A Letter from Dr. Shetty and the Costs of Care

Sometimes we here in the United States, me included, when dealing with all the problems we face with our healthcare system need to step back and understand why we are really here. In the end, it is about the patient, the person needing help.

If I had my druthers I would do nothing but work in Medicaid.  After spending almost 20 years providing disease management services to Medicaid programs and running a Medicaid health plan, the joy of helping this population improve their health has always felt like the pinnacle of my work.

While much of what we have done and continue to do is laudable, there are many flaws with our healthcare system, we spend too much, get too little, and are constantly looking for new solutions to the unique problems the system we created, creates. It seems as if we harp on the negative, but is it really negative to harp on the waste, inefficiencies, fraud and abuse, to point out these wrongs in an effort to fix them?

Recently I received a copy of a letter written by Dr. Devi Shetty. He is a world-renowned heart surgeon, but more importantly he is a heart surgeon who says about healthcare:


   “If the solution isn’t affordable, it’s not a solution,”


“For 92 per cent of people living on this planet, heart surgery is a distant dream,”

His mission has been to drive down the cost of heart surgeries and many other surgical procedures and care in order to increase access. Dr. Shetty has taken the cost of a heart surgery to about $800, a fraction of the costs in the West.


We too, as part of our efforts to provide care to all, must work to drive down the costs of care in the United States, it has to be an imperative. Reducing costs is part of the Triple AIM, but compared to the efforts being made to improve quality and the heavy focus on population health, cost reductions have received much less attention. Even as the ACA has resulted in expanded health insurance coverage, some people in the United States are still not able to or decide to forego care because of the costs. Employees have also been affected through higher personal contributions to health premiums and stagnating earnings, as employers reach their limit watching health benefits cost’s rise year after year.

Imagine what we could do with the inappropriately spent dollars in healthcare, if we took those and invested them in areas that we know can have an impact on one’s health, including homelessness, hunger, transportation, safe environments, education, workers wages and many others.

Every physician, hospital, supplier, pharmaceutical manufacturer, distributor, administrator, insurer, vendor and yes even the patient must ask themselves, what am I doing to lower costs? Am I actually creating efficiencies, real reductions with the same or better quality outcomes or not? If not, why do I keep adding new things and more layers of services for no net gain?  If Dr. Shetty can offer the quality of services he’s renowned for and continue to seek to drive costs even lower, shouldn’t we?

Reducing costs must be part of the mission, there is so much more we can and must do…


Dr. Shetty Letter to Kids


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