The sustainability of the health care system is a legitimate concern - worthy of attention and actions to ensure that it remains capable of meeting the health needs of the population in the decades to come.
Unfortunately, the conversation around sustainability as it relates to the healthcare system is often limited to the cost of providing healthcare. The focus is on saving the system money - almost by any means feasible. The focus is on demand management. The focus is on doing the things that will cost the least amount of money to do, or alternatively, choosing to save money by doing less, doing nothing or denying or delaying access.
There is no end of angst when people (some highly educated and informed) look at the historical patterns of health care use and growth in health care costs and apply current forecasts of population and forecasts of costs. The conclusion that things will go from bad to worse, is an easy conclusion to reach. If a person applies a pessimistic view to the trajectory of general levels of health and well-being (the consequences of less than optimal lifestyles) - a grey picture becomes darker still. However, it is folly to look at the future in this way - can you imagine if people viewed other industries similarly, with a view that how things are done will be the way that things will continue to be done and that demand would simply outstrip supply (note: such an approach does sound somewhat familiar with respect to worries about the food supply).
Almost paradoxically, by focussing on the money (on "taxpayer value"), on the cost of care - the sustainability of the system itself is being jeopardized, opportunities to advance the health and well-being of the population are being foregone, and things very likely will go from bad to worse.
By focussing on the money - policy makers put blinders on and are subject to thinking in the short-term, managing this year's budget and next year's budget - and perhaps if the government is newly elected maybe the budget 3 or 4 years down the road is taken into consideration. The ability to truly consider impacts for a generation or more is limited. The long-term view is abused to inspire "chicken-little" thinking. As such an investment in health that might take a decade (or more) to "pay-off" is likely to be foregone in favor of investments that have pay-offs in the short term. As such, short-term cuts to access become appealing because they improve the budget that is on the immediate horizon - the budget that becomes so central at the time of the next election. Cuts that impact a small group of people are chosen in order to please the majority of taxpayers with promises to keep expenditures "in-check". All the while, undertaking the business of healthcare, becomes ever more frustrating (and unsustainable) to both patients and providers, as innovation becomes an unintended casuality and provider burnout becomes an unintended side-effect of short-sighted cost-cutting.
However, consider for a moment, what might happen if the focus were to shift away from "taxpayer value" and towards a system intent on pleasing those who use it (patients), by doing what can reasonably be done to improve the health and well-being of patients. A system that truly values patients, and those who provide services to those patients. A system that is compassionate enough to understand that health needs often have soci-economic causes. Think about the kinds of wide-angle thinking that might be fostered - the kinds of innovation that might come to fruition.
If we desire a "sustainable health-system", the first step is fostering a shift in thinking and shift in focus, and to believe that "taxpayer value" will follow as a side-effect. I conceed, it is a radical leap to be made - but a critical one if true sustainability is the goal.
Perhaps, as some measure of evidence of the potential for this kind of shift, consider the results businesses have been able to achieve by making similar shifts. Consider the businesses that have shifted their thinking away from "shareholder value" towards delighting their customers - notable examples include WestJet, Telus, and Apple and in contrast, organizations who have refused to make similar shifts. Is there any real evidence that thinking a parallel shift in thought applied to public systems is foolish?