← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Scott Becker - 20 Different Healthcare Issues Shaping the Industry Today 10-22-25
00:12:55
Loading summary
Transcript1 lines
- [00:00]
A
This is Scott Becker with the Becker's Healthcare podcast. We're going to take you through today 20 key healthcare issues. But we're going to start with four core issues that we think of as really four healthcare having a math problem, health care having a power problem, healthcare having a thinking problem, and healthcare having what we call a hoping problem. Now we're going to talk through 15 or 16 other issues. We hope you find this informative. If you reach me at 773-766-5322 and you're the first person to text, Scott Becker, you know, publisher, founder of Becker's Healthcare doing this talk, I'd be thrilled to send you a 100 hour Amazon gift certificate. This way I know that you're listening and you can tell me whether you like the talk or didn't like the talk. Thank you so much for listening. Again. 20 healthcare issues that we're watching currently. In terms of a mass problem, we have 1 point million doctors, 1.1 million doctors in the country and a great percentage of our part time. We retire about 10,000 a year. We add about 25,000 a year. We're getting to the spot where the numbers just don't work. The math just doesn't work. 345 million people compared to 1.1 million physicians. More and more you need to know somebody to get care. We'll come back this point again. You need concierge to get a primary care physician. You've got these incredibly bad ratios in certain states of specialist to to the population in a whole host of places where the math just doesn't work. So that's number one, we've got a math problem. The second thing we talk about is healthcare is what I call a power problem. You've got four payers in the top 20 companies in all of America. That includes United, CVS, Cigna, Elevance and their power compared to the average provider. Even the largest healthcare system is just incredibly huge comparatively. And in many, many places there's one single payer that's dominant and you've either got to do business with them or you really can't do business in that area. So the payers have immense power compared to the providers. Third, we often say that health care is what I call a thinking problem. You've got a ton of sort of academics and others that constantly look at the payment system as the sort of root of all evils. The reality is if you've got fee for service, if you've got capitation, you've got problems on either sides of those spectrums, if you're on fee for service, you got X percentage of people that over bill overdue procedures overutilize. I remember seeing a knee doctor who's never seen a knee he doesn't want to operate. Plenty of situations like that in the pain business. I always just joke with podiatrist, if somebody had more than 10 toes, they would do more than 10 procedures. But just as much as there's some abuse on the fee for service side, there's just as much abuse on the other side. Decapitated the quote unquote value based care side where people essentially, you know, payers got rich during the COVID era because medical loss ratios went down to 80%. That's not good. That's just not giving care out as it's needed. And you've got just as much trouble on the capitation and quote unquote the value based care side. So we always like to say it's not the payment system stupid, it's whichever side you take capitation or free for service, you're going to have problems. And either way it becomes more of a supply and demand problem. Having enough supply to meet the demand we have in our country. The fourth issue we talk about is healthcare is what I call a hoping problem. We're hoping that tech GLP1s prevention will fix all of our problems. That is unlikely to be the case. At the end of the day these things will help. They're often 2x solutions vs 10x solutions we'll talk about a little bit later. But they're not going to solve all of our problems. And we better have enough staff and doctors and nurses to take care of people as well. So that's our first start of this talk. Healthcare is a math problem, a power problem, a thinking problem and a hoping problem. And we'll come back to this issue of supply and demand a lot and trust and verify. So let me go through 15 other points or so. The next point is we always talk about healthcare of this triangulation of quality, cost and access. And the common thing was always that you can get two of those three. You can get quality and access up, but then cost would also go in the wrong direction. You can get quality and cost to be really good, but access would be limited. No matter how you look at it, the concept was always you could get about two out of three of those. Increasingly it looks like we're struggling at all three. Costs are going through the roof. Quality and access are going in the wrong direction. We'll talk about That a lot going forward and a lot of this comes back to supply and demand. But again, quality, cost and access. It used to be that you can get two of the three and the, the real challenge is to get three of the three. Now it seems like all three are moving in different ways in the wrong direction. The sixth point we'll make today is about this clear movement towards two or three tiers. Increasingly in medicine, to get into the right specialist, to get into the right oncology program, to get in the right heart doctor, whatever it might be, you need to know somebody, you need to have access, you need to know somebody. The second point I'll make is that increasingly in healthcare there are vast areas of the country where you need to pay an access fee or a concierge fee to get a doctor. And you're going to see more and more of that. Obviously that means that the care is a lot less available to those that can't afford it. You've already had a double tier system, at least with a lot of doctors not taking Medicaid or Medicare and others doing private pay. But, but this concept of a two or three tier system is of course going to get worse and worse and there's not a lot you could do about it in reality without draconian regulations, because at the end of the day you have vast supply and demand problems. The seventh point I'll make is that ERA ers emergency departments are a symptom of the problem. We've gone over the last 10 years from systems advertising, they'll get you in the hour and 30 minutes to average wait times now throughout the country of three hours plus. And again, this is just another indication of partly the supply