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Is The US Healthcare System Collapsing? · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Wars, floods, drought, airline, and f a chaos.
• 0:04
  David: We've grown used to these in other apocalyptic stories, sweeping the country and the globe.
• 0:09
  David: But it's an ideas piece in Time Magazine called The Coming Collapse of the US Healthcare System that has everyone in healthcare a buzz right now.
• 0:17
  David: Welcome to Care Talk, America's Home for incisive debate about healthcare, business and policy.
• 0:22
  David: A robust show that's definitely not collapsing.
• 0:25
  David: I'm David Williams, president of Health Business.
• 0:28
  John: And I'm John Driscoll, the president of Walgreen, south David, what is all the, the hubub about?
• 0:34
  John: Are we really at the point?
• 0:36
  John: I mean, uh, the, you know, look there, there, there's floods in California.
• 0:40
  John: There are planes that are grounded, but our healthcare system's continuing to perform.
• 0:45
  John: What's all the
• 0:46
  David: buzz about?
• 0:47
  David: I'll tell you, John.
• 0:48
  David: Well, here's what the article says.
• 0:49
  David: Cause it struck a nerve, so it paints a picture of.
• 0:51
  David: There's always good articles, a good story if someone has a heart attack at
• 0:54
  4: 00 AM they're transported 45 minutes past two hospitals that had closed down.
• 0:59
  4: When they get there, it's overcrowding.
• 1:01
  4: There's no ICU beds.
• 1:02
  4: The cardiac unit is browned out cuz they have a lack of staff.
• 1:05
  4: So it's, that's kind of the portrait that it paints and like, oh my god, this is happening, uh, everywhere.
• 1:10
  4: And they talk about root causes being basically staffing and what happens during the pandemic and, and so on.
• 1:15
  4: So that's, That's the kind of thing, and they say, why isn't this a major news story now?
• 1:20
  4: It is.
• 1:21
  John: Well, David, David, are you, are, are you afraid of getting care in, in, in, in the people's Republic of Massachusetts?
• 1:28
  David: John, I've always been, uh, I've never wanted to go to the hospital.
• 1:30
  David: I think going to the hospital is, is a sign of failure, you know, uh, by itself.
• 1:34
  David: So, um, Yeah, I'm always concerned about going in the, the idea about hospitals being dangerous, sort of predates the, uh, predates the pandemic, the, the thing that they say or about the root causes being the staff not feeling valued.
• 1:47
  David: Uh, they talk about the nurses striking that strike, I think, has just been, uh, been settled.
• 1:52
  David: They talk about, uh, travel nurses shutting down the services, big weights for everything burnout going on, you know?
• 1:59
  David: Yeah, it's true, but I don't think the system is actually, uh, collapsed.
• 2:03
  David: But no, I'm in no hurry to go to a hospital.
• 2:05
  John: But I, but I, but I do think that it raises, I mean, maybe in an apocalyptic kind of, the world is on fire, hair on fire kind of way.
• 2:15
  John: It, it, there are some issues embedded in there that are important.
• 2:18
  John: I mean, the, the fact that, you know, a third of all nurses, uh, you know, if you ask them whether they could, if they could retire, would they retire today?
• 2:26
  John: Would.
• 2:27
  John: The fact that the, you know, the, the, we have so many more people turning 65, 10,000 people turning 65 every day.
• 2:37
  John: And you know, if you, you roll the, the tape forward, we probably don't have enough doctors and nurses.
• 2:43
  John: It's, the issues may not be apocalyptic or critical today, but certainly there is a supply demand dynamic that I'm worried about in terms of doc and nurse supply.
• 2:53
  John: And if you look.
• 2:55
  John: The UK right now.
• 2:57
  John: It is at the point of collapse.
• 2:59
  John: Yeah.
• 2:59
  John: Yeah.
• 2:59
  John: You know, people are, you know, elective surgeries like a year out in the UK and two years out in Ireland.
• 3:06
  John: Um, there are.
• 3:08
  John: Rolling strikes in, in, in the, at the NHS level.
• 3:13
  John: I mean, if you don't deal with this supply demand dynamic where people's needs versus the system's ability to provide for it early, you know, you can't just add doctors and nurses on demand.
• 3:25
  John: You have to train them.
• 3:27
  John: You have to create those educational alternatives.
