JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
JAMA Forum
April 23, 2020

After COVID-19—Thinking Differently About Running the Health Care System

Author Affiliations
  • 1Brookings Institution, Washington, DC
JAMA Health Forum. 2020;1(4):e200478. doi:10.1001/jamahealthforum.2020.0478

Wars and other national crises force society to act differently for awhile. But in doing so, they highlight organizational actions and innovations that should not end with the crisis and should be allowed to play a greater role in the future. The coronavirus disease 2019 (COVID-19) pandemic has similar features, and it should spur policy makers who shape the US health care system, to—as Apple Computer cofounder Steve Jobs often urged—“think different.”

The US response to the COVID-19 pandemic highlights several strategies that should be emphasized more in the management of the health care system. These strategies include using waivers to boost federalism, reconsidering the role of hospitals and other institutions as hubs for care, expanding the use of telehealth, and bringing together funds from multiple programs to improve the delivery of health care and health-related services.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    5 Comments for this article
    Paradigm Paralysis
    Paul Nelson, M.S., M.D. | Family Health Care, P.C. ,Retired
    Any strategy to achieve a paradigm shift for our nation's population health and its healthcare will likely encounter deeply entrenched traditions which will require as yet undiscovered levels of knowledge, resources, and human dignity to change (the ACA 2010 attempt to improve financial accessibility to healthcare for all citizens, eg). And yet, healthcare continues to be the number one cause of individual bankruptcy.

    Our nation's total annual health spending has continued to increase faster than economic growth. The portion of our nation's GDP devoted to health spending was 5.0% in 1960. For 2019, it
    was 18.0%. The current strategy to "fine-tune" our nation's healthcare reimbursement systems demonstrates absolutely no progress for persistently reducing its annual increase. Remember that the other OECD nations devote less than 13.0% of their economies to health spending. The difference between 18% and 13% of our GDP in 2019 was $1.008 trillion. This excess would represent the cost of fighting 10 Afghanistan/Iraqi wars simultaneously in 2005. In sum, we really have no reliably understandable plan to solve our nation's excess health spending other than coercive, autocratic, and centralized rationing. (Altarum 2020)

    As for population health, we have no carefully conceived and broadly supported understanding for the annual worsening of the following list of health problems: maternal mortality, childhood maltreatment, childhood obesity, adolescent homicide/suicide, substance abuse/suicide, homelessness, mass shootings, mid-life depression/disability, and senile dementia. Since it affects 50% of our nation's citizens, everyone should understand that maternal mortality has worsened annually for 50 years. As compared to the other OECD nation's with the lowest maternal mortality incidence, we would need to reduce ours by 70% to rank among the 10 OECD nations with the lowest maternal mortality. Using birth rates of 4 million live-births annually, this means that nearly 700 women die in the United States annually with a pregnancy solely because they lived in the wrong nation at the time of conception.

    The social adversities that linger unattended in most communities have evolved over many years. There is no current strategy to systematically invigorate the levels of social capital and social cohesion within every community, state by state as the best strategies for their prevention. And there is no associated process to identify and foster the local search for the collaborative mobilization of local assets to prevent, mitigate, and ameliorate the current deficiencies in the local safety net to improve the social mobility disparities and reduce social isolation. This local mobilization should be responsible for assuring that primary healthcare is equitably available to each resident person, a community Master Disaster Mitigation Plan is annually upgraded, and discontinuities within safety net resources are recognized and a collaborative-solution process organized.

    Altarum Center For Value In Health Care. 2020. HEALTH SECTOR ECONOMIC INDICATORS-March 13,2020 Health Spending https://altarum.org/sites/default/files/uploaded-publication-files/SHSS-Spending-Brief_March_2020.pdf
    Healthcare Insurers are Missing in Action During Covid
    Michael Young |
    What would we have done about Covid if the federal and state governments didn’t lead? It would have been a total disaster. Instead we are now thinking how to fix things. What about the role of the insurers? Most are hiding out hoping their lack of participation isn’t noticed. Can anyone tell me why profits in providing healthcare insurance are justified? What is the role of insurers - enforcing PAs, denying coverage- what about PPE provisions focus instead of insurers creating more coding?

    My goodness isn’t it obvious they there is no role for private insurers in medicine? If
    not now when will we fix this?
    Thinking Differently Need Not Be Complicated
    George Bohmfalk, MD, DABNS | Health Care Justice North Carolina, the Charlotte NC chapter of PNHP
    Why braid and blend? Why create special intermediary bodies to cut through red tape and foster joint planning? One giant step to Medicare for All would get us there. Hospitals would immediately reduce their expenses by around 25% by eliminating their leviathan billing and insurance departments. Assured of regular payments through global budgeting, they would not fear the bankruptcy and closure that threaten so many in the pandemic. We would not be scrambling around to determine who might pay for what. Monetary and equipment resources could be efficiently redistributed where needed most during challenges like this. We would begin to address health social inequities. We would finally control healthcare costs. Very simply, the Health Care System after Covid-19 should be run as an expanded and improved Medicare, for all.
    MCRA Smoother and More Effective than Medicare For All
    John R. Dykers, Jr., MD | Chatham Hospital, Siler City,NC, USA
    The Medical Care Restoration Act (MCRA) is both voluntary and universal, returns the non-monetary rewards to the practice of medicine and surgery and largely eliminates defensive medicine, thus lowering costs. It focuses the economic power on the doctor-patient relationship and uses government to prevent fraud and exploitation of taxpayers. Patient care and learning are improved. Bureaucratic cost and inflexibility are minimized. The 3 legged stool of Medical Staff, Hospital Board, and Administrator are put back into balance. It is time to stop bleeding patients. We physician will have to earn our keep but we can regain our honor, professionalism, and affection of those we care for.
    It's Time for Meaningful Healthcare Reform
    Lawrence Danto, MD |
    The crisis of World War II brought government-sponsored systems of national health care to Europe and the Far East but left the United States, not under direct attack, with an overly expensive, inefficient, private, employment-based health system. Sadly now we are under direct attack; but hopefully this terrible pandemic leaves us with the will for much needed healthcare reform focused on essential patient care.