The American Dream in Health Care: Finding Our Way — in conversation with Peter Waziri
Research tells us that the U.S. spends more on health care than any other high-income country but has the worst outcomes — including the lowest life expectancy. What’s driving this discrepancy?
We’re in conversation with Peter Waziri, a financial strategist with a global perspective who is also a keen observer of health care systems worldwide,
Peter, although the U.S. is among the wealthiest nations in the world, health care outcomes compared with our peers are often inferior. Why are we struggling?
Other rich countries achieve these numbers with a heavy dose of government spending along with relatively high taxes. Our health system delivers superior care compared to other developed countries but mostly for those who can afford it. This has prompted some to call for greater government intervention. But the U.S. was founded on the concepts of freedom, individualism, and “exceptionalism” — the belief that we are special or different than other nations. This self-concept often keeps us from doing what many other countries are doing. For example, we could make more effective use of private-public partnership strategies to develop a robust combination of the current system and reforms that will offer health coverage for those unable to afford it.
But our history shows that wide-sweeping government intervention typically follows major cataclysmic events. For example, the Great Depression in the ’30s where approximately one in four Americans were out of work led to the New Deal. Historically, no such single event has jarred the health care industry at such magnitude to usher in a similar level of government intervention. Instead, government intervention has typically occurred through broad consensus (e.g., Medicare). This is precisely why the most recent notable government health care initiative, the Affordable Care Act, remains heavily controversial. Until we reach broad consensus, we will continue to remain at the bottom of the league in health outcomes compared with other wealthy countries.
Is the concept of the American Dream still achievable — in our culture overall, and in health care in particular?
The idea of the American Dream didn’t really take hold until after the end of World War II. The GI Bill among other factors enabled returning veterans to become homeowners, which ushered in the housing boom and the perfect family life — in short, upward mobility! This period of steady and sustained economic growth enabled the concept of the American Dream to be woven into the psyche of the American culture.
American economic dominance was sustained because other countries were either destroyed by war (Japan and Germany) or financially broke (Great Britain). Now we have greater economic competition from other countries at a time when world economies have become more integrated through trade and with greater emphasis on services and information technology. And when you add the exponential sophistication of financial services, you have a world that is vastly different from the one that enabled the American Dream to thrive. Upward mobility is increasingly difficult to achieve for many Americans.
For health care, to find some semblance of the American Dream, we have to retain the best part of the current system and then improve on it. First, we need to have greater investment in public health through private-public partnerships with the goal of making health care affordable. Affordability by itself also needs to be clearly defined from the American perspective without losing sight of the virtues, ideals, and practices that have made America the greatest county in the world. If anything, the pandemic has brought this imperative to the forefront.
Second, we need to have a system where we can put the patient or the member at the center of the equation to improve care quality and begin to reduce health care costs. Only when we do that will we have a greater impact on the health care outcomes for those who currently have access to care and those who’ve been left behind in our current system.
Thank you, Peter, for your thoughtful observations.
A financial and health care leader with a global perspective, Peter Waziri has deep experience across several industries. He currently provides financial leadership for Parkland Community Health Plan’s operational and clinical management functions. Previous positions include CFO at Umpqua Health and also at Cascade Comprehensive Care, along with management positions at GE Capital, Ernst & Young, PNC, KeyCorp, and the Institute of European Finance in Great Britain.