• 3:31
  John: You gotta give them the opportunity to train in the field to support the demand that's coming.
• 3:35
  John: So I, although it's, it's a little bit over the top, I do think it raises some issues that we ought to, as a country start to think about dealing with.
• 3:43
  John: for sure.
• 3:43
  David: John.
• 3:44
  David: You know, I think the point here is that when the costs are totally outta control, right?
• 3:47
  David: This isn't like, okay, we cut cost 20%, now we have these problems.
• 3:51
  David: No cost is basically unconstrained, continuing to rise and erode all the other possible things that we could be spending money on.
• 3:57
  David: And we still have the problem.
• 3:58
  David: That to me is the, is the real crisis.
• 4:01
  David: There's some things that they say in there that are just not correct though.
• 4:04
  David: So one of the things is they, they say, well, you know, the nurses are upset because they have to have a vaccine.
• 4:10
  David: And they don't have autonomy, so they're not being respected.
• 4:12
  David: There may be, there are certainly some people that think that way.
• 4:15
  David: On the other hand, I think one of the causes of burnout was that while the healthcare providers were, were taking all sorts of precautions working around the clock, peop they're seeing people that would come in because they hadn't been vaccinated.
• 4:27
  David: because they didn't wear masks.
• 4:28
  David: And then they're saying, well, gee, we're going to all this trouble.
• 4:30
  David: And look, people aren't taking things seriously.
• 4:33
  David: There's other things that are incorrect in the article.
• 4:35
  David: So they talk about how, you know, nobody wants to go into uh, medicine anymore.
• 4:39
  David: And that's just not the case.
• 4:40
  David: In fact, the sub case at all, no.
• 4:43
  David: There's been a huge increase in 18% increase in medical school applications.
• 4:46
  David: Uh, it's actually the increase is led.
• 4:48
  David: Historically underrepresented minorities and there's a 25% increase in nursing school applications since the start of the,
• 4:54
  John: and, and we could, and we could probably fill the, a, the average, you know, we could probably double the size of the number of, of, of medical school students with qualified applicants if we increase the number of slots
• 5:08
  David: for sure.
• 5:09
  David: John.
• 5:09
  David: So I think that's, uh, you know, that's, that's absolutely right.
• 5:11
  David: So there's enough people that are interested.
• 5:13
  David: Now there are problems like medical schools, very.
• 5:16
  David: Uh, you know, that's an issue even on the first thing, the way they start about going past two hospitals that had closed, first of all, uh, there's about 20 hospitals that close, uh, per year over the last several years.
• 5:26
  David: So if you went by two of them, that means you went by 10% across the whole, uh, the whole country.
• 5:31
  David: Hospitals also, you know, when you get to a hospital, that's a failure.
• 5:34
  David: So you don't, you don't actually wanna get to that, uh, to that point anyway.
• 5:37
  David: It shouldn't be such a hospital centric.
• 5:39
  David: Uh, acentric system.
• 5:41
  David: You really don't
• 5:42
  John: like the authors of this story.
• 5:44
  John: You think they're just bloviating Basically
• 5:47
  David: they're professors and they don't cite any statistics or any sources at all.
• 5:50
  David: And I don't know if where the Time Magazine just cut 'em out.
• 5:52
  David: It's cuz the facts actually go against what they're saying.
• 5:55
  David: Even if they have some points.
• 5:57
  David: And in fact, one of the things that you could prescribe is to have, uh, less of certain, uh, you know, uh, news channels,
• 6:04
  John: professors, you're basically your anti profess.
• 6:09
  David: I hate the, yeah, that's it, John.
• 6:10
  David: I'm an anti, uh, anti-intellectual in that way, you know, but John, but I, but I think,
• 6:14
  John: but, but yeah.
• 6:15
  John: How about immigration?
• 6:17
  David: Uh, it serves to reason that, you know, one of the, one of the causes of, uh, of shortage, not necessarily of physicians, nurses, but more broadly about in the US healthcare economy, including, uh, home aids and, and others, is yeah, a number of immigrants has been, uh, reduced because we have policies that don't make sense.
• 6:36
  David: So, yeah, more immigration would help.
• 6:39
  David: ?
• 6:39
  David: John: No.
• 6:40
  David: I mean, there's, there's no question.
