Articles

Published July 2025

Change Is Inevitable
By Dave Jakielo

I have spent my entire professional career in the medical arena, including working as the Director of Patient Finance in a local hospital, managing a large university anesthesia practice, followed by a multi-specialty group, helping to establish and grow Business Process Outsourcing (BPO) companies, buying, assimilating, and running medical billing companies, and consulting with a plethora of medical billing companies for many decades.

I appreciate that these opportunities have allowed me to enjoy a comfortable living and lifestyle. However, the healthcare system in our country is so dysfunctional that it cannot sustain itself and radical change will have to occur if it hopes to remain operational.

Why Is It Unsustainable?

1. High Costs

• The United States spends significantly more on healthcare per capita than any other wealthy nation. Even so, it does not consistently achieve better health outcomes. In 2023, our healthcare spending reached $4.9 trillion, or $14,570 per person, representing 17.6% of the nation's Gross Domestic Product (GDP). The 2023 growth rate of 7.5% was the highest since 2003, excluding the pandemic year of 2020. This trend of healthcare costs outpacing economic growth is a major driver of unsustainability.
• Prices for things like prescription drugs, procedures, and hospital stays are significantly higher than in other countries.

2. Administrative Overhead

• About 25-30% of healthcare spending goes to administration, not patient care.
• The multi-payor system with numerous private, public insurance plans, and middlemen creates massive administrative overhead. The United States spends far more per person on administrative costs, compared to other developed countries. This complexity also leads to inefficiencies in billing, prior authorizations, and other processes.
• According to Becker's, in 2024 the CEOs of the top six insurers received a total of over $125 million in total compensation, the equivalent of average earned income for 1,959 workers in 2024.

3. Unequal Access

• Millions of Americans remain uninsured, or underinsured, leading to financial hardship, delayed or forgone care, and poorer health outcomes.
• This also contributes to the overall inefficiencies of the system as preventable conditions can lead to more expensive emergency care.
• Access depends heavily on employment status or income, which can make people vulnerable during economic downturns.

4. Poor Health Outcomes

• The U.S. has relatively high rates of infant mortality, chronic disease, and lower life expectancy compared to peer countries, despite higher spending.
• The healthcare system often provides incentives for treating illnesses rather than investing in preventive care and public health initiatives which would reduce long-term healthcare costs and improve overall population health.

5. Profit-Driven System

• Many hospitals, pharmaceutical companies, and insurers are for-profit which can lead to decisions that favor shareholders over patients.

6. Chronic Disease Burden

• A large share of healthcare spending goes to preventable chronic conditions like diabetes, heart disease, and obesity.

What Can Be Done?

1. Universal Healthcare or Public Option

• Systems like Medicare for All or a public insurance option could reduce administrative costs and improve access.
• Universal coverage could shift the focus from profit to outcomes.
• This would involve a national health insurance program funded by taxes, potentially simplifying administration, and negotiating lower prices, but would represent a significant shift from the current system.

2. Increasing Transparency Price

• Making the costs of medical services and procedures more transparent to patients before they receive care could empower them to make more cost-conscious decisions and, potentially, drive down prices.

3. Drug Price Regulation

• Allowing the government to negotiate prescription drug prices, similar to what happens in many other developed countries, could significantly reduce costs. The Inflation Reduction Act of 2022 took a step in this direction by allowing Medicare to negotiate the prices of some drugs.

4. Value-Based Care

• Moving away from a fee-for-service model, which incentivizes volume and number of services towards value-based care models that reward quality, efficiency, and health outcomes, could help control costs and improve outcomes.

5. Preventive Care & Public Health Investment

• Focus on preventing disease rather than just treating illnesses.
• This includes better access to mental health care, nutrition programs, and health education.

6. Administrative Simplification

• Streamlining billing, reducing paperwork, and standardizing procedures across insurers would cut billions in waste.

7. Expand Telehealth & Innovation

• Technology and telehealth can improve access, especially in rural areas, and lower delivery costs.
• Health outcomes are deeply tied to housing, education, income, and environment. Holistic approaches can reduce long-term costs.
• Investing in primary and preventive care: Strengthening primary care and public health infrastructure can help prevent illnesses and reduce the need for future, more expensive interventions.
• Improving Care Coordination: Better care coordination across different providers and settings can reduce duplication of services and improve patient outcomes.
• Promoting Efficiency and Innovation: Encouraging the adoption of cost-effective technologies and innovative care delivery models can help improve efficiency and lower costs.

It is important to note that there is no single, easy solution to the challenges facing the American healthcare system. Meaningful reform will likely require a combination of different approaches and sustained political will. Current proposals in Congress focus on areas like streamlining prior authorization, reforming Medicare payment models, and extending telehealth flexibility, indicating ongoing efforts to address some of these issues. But will it be enough to lead to permanent improvements?

Dave Jakielo is an International Speaker, Consultant, Executive Coach, and Author, and is president of Seminars & Consulting. Dave is past president of Healthcare Business and Management Association and the National Speakers Association Pittsburgh Chapter. Sign up for his FREE weekly Success Tips at www.Davespeaks.com. Dave can be reached via email Dave@Davespeaks.com; phone 412-921-0976.