Often the key to solving a troublesome problem is approaching it from a different direction. As 19th-century mathematician Carl Gustav Jacob Jacobi wisely noted (and as popularized by renowned investor Charlie Munger), “Invert, always invert.”
Therefore, when we consider ways to transform our current health care system in the U.S. to deliver more reliable, equitable, cost-effective value, we should explore the factors that perpetuate a continued unreliable, wasteful system that propagates inequity.
Fee-for-service (FFS) challenges
Let me elucidate. The prevalent FFS payment model in the U.S. health system inadvertently fuels health inequities by incentivizing the volume of services over outcomes. It fails to account for and address underlying disparities in health care access and the impactful influence of culture and social determinants of health (SDoH) — both significant obstacles to well-being. Moreover, implicit and explicit biases, structural racism, and historical trauma contribute to our current inequitable care model. This intersectionality is why health inequities tend to manifest along lines of race, ethnicity, and socioeconomic status, persisting within historically marginalized communities.