• 6:41
  David: If you, if you look at the qualified folks who wanna serve as nurses and doctors, there's, there's thousands and thousands of them.
• 6:49
  David: I think it's like 10,000 stuck in the immigration system that basically since the nineties we've cut the number of, of le legal immigrants by more than half.
• 7:00
  David: I mean, it is a.
• 7:02
  David: You know, your ability to grow the economy, um, one of the inputs is how many people, how many employees you have, and we're reducing the number of employees and even, even more critical, we're reducing access to some well qualified nurses and doctors from abroad.
• 7:18
  David: It just doesn't make any sense.
• 7:19
  David: So I, but I think there is some merit, David, we forget the apocalyptic approach to the, the, the healthcare systems is collapsing.
• 7:30
  David: We do.
• 7:32
  David: If you combine the growing labor shortage, um, the fact that in rural areas you actually do have a challenge keeping hospitals open.
• 7:42
  David: Sure.
• 7:42
  David: I do think that there are, there are, you know, there are, in with an aging population, you're gonna have more needs, you're gonna need more doctors, you're gonna need more tertiary support.
• 7:51
  David: I don't think it is.
• 7:52
  David: Completely unfounded.
• 7:54
  David: Although again, the meandering, apocalyptic wine of the, of, of the professors that you, so in you, you, you, you, you so enjoy.
• 8:03
  David: You know, I, I, I get again, is, is, is irksome.
• 8:06
  David: I mean, the notion that somehow that you, you, you, you'd say, well, the people aren't respected because they, they, they don't, they don't choose to actually get a vaccine at the same time.
• 8:17
  David: I mean, the whole thing is just sort of Yeah.
• 8:18
  David: Seems it's like a so silly.
• 8:20
  David: John.
• 8:20
  David: It's like a random walk to the apocalypse.
• 8:22
  David: You know, the article talks about how, you know, nurses aren't well paid and not well taken care of, and then it talks about travel nurses making three or four times.
• 8:28
  David: Uh, what other nurses are making it talks about locum tens, uh, physicians.
• 8:32
  David: Well, to me it also seems yeah, there's a lot of labor market flexibility.
• 8:35
  David: So they are well paid because you can go and, and if you wanna make money, you can go that.
• 8:39
  David: Well.
• 8:39
  John: Again, it's per, you know, you and your, your Latin phrases aside.
• 8:43
  John: Locum 10, yourself, Mr.
• 8:45
  John: I.
• 8:47
  John: I, I think, I think, I think that what you ought to think, what, what the, the point that they're making is that when there's a labor shortage, you end up overpaying for the, the people, the doctors and nurses on demand that you have to do to fill those jobs.
• 9:05
  John: And it, and it does create a, you know, a, a a sort of a painful comparison when you're working on a ward late at night with really difficult.
• 9:17
  John: At a third, the wages of the person next to you who's only gonna be there for a month or two, that, that, that, that is, sure.
• 9:25
  John: You may not, you may not understand what I SSON means, but you would, if you were in that situation.
• 9:29
  David: Is that, I, I, I, I, it doesn't sound Latin.
• 9:31
  David: I don't think they have that K but John, there's a few things that are, that are there besides, you know, immediate, you know, an immediate case.
• 9:36
  David: Yeah.
• 9:36
  David: They can't open a bed because they don't have a doctor or nurse there.
• 9:39
  David: So I think there's a few things that are needed.
• 9:41
  David: One is to.
• 9:42
  David: Uh, you know, tools that can support people so that they're not spending 30% of their time, you know, typing stuff into a computer.
• 9:50
  David: You can have ai.
• 9:52
  David: That means that you can get to diagnosis faster.
• 9:55
  David: and you can have, uh, you know, better other technologies, like better use of the right pharmaceuticals.
• 9:59
  David: So people are, are not, uh, you know, ending up in the, in the hospital in, in the first place.
• 10:04
  David: So, and the hospitals haven't necessarily managed things, you know, that well, uh, on their own.
• 10:09
  David: They don't have the greatest management practices, and that's, that's another source of, uh, of trouble.
• 10:14
  David: And
• 10:14
  John: there's also, but none of this, but none of this ties to the end of the world.
• 10:19
  John: The, the time, time magazine.
• 10:22
  John: I mean, what are they trying to do here, David?
• 10:24
  John: I mean, it just seems like, are they just trying to grab a headline?
