Recently I was sent this commentary on the issue of health care costs. It seemed like a pretty good summary of the problem to me, though it didn’t delve into solutions or the current controversy about the Affordable Health Care Act. In our country, we’ve built up a huge medical-industrial system that can do lots of good but at a huge cost. It seems that we are on the brink of a “health care-cost bubble” because we are now dragging down economic growth with continued double digit rising insurance rates. Individuals, small businesses, corporations, and government entities are all crying for relief from this health care cost burden. An example of the medical-industrial complex is in the area of sleep apnea treatment.
A splashy story about a successful company in San Diego, ResMed, was published in the Union Tribune recently. Not much was said about their medical devices but their CEO has “spent $10 million so far for art in the company’s 18 locations around the world”. Apparently it’s felt that these millions spent for art help to inspire the workers. This is a small example of the extraordinary spending in the medical-industrial complex. Multiple profitable health care businesses are benefiting from the “piggy-bank” bulging with growing health care dollars. Many MD’s in top administrative positions in non-profit hospitals make more than one million dollars. Now, I understand that most of the drug companies, device makers, glass and steel hospitals, procedure doctors, medical directors, CEO’s, scanners, robotic devices, etc. are wonderful, but just not wonderful in their current excesses. The challenge is to change incentives in order to bring costs down.
There are a number of possibilities for improvement, and one of the smartest of the innovators is Dr. Donald Berwick. This Harvard pediatrician recently had to step down after about a year and a half as the head of the Center for Medicare and Medicaid Services. He was a recess appointee by President Obama and had no chance for a permanent appointment by the US Congress. Kaiser Health News recently noted the top five accomplishments at CMS by Dr. Berwick. His leaving is certainly a set-back to accelerating reform, however he remains a nationally respected promoter of quality improvement.
The Hastings Center, a non-profit which deals with ethical issues, has published a Health Care Costs Monitor containing several articles with different takes on the issue. One by ethicist Daniel Callahan deals with the cost of end-of-life care, a problem in every ICU in every hospital in the USA.
Recently the New Yorker reported that, “Yet, strange as it may sound, the federal government does not have a spending problem per se. What it has is a health-care problem. The cost of most budget items typically rises at a reasonable rate, if at all, but the cost of Medicare, Medicaid, and the tax subsidy for employer-provided insurance has been rising much faster than everything else…”
Dr. Berwick has shown that there’s good evidence that we can still maintain and improve quality while trimming costs. But do we have the political will? Every dollar spent is “benefiting” someone. In the equation are the patient, doctor, administrator, nurse, other providers, clinics, hospitals, device manufacturers, drug companies, lobbyists, research tanks, politicians, pharmacies, nursing homes, unions, AARP, insurance companies, Wall Street, etc.
Some doctors and medical specialty societies are addressing the problem of overuse of technology. These physicians look at the research evidence and encourage limiting unnecessary testing and treatment. Although this isn’t rocket science, it is quite hard to implement change in both lucrative medical procedures and the desire by some patients to “do everything.”
It seems like a huge bucket of largely poorly controlled health dollars is being sprinkled around with often ineffective and wasteful administrative attempts at control. Let’s hope we find ways to get a much less leaky bucket soon. Our medical-industrial system is long overdue for a real wake-up and shakeup. Here’s an example from an interview with Stanford economist Victor Fuchs.
Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.
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