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What could we do with $5 trillion?

Apparently, we do a lot, and yet sometimes it seems like it’s just not enough.

This amount is an approximation of the U.S. annual healthcare spending, nearly 18% of the national GDP, which gives us probably the most expensive healthcare in this world without giving our citizens the best health. We spend and we spend and we spend, and then we spend more trying to figure out why what we spent didn’t work.

In a recent article in the New York Times, a report from Britain on the state of their National Health Service decried the terrible prognosis of their beloved healthcare system, from the point of view of the beleaguered, overwhelmed, and burned-out nurses desperately trying to take care of patients. Patients piled in hospital corridors. Patients denied their dignity. Patients dying for lack of timely and compassionate care. Everyone there — as well as most everyone here — seems to be in a place that is not the best place for taking care of human beings.

How have we allowed such a system to be built up around us that costs more and delivers less?

Doctors, nurses, and every member of the healthcare team — we went into our fields because we love taking care of people. We love this job, and we want to do what’s best for our patients. Over and over, we hear about different models of innovation, new structures that someone came up with to rethink how to deliver care. With all this money we’re spending, wouldn’t it be great if we could flip things on their heads, if those of us in healthcare could decide what things cost, what to spend it on, and how to get everyone paid what they deserve?

Every day, we hear stories, either from our family or friends, or from patients who come in to see us, telling us about a terrible healthcare experience. Lack of access to care and mind-numbing delays, inequitable care, miscommunication or no communication, over-testing and over-diagnosing, waste upon waste upon waste, doctors and nurses spending hours staring at their computer screens creating documentation instead of caring for the patients in front of them.

Working around the margins, re-creating the wheel with some new system to give providers a few more pennies per patient per month to fill out more forms, click on more boxes in the electronic medical record, and ask them to try to do more work without the right tools and adequate resources, probably isn’t going to make anybody better.

True, there is so much more than what we do in healthcare that directly impacts our patient’s health, from the neighborhoods they live in, their safety, their access to clean water and healthy foods, safe places to exercise, and a decent job and education. Clearly fixing the healthcare system locally, even if we were to do it across the entire country, will never be enough to overcome these other obstacles. But if we built a system based on the ideas that doctors, nurses, social workers, mental health providers, community advocates, and patient activists have for the best ways to take care of people, we’d probably be a lot better off.

Returning us to a day where everyone had a primary care doctor who knew them and took care of them through the days of their lives, helping them to get and stay healthy, helping them overcome acute health challenges and manage chronic health issues, and getting them all the care they need — the right care at the right time — could go a long way.

From prenatal care through end-of-life care, from preventive medicine to surgery or chemotherapy for catastrophic illnesses, if we built a system that works smoothly, that gave us the almost limitless resources that $5 trillion should afford us, then we would probably be a lot better off than we are today, and we’d probably have a nice chunk of change left over.

Someone once told me the difference between a millionaire and a billionaire. If I gave you $1,000 a day, before 3 years were up, you’d have $1 million — you’d be a millionaire. But if I gave you that same $1,000 a day, starting in the year 0, you’d still have a couple of hundred years to go before you amassed $1 billion. And that’s only a billionaire. The concept of a trillion dollars (let alone five), is just so big we can probably never really get our heads around it.

So I’m thinking that with $5 trillion, under this kinder and gentler healthcare system that we can envision in the future, we can spend and spend on prevention, access to care, cheaper medications, unlimited mental health care, and equitable pay for every member of the healthcare team so they can live and thrive and come to work each day with joy in their hearts.

Then it’s up to the rest of society to take care of the rest of the stuff, the other social determinants of health, the things that are barriers to our patients succeeding once they leave our offices.

The bill comes due.