and demand problem that we've got in our country. The eighth thing I'll talk about is medical education. Again, physician education was developed before the Internet. Where to spot, where to be a doctor in this country. Four years of college, four years of medical school, three to four years of residency and often a fellowship. So you're not out truly practicing until your early 30s. And a great percentage of doctors go part time by 40. In other countries they produce doctors by 26, 27, 28. We are extremely fortunate in our country to be the beneficiary of that. But we've got to figure out a way to fix medical education in our country so it doesn't take so long, so it's not so expensive, so we get our doctors out earlier. Fascinating enough, nurse education has been incredibly accelerative over the last few years. It's gone We've gotten back to where we're producing about 185,000 doctors a year, 185,000 nurses a year, about 25,000 doctors a year. And just a big move in the right direction there. And people can complain all they want about the quality and the amount of time those nurses have been practicing, but in a lot of ways that solved a lot of promise for a lot of our country. How quickly they've accelerated nurse education, how well that has gone. The next thing I'll talk about is Medicare Advantage. This has ended up being an awful thing. It's now 54% of Medicare going down a little bit, but it's essentially been just an additional tax in the system. We pay taxes to Medicare, Medicaid, and they then turn this over to Medicare Advantage plans or to big commercial insurers. They've just added another whole way of cost to everything. Like many government programs, it's ended up costing a ton more than expected. In fact, Medicare Advantage is costing more than Medicare. Just a disaster all the way around. The tenth thing I'll talk about is two solutions versus ten solutions. Two x solutions are telehealth, remote health, flexible scheduling, different ways that you get more time out of the doctors you have and the nurses we have. The healthcare system we have. 10x solutions are where technology or AI or something essentially replaces the doctor or you replace them with a much lower cost person or asset that's easier to train and get up to speed. You're going to see more of these 8-10x solutions in primary care than the specialties, at least in the near term. But essentially what we've got right now is eight excess improvement solutions, leveraging solutions versus replacement solutions. And unless we can get to the other side of that, we're just going to need more doctors and nurses to take care of all of us. And we need more specialists and subspecialties as well. Eleventh, private equity. Private equity, if you're on the right or left, is an easy bogeyman. It's an easy place to point blame at. But the reality is private equity employs about 8 and a half percent of 6 and a half percent of doctors in the country, 8% of pain medicine doctors in the country, and it owns about 8, 8.5% of hospitals in the country. Some of those are well run, some of those are not well run. But the call private equity. The problem is, I think, a vast overstatement. Obviously, there's plenty of places where private equity is a disaster. Twelfth, there's all these thoughts about preventive measures in other countries where they've relied upon heavily on prevention. It's not been the solution to the panacea people thought it would be. At the end of the day, I believe you're going to need doctors and nurses to go with the technology the GOP wants to prevent health and everything else. 13th Washington, D.C. remains, as far as I can tell, pretty broken. And that's not a Republican or Democratic thought, it just is. The ability to actually solve problems versus grandstand has been largely lost. I'll give a couple quick stats. 14, 15 to 16 on hospital systems and what we're seeing in the country and payment systems. But 14, 60% of sum of systems are seeing some margin, some profit. 40% of systems, often smaller ones, decentralized ones, independent ones are seeing no profit or no margin. 15th there's recent studies, 7760 hospitals at risk of closing. We report regularly on the hospitals that are cutting jobs. I think we've got a list so far this year, about 80 to 90 hospitals also was cutting jobs. That's what you're seeing throughout the country as margins get tighter and tighter. 16th in terms of payer mix, in terms of the entire U.S. 40% governmental, typically Medicare, Medicaid, some VA, 30% commercial payers. And the third bucket is consumer spending, which is now up to about 30%. So that's, that's what we're seeing. 70th point I'll make is that the administrative cost of healthcare are enormous. Hundreds of payers, sort of middleman, middle person on top of middle person throughout the system and the administrative cost have become sort of obnoxious and horrendous. 18th all payment systems have different abuses. Whatever payment system you use, there's going to be abuses and challenges. I think it really comes back to supply and demand versus fixing the payment system. 19th Health care affordability is in an awful, awful situation. I think the average family cost now is between 25 to 30,000 a year with 7 to 8,000 that being deductibles, the rest being insurance problem, insurance premiums, but awful and getting worse and it's going to get a lot worse now. 20th if I was czar or king for the day, which I am not, so don't worry, we could do our own no kings thing here. I get that. No, I'm just kidding. But if I was, if I was medical czar for the day, we would medical education would be shortened, we would have more residency spots, we'd have a lot more PAs in physician assistants and nurse practitioners. Doing PC, doing primary care work with primary care oversight, we'd have a lot more resonances for specialists as well. We would get the government fully out of government plans. Drug companies would charge the same in our country that they charge in other countries. And we would continue to really fund research and double down on research as well, as we would keep at least the essential vaccines and aggressively continue to work on vaccines, though that's become an improper subject. And that's not to say that I'm pro vaccine everything, but I'm also a huge believer in the traditional childhood vaccines, the polio vaccines and so forth and so on. In any event, that's our talk for today about 20 healthcare issues that we're following. Thank you so much for listening to the Beckers Healthcare Podcast. Thank you very, very much.