It’s time to reimagine healthcare in Delaware

The cost of healthcare is out of control. In the current fiscal year, the State of Delaware is spending nearly $2 billion on Medicaid and insurance plans for state employees and retirees – a $200 million increase over FY 2024. Gov. John Carney has repeatedly called the growth of healthcare expenditures unsustainable, and he's right.

According to the Bureau of Economic Analysis, Delaware ranked dead last in 2023 among all states for gross domestic product growth at -1.2%. We were the only state to experience a negative GDP growth rate.

In 2022, combined public and private U.S. healthcare expenditures accounted for 17.3% of GDP. Our nation has the highest healthcare spending, as expressed by a percentage of GDP, among all developed countries.

If nothing changes, healthcare spending is expected to reach 20% of GDP by 2031, with a total outlay approaching $7 trillion.

Commonwealthfund.org confirms the U.S. has the most expensive healthcare system while ranking last in outcome quality compared with six other industrialized countries (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom). Those outcomes were measured based on quality, efficiency, access, equity, and the ability to lead long, healthy, productive lives.

The General Assembly has taken some positive actions. Earlier this year, lawmakers passed measures to improve access to maternal healthcare and reduce infant mortality. The impact of these initiatives will be monitored for several years to evaluate the results.

The U.S. is still a leader in medical research and the development of new treatments. Of course, these breakthroughs often carry steep price tags. As noted by the Peter G. Peterson Foundation, rising costs are more than offsetting our national genius for innovation by threatening the stability of the whole U.S. healthcare system.

Feeling the pressure to reduce healthcare costs, the General Assembly passed a controversial bill earlier this year that will give a government board oversight of private, nonprofit hospital budgeting. The supporters of this misguided proposal seem to have forgotten the business axiom, "You can't cut your way to prosperity." By ignoring the impact of pharmacy benefit managers and the cost of services provided outside the network, such as private lab services, many like us feel expensive cost items outside the control of the hospital budgets were ignored. Potential consequences of failure to evaluate all issues will likely result in a questionable impact on the real causes of healthcare inflation and could further exacerbate health services’ availability in Delaware.

We believe it's time to rethink our healthcare focus from a reactive system – treating illnesses after they occur (aka sick care) – to one that is proactive and emphasizes well care and the prevention of disease when possible.

According to the Impact of Diabetes in Delaware 2023 Report, in Delaware alone, consider that 28% of all Delawareans are diabetic or pre-diabetic, and nearly 40% of Delawareans are obese. Our state spends $1.1 billion annually on treating diabetes alone. Understanding diabetes is a linchpin disease for so many other common metabolic diseases like hypertension, cardiac conditions, kidney and liver, and even Alzheimer’s.

The research is clear. In most cases, Type 2 diabetes is reversible and curable if patients adopt modest lifestyle changes, such as eating healthier, reducing overconsumption, increasing exercise, getting more sleep, avoiding tobacco and minimizing alcohol consumption. Minor improvements in these areas, alone or combined, could profoundly impact personal health and our collective healthcare costs.

Positive societal changes can occur when citizens are motivated to act. Consider that since the surgeon general first issued a warning in 1964 that smoking was hazardous, that habit has decreased by 73%. The American Cancer Society reports that since 1990, death rates from lung cancer have been reduced by 54% in men and 30% in women.

We need to declare war on diabetes and the poor choices that lead to it and so many other bad outcomes. So, how does this work for diabetes care? As we live in a world driven by technology and advanced computer chips, technology is an answer. Companies exist to provide measuring and monitoring of baseline blood testing, glucose monitoring, body measuring, individualized diet and exercise plans based on lab testing, and comparative labs, all coordinated with a local health system and well-trained providers to move the needle on wellness. When better wellness is achieved, and proactive measuring and monitoring are maintained, outcomes will improve, health will improve and costs will be reduced. 

We took the first step in implementing this vision by sponsoring House Resolution 32 last month, which calls for a public-private partnership to craft and test a pilot program to reduce the incidence of diabetes.

Curtailing the factors leading to diabetes will not only reduce its prevalence but also lessen the consequences of other diseases like hypertension, heart attacks, kidney and liver ailments, and even conditions like Alzheimer's disease.

If we just move the needle by 5%, Delaware will have healthier, happier citizens, and we will save the taxpayers $55 million per year. We are looking forward to working with the Department of Human Resources and providing updates as progress is made.