Segment 1 – Welcome to Explaining U.S. Healthcare

Segment 1 – Welcome to Explaining U.S. Healthcare


This is the first of a 10-part series in which Duncan MacLean MD explains the U.S. healthcare problem and how to fix it. Dr. MacLean has 40 years experience with medical practice and healthcare policy.

You know, almost every day my patients have been asking me, What is the problem with U.S. healthcare? Of course, I couldn’t really answer in the middle of busy office hours.

“Now I have to tell you It’s an unbelievably complex subject. Nobody knew healthcare could be so complicated.”

“So complicated,” indeed. . .

Healthcare is more complicated than just “repeal & replace Obama-care”. Voters who supported Donald Trump in the 2016 election said that they knew that all along. They just wanted someone to fix the system. They didn’t care about the complicated details.

But just how complicated is healthcare? Does it really need to be that complicated? And can it be fixed?

Please join me over the next 10 segments to talk about this. I’ve been in healthcare for 40 years, as a doctor, teacher and administrator. I’ve worked in private practice, a non-profit teaching hospital, for-profit business, and government healthcare. I’ve served on state and federal commissions.

More importantly I’ve been a small businessman and have raised a family. So I know the system from both the outside as a father and employee, and from the inside, including some dark secret corners.

Come along as I explain all these things. You might be surprised at some of my answers.

Here are some of the questions I’ll tackle in future segments:

– How did we get here?

– What is the problem

– Why is the healthcare problem important?

– Can healthcare be fixed?

Spoiler alert on that last one – I hope so. And in the last segment I will tell you about a fix that actually worked — 25 years ahead of its time.

I hope you’ll queue up the next segment. I’ll see you then.


10 thoughts on the state of healthcare from Scott Becker

1. Healthcare, given that we have 325 million-plus people in the U.S. with an aging and growing population that is living longer, is a very complex problem.

2. When I hear any executive, technology person or sales person look at an audience and say, “If everyone would just use this type of coaching app for diabetes or behavioral health, we would cut billions of dollars in costs,” I cringe, scoff, laugh and tend to get angry. I recently heard this in a speech I listened to.

3. Healthcare at its core is really taking care of individual patients. I see the theories behind population health and preventive health but I’m skeptical that it’s a fix-all.

4. When people say there should be no fee for service, I tend to think they’re representing some constituency. I assume at some level someone will still need to get paid to do something.

5. Hospitals and physicians and many providers will struggle as they become more reliant on governmental pay and as commercial patients are siphoned off. Government reimbursements will soften.

6. I’m not so dumb as to not see the irony in the campaign signs that said “get the government’s hands off my Medicare.”

7. Notwithstanding No. 6, whenever the government does place fingers on the scale, they are often wrong, and it often has massive unintended consequences.

8. The system costs with 325 million-plus people in the U.S. are crazy and insurance costs per family are insane.

9. Both parties are tone deaf as to the needs of the American people. Simply stated people that are poor need healthcare, and people that aren’t poor need affordable healthcare. These people are both Republicans and Democrats.

10. Given the quasi-monopolies of insurance companies in certain areas and the lack of insurance options, it’s likely we will need some sort of public option at some point.