Healthcare Resolutions for 2025

Happy New Year, everyone.

New year, new federal administration, US Senate, and House of Representatives. Time for goal setting.

I propose the United States of America strive toward gaining parity with its international peer countries for longevity, quality of life and health, and the efficiency of its health system. Fortunately, we have credible data to use for benchmarking.

It is a heavy lift, but let’s give it a try.

First, some background.

Americans agree broadly that our healthcare “system” is a mess that needs big-time fixing. But because this $5 trillion industry comprises nearly 18% of the gross national product, a seemingly boundless engine for jobs and a source of investor dreams, the likelihood of a consensus “fix” is virtually zero.

Short of some unforeseen mass calamity, the chance to build an ideal new system from scratch is also zero. So, incremental improvements for substance and timing may be all we can hope for. Every change proposed to solve some problem may create another set of problems, with both foreseen and unintended consequences.

Change is often difficult, and resistance is ubiquitous. Why change? Because the status quo is unacceptable and we can — and should — do better. The “health” of our public must at least compete, if not surpass, the “wealth” of our public.

Resolutions to consider, in no particular order:

1. Keep and improve traditional Medicare, and plan to expand it gradually by lowering the age of entry.
2. Expand Medicaid to cover many more people, including a "public option" with the goal of providing basic health insurance for essentially all Americans. Heavy federal hands may be required to move states that resist. Use Medicaid to creatively incorporate improvements in the social determinants of health.
3. Diligently strive to lower the overall costs of US health and medical care by some 30%, using methods such as those listed below.
4. Eliminate "middlemen," such as pharmacy benefit managers, as much as possible.
5. Abolish direct-to-consumer advertising of prescription medications.
6. Empower the USPSTF (and its new sisters, USDSTF and USTSTF; D means Diagnosis and T represents Treatment) to determine appropriate standards of evidence-based reimbursable care. Doing so could reduce the influence of physician organization-driven guidelines which are contaminated by conflicts of interest.
7. Phase out for-profit sickness insurance companies, unless used for processing — not for approving or denying — claims.
8. Phase out employment-based health insurance to assure portability of coverage.
9. Eliminate the jobs of most of the “bean counters” and minions who track only the money.
10. Empower Medicare and Medicaid to negotiate the pricing of all drugs and devices, not just a select few.
11. As much as possible, pay for value, quality, and good outcomes, and not for process, errors, fraud, and waste.
12. Require nonprofit hospitals and systems to act out their name, tax classification, and tradition, and not continue to sully it.
13. Establish salary level ratio differentials between high-level health system executives and their employees, more like the 1950s or 1970s.
14. Pay primary care providers much more and procedure-oriented physicians much less. Doing so is only fair and is in the public interest.
15. Encourage more "not for profit" systems like Kaiser Permanente nationally.
16. Support prevention, prevention, prevention; for example, ban manufacturing, marketing, and sales of combustible tobacco-containing nicotine. ( Some might wonder, Why not alcohol also? A very different issue. A nicotine/combustible ban is feasible. An alcohol ban is not; remember American prohibition. There is no redeeming medical or social value in using nicotine, except to treat nicotine dependence, which is a tightly addicting agent from the get-go for many people.)
17. Because obesity, once established, is so difficult and (now) expensive to treat, prevent overweight from the beginning. This goal may be difficult to achieve in 2025 but was the norm for thousands of prior years and will be addressed in a later column.
18. By addressing both supply and demand, decrease our annual per capita intake of sugar by 50%, to 1950 levels.
19. Put the National Institutes of Health to work in testing published results of the research it funds to determine reproducibility — and publish the results.
20. Cease using drug company money to fund FDA approvals of new medications — an obvious COI.
21. Stop, or at least delay, the revolving door for paid positions for regulators and the industries they regulate.
22. Create compassionate retraining bridge programs for the millions of Americans who will lose their unnecessary jobs in this revolution.
23. And, as a uniquely American freedom valve, permit people to use their own money to go outside the insurance system to purchase whatever healthcare product or service they wish, as long as the providers involved obtain a fully informed consent and are neither false nor misleading in representing their wares.

That is a lot. A substantial literature supports all 23 items. Improvements in costs and outcomes, if these are fully enacted, could be expected to be dramatic. I, personally, would welcome positive movement on any of these resolutions. Might some DOGE investigator become interested?