On Healthcare Costs

“Monday Musings” for Monday August 19, 2013

Volume III, No. 31/124

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Health Care Reform

 By Assad Meymandi, MD, PhD, DLFAPA*

With Obamacare looming to take effect in 2014, and opponents dismembering it limb by limb, we thought another essay on American healthcare is in order. To begin, American healthcare is the costliest in the world, yet quality is patchy and millions are uninsured. Incentives both for patients and suppliers need urgent treatment. The cost of healthcare in one state of Indiana is more than the entire country of India. America spends twice as much per person on health care as Swedes do. Yet there are over 50 million uninsured and many more underinsured. We are spending 16%, soon to be 17% of gross domestic product (GDP) on health care, the most expensive in the world. Literally billions of words have been written since the Truman administration attempted health care reform. Surely, billions more words will be written before we arrive at a satisfactory solution. Meantime, here are some practical and simple suggestions to ward off the current crisis.

1)    Number one money guzzler is obesity. Obesity causes diabetes, cardiovascular disease, hypertension, musculoskeletal problems, back pain, and stroke. The cost of cardiac bypass is $16,000 to $18,000. The cost of back surgery, ninety percent related to obesity, is in the tens of billions of dollars. If we could prevent even a small percentage of people from becoming obese, we could drastically reduce medical expense. We need preventive measures and ought to offer incentives to encourage healthy eating and exercise.

2)    Reimbursement issue: The system encourages oftentimes unneeded procedures and very expensive lab tests and scans. The system does not pay for process and thinking medicine. This flawed system drives the doctors to spend less time with their patients. I do know that with the inflation- adjusted rates, primary care physicians are receiving one-third less pay today than they did 20 years ago.

3)    Government mandated single payer may be the answer. But look at the examples of Canada and England. It takes as long as three years to get elective surgery in their system. That is not consistent with the temperament of freedom seeking Americans.

4)    For-profit driven health care companies should be banned. The middle man and health care insurance companies/venders are poisonous. The dollars that should go to patient care go to pay the salaries, bonuses and backdated stock options of the company’s chief executive officers and their staffs. Convicted William McGuire of United Healthcare and many others like him are examples of these unwelcome middle-man-intruders in medicine.

5)    Waste, repetitious expensive lab work and million dollar work-ups are commonplace in medicine. The primary cause, besides financial incentives of the sinister “more-lab-work-you-do, the-more-fees-you-collect”, is the practice of defensive medicine. We need some comprehensive tort reform to keep physicians from over-ordering. The fear of malpractice litigation does indeed lead the doctors to order tests that may not be necessary to the patient’s care, resulting in billions of dollars of needless expenditure.

6)    There is no question that there are a few bad apples in the barrel. The holy house of medicine does have contaminants. There are a few physicians who go into medicine for anticipated financial rewards, but they are not very many. Remember in the 1970’s, insertion of Swan Ganz catheter in pulmonary arteries was the rage in medicine. Cardiologists were suing their pulmonologist colleagues as to whose practice domain insertion of the catheter belonged. We have had reports of unethical behavior in the ranks of cardiothoracic surgeons scaring patients to submit to procedures such as bypass operation and insertion of stents for which there was no indication. But these unethical doctors are very few. The overwhelming majority of physicians consider medicine a calling and their sacred profession a priesthood. But we do need to keep a closer eye on the few bad apples, thus requiring us to strengthen the States’ Medical Boards.

7)    Finally, in order to reduce cost, we must emphasize and preach the gospel of prevention. Recently in a health related meeting with several people, among them Lanier Cansler, former Secretary, NC Health and Human Services, I asked what percentage of the Department’s budget is spent on prevention. It is an astonishing 5 to 7%. I believe we should approach this issue with thoughtful planning, but a revolutionary attitude. We must effectively combat the unwelcome and dangerous epidemic of obesity. But first, we physicians, nurses and members of healthcare providers, including US Surgeon General, the country’s highest ranking medical doctor, ought to combat obesity.

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 *The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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