Seventy-five years ago, America and the free world faced an existential threat. Thankfully, the Greatest Generation responded. While it took entire countries pitching in, there’s no doubt that 18- to 35-year-olds paid the heaviest price earning their place in the pantheon of history. I believe, today, our country faces a challenge of that magnitude, albeit, I hope it is far less bloody.
Imagine if a foreign country was devastating household income creating a 20-year long economic depression, choked off funding for education, killed more people than all but two diseases, crushed nest eggs so badly that 70% of households had less than $1000 in savings, and caused more than half of doctors to suffer from burnout. If one takes a sober look at healthcare’s collateral damage, it’s clear we’ve gone to war for far less than what the healthcare system is doing to America. The media narrative during the election cycle missed how healthcare was driving 20 years of wage suppression behind the Trump/Sanders phenomena that drove their populist campaigns.
How healthcare stole the American dream
In my recent TEDx talk, Healthcare Stole the American Dream – Here is how we take it back, I asked why is it that millennials are the first generation in American history to think that life won’t be better for them than their parents? The most optimistic scenario laid out in David Goldhill’s terrific book on healthcare (Catastrophic Care) was how a millennial he calls “Becky” would spend over half of her $3.8 million in lifetime earnings on healthcare. That was if healthcare costs grew at half of federal government estimates (I’m not aware of the government underestimating healthcare cost growth in the past).
The more realistic scenario is healthcare costs grow at the rate of inflation, which means millennials would spend 75% of their lifetime earnings on healthcare. In other words, millennials are on track to be indentured servants to the healthcare system. Of course, many of these costs are masked (e.g., big chunks of federal and state taxes pay for Medicare and Medicaid) from them, but make no mistake, Goldhill’s book is very well sourced and those numbers are real.
Fixing healthcare is the millennials’ opportunity to be the Greatist Generation
There will be riots in the street before millennials let that happen. Who could blame them? I believe fixing healthcare represents millennials’ opportunity to be the Greatest Generation for the 21st century. Every major societal problem in my lifetime has been tackled bottom up whether it was civil rights, better food, climate change, energy independence, better food, etc. Each movement was catalyzed by 20 and 30 somethings (though many generations were involved). With millennials now the biggest chunk of the workforce and the majority of Americans getting healthcare through their job, it’s easy to underestimate their impact. Read more on millennials and healthcare in Deloitte’s Millennial Survey.
As they are only now leaving the “invincible” stage of life, millennials are just starting to wake up to the reality of a healthcare system that is designed as a near-perfect polar opposite of what they want and value, yet, is stifling their future and delivering average-at-best health outcomes. Older millennials are also experiencing the healthcare system as their Boomer parents get overtreated in the healthcare system as highlighted in the recent Lancet series assembled by the Lown Institute. Another underestimated impact that traditional health systems are unprepared for is adult children taking increasing responsibility for their parents.
The way out of the healthcare caused nightmare
The great news is that employers all across America in virtually every sector have proven that even with very tough challenges (in terms of disease burden), they can spend 20-55% less per capita on health benefits with some of the best benefits packages in the country. For example, one employer uses the savings from avoiding wasting money in healthcare to pay for the college education for their employees and their children. If every employer followed the Health Rosetta model, it would be like a $500 billion citizen-driven stimulus. The goal is for the private sector to be the source of innovation that extends into publicly funded healthcare programs such as Medicaid and Medicare.
Sadly, most employers are viewed by the healthcare industry as dupes to be taken advantage of. While it’s challenging to read healthcare’s tea leaves, it appears that employees will have increasing responsibility for their health benefits decisions just as has already happened with retirement benefits decisions. As the largest chunk of the workforce, it behooves millennials to drive their employers to change their abysmally performing health benefits to wiser approaches.
