Sunday, November 30, 2008

Cutting The Cost Of Health Care

Much of the ink and electrons spilled on the issue of health care in the United States has focused on a single-payer plan which would, in effect, replace insurance companies with the federal government in order to extend coverage to all Americans. I admit I'm in favor of such a plan, but this article in the Washington Post reminded me that more is involved in the health care issue, much more.

What the article makes clear is that we are paying too much for health care, and we aren't getting our money's worth. And that finding has been underscored by leaders in charge of delivering that health care.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Now, just to put those comments in perspective, here are some of the numbers provided by the article:

The United States today devotes 16 percent of its gross domestic product to medical care, more per capita than any other nation in the world. Yet numerous measures indicate the country lags in overall health: It ranks 29th in infant mortality, 48th in life expectancy and 19th out of 19 industrialized nations in preventable deaths.

Those are pretty damning statistics, given the amount of money we pour into health care each year. So, what's going on?

Well, Americans, always in love with technological innovation, are paying for expensive diagnostic tests which aren't always necessary, such as the MRI (magnetic-resonance imaging). The MRI is a marvelous technique for getting a more complete picture of a spine (for example) than a simple x-ray, but it's also very expensive and not always needed, especially at the beginning of treatment. The article uses the example of StarBucks coffee pourers with back pain. Chances are these employees had not been doing heavy lifting when they noticed the pain, nor had they had any kind of frank incident immediately preceding the onset of the pain. Instead of rushing them over to the local MRI shop, they were given two weeks of physical therapy, a much less expensive procedure. In most cases, the employees were able to return to work and the back pain dissipated.

Americans also love newness, assuming that the latest drug or treatment regimen is necessarily the best drug or regimen, yet that is frequently not the case. Many older generation hypertension drugs are just as effective as the latest generation and are almost always far less expensive. Yet as soon as a new drug is approved for use by the FDA and touted by the pharmaceutical company in ads appearing on television and in newspapers, patients rush to their doctors demanding the new drug, and in too many cases the doctor simply reaches for his prescription pad.

What's the answer?

Well, if the federal government really is going to get involved, then a way to control these costs has to emerge and be used. One such way, comparative effectiveness research, is something Tom Daschle, President-Elect Obama's choice to head the Department of Health and Human Services, is in favor of, as are many others involved in providing health care coverage, especially employers:

The members of [Helen]Darling's group [National Business Group on Health] are in the vanguard of a movement toward comparative effectiveness research, which evaluates various drugs, devices and treatments and publicizes which work best and at what cost. Ideally, doctors and patients armed with that data could make more rational decisions -- such as whether to choose a more expensive, but therapeutically equivalent, medication.

If the research is done honestly, and not just to drive down benefits to the patient, then it has to be a useful tool. That might just be enough to break up some of the unholy alliances in the delivery system, among them those between PHARMA and physicians and hospitals, and it might foreclose the unethical practice of doctors referring patients to diagnostic centers in which they have a financial interest.

The money saved could then be directed towards wellness practice, which should be just as much a part of medical care as treatment.

By the way, this is the kind of article which actually advances the rational discourse on one of the biggest issues the new administration will face. I hope that the Washington Post continues in this vein.

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Anonymous Anonymous said...

Entirely agreed. The numbers I usually encapsulate the issue with are per capita spending, which, in this country, is just a bit less than twice what it is in countries like France, Australia, Germany and Japan, which have better health results and universal coverage.

I'd note, though, that a doc who, rightly or wrongly, fears lawsuit--which they all, without exception, do--will err on the side of a head CT for a headache, lest he miss a brain tumor.

But it isn't at all uncommon for docs to invest in, say, an MRI unit from which they profit when they send patients for images. A particularly egregious example is the marketing of dedicated radiotherapy units to urologists, who choose between surgery, chemotherapy, radiation of several types, and simple observation as treatment strategies for prostate cancer.

That a sentient adult would expect a commercialized, entrepreneurial, for-profit system could be expected to hold down costs while improving access to care has baffled me for some time...


7:28 AM  

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