.

18:20 Should we separate Medicaid funding for low income families from duals and disabled since patient segment needs are so different?

19:00 Should we revoke the non-profit status for hospitals or restructure the assessment of community benefit so the contribution of economic value can be fully realized?

21:30 Are B2C digital health companies more appropriate than B2B digital health companies (e.g Teledoc, Livongo) in enabling a consumer-driven revolution in healthcare?

26:45 Establishing an individual lifetime healthcare account that leverages genetic profiling and predictive analysis as a replacement payment strategy

31:14 How can we integrate pricing transparency reforms to facilitate a consumer-level understanding of how much they should save for healthcare during their lifetime?

34:45 Why is “spending transparency” is more important than pricing transparency in healthcare from a consumer-consumption perspective?

40:10 How will consumerization in health care work if we have a subset of the population that is relatively unhealthy which cannot and/or will not make the best decisions about their spending?

41:20 Should commoditized, low-dollar, high-value services like primary care be entirely covered by insurance or instead have costs borne by the consumer to ensure full engagement in health outcomes?

44:30 Unnecessary knee replacements as an example of overutilization

46:25 How can a consumerized health market ensure health equity and better serve those who are underserved, underrepresented and who are treated inequitably?

48:10 The role of government in fixing income inequality and education inequality to ensure public health

50:25 Ethical issues of genetic testing in a consumer-driven model when expensive genetic conditions are pre-diagnosed in under-funded populations

53:35 Leveraging innovation to improve health literacy in underserved populations as a strategy to promote equity in outcomes

56:00 The “social accountability problem” in the America and how it affects health care reform

57:20 The tragic normalization of obesity and the tracking of the Millennial generation as the most obese generation ever

1:00:00 “We should be doing things to help us be as healthy as we can be. That is our social accountability to one another.”