One of the smart approaches employers take is thinking about transitioning health benefits similar to how communities transitioned from steam/oil/candles to electricity. There wasn’t a magical day when the old way turned off and electricity turned on. Rather, there was a transition over many years. Wise employers introduce a new benefits package while allowing the old, wasteful health benefits to continue. In effect, the new benefits package is positioned as the Tier 1 offering and is highly attractive (e.g., wise decisions are free or near-free). Meanwhile, the old essentially becomes Tier 2 and employees are welcome to continue paying more and getting less every year if they choose. New employees get defaulted into the new Tier 1 plan. Because millennials are often the new employees and open to new solutions, they often lead the charge. Most of the employee base shifts over the course of 3 years when it is well managed.
Millenials have already proved their power
Whether it’s smartphones, media choices, or better food, millennials have been the early adopters and evangelizers of new approaches. For example, millennials have personally felt the consequences of bad health choices as they’re the most obese generation in history at their age. It’s payback of sorts when you see millennials punishing Big Food and Soda with dramatically lower earnings. The Christian Science Monitor did a broader analysis of how widespread the millennial impact is on the food industry. The healthcare system is next.
As co-founder of the non-profit Health Rosetta Institute that is providing an open source blueprint for how to purchase healthcare services wisely and a set of guiding principles for how the industry should respond, we draw on lessons from other sectors that millennials intuitively understand. For example, millennials understand the impact Fair Trade and LEED have had on the food and building industries. Further, “Buy Local” has newfound applicability in the rise of the next generation health ecosystem that looks at the totality of health—not just the sick care portion (see graphic above).
A centralized, outdated, mainframe-like healthcare delivery system is the antithesis of what millennials want. Chrissy Farr has written previously about how millennials are ditching the traditional healthcare system. Millennials have personally seen the catastrophic misalignment of resources where healthcare has taken from various social determinants of health. This includes being a central driver of college expenses skyrocketing as states struggle to balance budgets.
The Choice: Massachusetts “model” where Social Determinants of Health get devastated by healthcare or Orlando where money otherwise squandered in healthcare resulted in 67% crime drop and high school graduation rate spiking from 45% to nearly 100%
Millenials are no longer waiting for solutions from somewhere else
Millennials are no longer waiting for solutions from somewhere else. Leaders are looking in the mirror and realizing it’s on all of us to restore the American Dream.
Here’s the great news. Former adversaries have realized their goals are aligned to fix healthcare. For example, in Pittsburgh, unions and management put aside old battles and rethought how to deliver great benefits to teachers. This resulted in that fact that Pittsburgh kindergartners will have $2 billion more available for education during their K-12 years than their counterparts in Philadelphia who are doing things the old way and needlessly paying 40% more for health benefits. Consequently, Pittsburgh teachers are paid more, have better benefits, and 30% smaller classes sizes. There are also four times as many librarians.
These successes are coming from people across the political spectrum. Progressives are the ones implementing healthcare ideas that people call conservative. Conservatives are implementing ideas that would be called progressive. Each of us has had an awakening that we don’t need a left solution or a right solution. We need an American solution and this good news is spreading like wildfire.
But of course, there are 3 trillion reasons to protect healthcare’s status quo. No industry spends anywhere near healthcare at the local, state, and federal level, lobbying to preserve such a wildly under-performing system. Those looking to protect the under-performing existing state of affairs will try to politicize healthcare and use fear, uncertainty, and doubt to protect their interests. To stop progress, there’s nothing easier to politicize and frighten people with than healthcare. After all, it’s life and death, right? But change agents must inoculate ourselves against the enablers of the status quo who benefit themselves—at the cost of our health and our wealth—when they infect us with the sense that healthcare is too complex to fix. This is simply false.
This is the millennials’ moment. They won’t be alone but they, more than anyone, face the devastating consequences of an out-of-control healthcare system that threatens the future of our country. A do-it-yourself health reform movement is rising. The challenge isn’t unique to America—it’s just hitting sooner as America has been skilled at needlessly overspending on healthcare at the expense of the overall well-being of the country. When millennials rise to the occasion, I believe they’ll be remembered as the Greatest Generation of the 21st century. Then, it will be what one president called Morning in America.
This was first published on LinkedIn on 02/10/17. It has been republished here with the author’s permission.