Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens.
Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out.
The first is our unrealistic expectations as American healthcare consumers. Here are a bunch of words beginning with the letter “C” that I think fairly describe our typical hopes for our healthcare: convenience, compassion, communication, coordination. Nothing wrong with those hopes, but they all require time and people which means higher cost.
However, the “C” word that I believe really affects cost is this one: Cutting Edge. (Yes, I know that is two words, but you get the idea). We Americans have come to believe that the newest drug/device/test/procedure is the best.
This belief is fueled by many forces, but the most important may be the constant barrage of reporting about medical “breakthroughs” in our media.
This is a subject that hits home given that I spent 25 years as the Medical Editor of ABC News. I remember vividly when I first fully realized how we in the media were contributing to this public expectation/belief that the newest was the best.
During the 1990s some leading experts in the treatment of breast cancer began to “report” that the use of bone marrow transplants (which include very high-dose chemotherapies) for advanced breast cancer was better than standard chemotherapy. And because these reports were coming from true experts in the field, we in the media reported on their statements.
Predictably, women with advanced breast cancer, and their families, started demanding this new treatment, and when insurance companies denied payment, they often sued those companies.
This growing demand went on for several years until 1999 when three gold standard studies were finally presented at a major cancer meeting (the American Society of Clinical Oncology meeting) showing definitively that bone marrow transplants for advanced breast cancer were no better than standard chemotherapy.
American doctors stopped doing those transplants very quickly but because these studies had been so long in coming, tens of thousands of American women had been subjected to unnecessary treatment that was more costly and dangerous than the standard treatment available.
This phenomenon – the reporting of new breakthroughs – has grown in our society, especially with the addition of “direct to consumer” advertising for new drugs and procedures.
And this has often led to an “arms race” between major medical centers in the same geographical area who are competing with each other for “good patients” – meaning patients with money and/or insurance who can pay for the (usually) costly new tests and treatments that bring in good income.
But there is a final “C” word to add to the list of our typical expectations: we Americans want healthcare that is “Cheap”or even “Cost-free” in terms of our pocketbooks. In other words, we Americans have been raised with the expectation, now often subconscious, that “someone else” should/will pay for our healthcare – our employer in many cases, government programs for many others.
Timothy Johnson trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor. He blogs at Timothy Johnson, MD: On Health.