• 10:29
  David: I would assume that is their business . Um, so he, you know, but, but John, the other part, I think from a structural standpoint, and I got lost and was trying to remember how to say it in Enlight, but was the, the fact that the hospitals relied so much on procedures, so the apocalypse is the, that they were not able to do.
• 10:47
  David: Knee replacements, for example, or other sorts of orthopedic, uh, specialties and other procedures that actually make a lot of money for them.
• 10:56
  David: That's what's caused the problem.
• 10:57
  David: Uh, and the staffing is part of it, but that's not, that is not the main issue.
• 11:01
  John: You're just anti hospital, David.
• 11:04
  John: Okay, come on.
• 11:05
  John: We need hospitals.
• 11:06
  John: If it was your knee that needed to be replaced, you would be less, you wouldn't call it elective, you'd call it necessary and mandatory, I mean, Come on, dude.
• 11:15
  John: We, we, we need, we need hospitals.
• 11:17
  John: We, we can't like, be without them.
• 11:19
  John: I mean, sure, yes, they're dangerous.
• 11:21
  John: Um, but I, but I, I think there's a genuine emerging labor crisis that we gotta deal with.
• 11:27
  David: All right.
• 11:28
  David: So we'll do it John.
• 11:28
  David: We'll have immigration.
• 11:30
  David: We'll have, yep.
• 11:31
  David: Check better, better IT tools and other sorts of tools that,
• 11:35
  John: oh, now you're in favor of technology because maybe it'll help you avoid the hospital.
• 11:41
  David: I was listening to the, uh, our, you know, brilliant podcast on, uh, artificial intelligence in healthcare, and I thought, Hey, here's a use for it, uh, right here.
• 11:50
  David: Um, so yeah, and I think, you know, fewer pandemics would be great, John, and maybe that could be, uh, brought down to, uh, you know, reduc.
• 11:59
  David: Climate change, uh, keeping the world a little cooler so the new viruses don't emerge, uh, et cetera, you know?
• 12:04
  David: So why don't we do that?
• 12:05
  John: You poll, you Pollyannish pr, pr prognosticator
• 12:10
  David: you.
• 12:11
  David: Yeah.
• 12:12
  David: Well, I don't know, John.
• 12:13
  David: I think that the, uh, that it's raised some important issues is clearly, you know, struck a nerve.
• 12:18
  David: I would say that one of the things, if you wanna focus on that supply, . Let's, let's not, you know, let's actually enable people to go to nursing school or medical school if they're interested in it.
• 12:27
  David: And let's make it that, that the career is something that's sustainable, including non and, and you
• 12:32
  John: don't, and you don't have to borrow the equivalent of a Of a, of a, of a, of a condo in value.
• 12:38
  John: Yeah.
• 12:38
  John: In order to actually.
• 12:39
  John: Get an education to care for people.
• 12:42
  John: It's sort of nuts.
• 12:43
  John: But David, it didn't just strike a nerve.
• 12:45
  John: It found a nerve and dug it out.
• 12:47
  John: I mean, this, this whole, this, the, the article was sort of dopey in, in, in, in, it, in, its in, its, uh, in, its in, its sort of screed about the collapse of the system.
• 12:57
  John: There is a collapse of a healthcare system.
• 12:59
  John: It's in the nhs in the uk.
• 13:01
  John: It's not, it's not in the us so let's invest in those doctors and nurses.
• 13:06
  John: And that capacity to, to educate and train and support those doctors and nurses and invest in a way that, that, that doesn't bankrupt them early on in their career so that we can keep them, um, caring for, for, for folks like, You as you age.
• 13:21
  John: Dave, you're looking kind of old in the picture right
• 13:23
  David: now.
• 13:24
  David: Thank you, John.
• 13:24
  David: I, I appreciate it.
• 13:25
  David: So I think that's a good place to, uh, at least my hair's not on fire as they were, as you were saying before I say, John, that's it for yet another episode of Care Talk.
• 13:33
  David: I can sleep better tonight knowing that the apocalypse is not coming until sometime down the road, maybe next week or the, or the week after.
• 13:40
  David: I'm David Williams, president of Health Business Group,
• 13:43
  John: and I'm John Driscoll, the president of Walgreens South.
• 13:45
  John: If you like what you heard and you didn't, please subscribe on your favorite service.