Bioethics for Breakfast: Our Sick Health Care System: What’s the Differential Diagnosis?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyLaura Appel and Marti Lolli presented at the December 5th Bioethics for Breakfast event, offering perspectives and insight on the topic “Our Sick Health Care System: What’s the Differential Diagnosis?”

This year’s Bioethics for Breakfast series centers on the theme “Is There a Cure for Our Sick Health Care System?” The series is generously sponsored by Hall, Render, Killian, Heath & Lyman.

Our health care system is exhibiting multiple symptoms of serious illness. Treating symptoms is rarely a good idea. What we need is a differential diagnosis. What are the root causes for skyrocketing costs, increasing access barriers, physician burnout, patient non-adherence and dis-satisfaction, failed therapies, and so on? Too many greedy profit-takers? Too many stingy insurers? Too much administrative bureaucracy? Too much competition? Too little competition? Too much unhealthy behavior by patients? Too little time for patients? Too much technology? Large empathy deficits? Too little prevention? Too many medical specialists? Too few primary care physicians? Not enough evidence-based medicine? Too much waste and inefficiency? Too many hospital mergers? Too fragmented a financing system? Patients demanding too much care? Unregulated drug prices? Too many special interests shaping health care policy?

Addressing these questions, Priority Health’s Marti Lolli first emphasized that these challenges are complex and cannot be simplified. She posited that there is enough money in the system—collectively we must get creative. In “diagnosing” our health care system, she put forward three items: 1) radically overhaul the fee-for-service system, 2) move away from the “one size fits all” health care model, and 3) accept data, technology, and transparency.

Michigan Health & Hospital Association’s Laura Appel then shared her perspective. Her three-item “diagnosis” began with the first point that there is a focus on health care when the underlying problem is health. One example she gave was that kidney disease in Michigan cost Medicaid $1 billion, stating, “We cannot change the output if we don’t change the input.” Her second item was that we don’t really have a “system,” also discussing the need for more behavioral health resources. Her third item focused on evidence, and that overall, to have a “system,” the system needs to respond to the evidence, recognizing what needs to change.

Attendee questions and comments addressed a variety of topics, including caregiver education, advance care planning, evidence-based medicine in practice, and social and structural determinants of health. Finally, one overarching point that those in attendance seemed to agree on: change is hard.

Marti Lolli Laura Appel and Leonard Fleck speaking to audience
Image description: pictured left to right are Marti Lolli, Laura Appel, and Leonard Fleck during the question and answers portion of Bioethics for Breakfast on December 5. Image source: Liz McDaniel/Center for Ethics.

About the Speakers

Laura Appel
Laura Appel is senior vice president and chief innovation officer at the Michigan Health & Hospital Association. She focuses on healthcare policy, hospital finance, legislation and governance. At the federal level, she represents the interests of Michigan hospitals and health systems in both the legislative and regulatory arenas on key issues, including federal healthcare reform and Medicare. She is an expert in auto insurance and legislative policy and has a proven ability to influence legislation and healthcare policy through her understanding of the issues, educating influencers and policymakers, and introducing fresh ideas.

Marti Lolli, MBA
Marti Lolli is chief marketing officer and senior vice president of consumer and government markets at Priority Health, a nationally recognized health plan. She oversees the individual market, Medicare advantage and Medicaid markets, and market intelligence. She also oversees all marketing, digital strategy, communications and customer experience at Priority Health. Her areas of expertise include consumerism in health care, market trends in health care, competitive and consumer analytics, health care reform, health care innovation and strategic planning.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.