Blog | Monday, November 12, 2018

How to save health care dollars

Health care costs in America are incinerating nearly 20% of the Gross National Product. Can you say, “non-sustainable”? Folks have been bloviating for decades about reforming the health care system with respect to quality, cost and access to care. This is quite the quagmire. If it were easily solved, then it would have been done during the Truman administration.

Here are a few reasons why it has been so tough to crack this case.
• Cutting costs can threaten medical quality.
• I know of no player in the Medical Industrial Complex who is willing to sacrifice his own revenue to serve the greater good.
• Pharmaceutical companies receive federal research dollars but are not subject to reasonable governmental control on their opaque pricing schemes.
• The public expects every conceivable medical benefit, preferably for free.
• The fee-for-service model drives unnecessary medical care.
• Pharmacy Benefit Managers—huge middlemen—suck out gazillions of dollars from the system, much of which could be returned to patients to reduce their costs.
• Medical students typically borrow a few hundred thousand dollars in loans. This reality drives many of them into high earning medical specialties which ultimately cost the system more money. We need more primary care physicians, not plastic surgeons.
• There is an explosion of pricey medical technological health care with duplication of services among competing institutions which may be across the street from each other. How many MRI machines does one city really need? And, to justify the costs, each institution must aggressively market for patients.
• Pharmaceutical ads, much of which is aimed directly to the public who cannot prescribe their own drugs, costs money. Aren't you sick of hearing, “Ask you doctor if _____ is right for you!”
• There is a tsunami of overdiagnosis and overtreatment that is draining the system of zillions of dollars, while also exposing the public to the risks of unnecessary care.

It has always been my personal view that we could markedly increase medical quality and decrease costs simultaneously. If we could cull the system of unnecessary care, costs would plummet and patients would be liberated from the medical labyrinth that is often the final destination of an unnecessary medical inquiry. Patients can enter this maze easily, but struggle to find the exit. Some are trapped inside for years.

So often, an unnecessary (or even necessary) medical test turns up ‘abnormalities' unrelated to the issue at hand. Every one of us has internal imperfections that mean nothing. Once doctors discover them, however, they then assume an attack mentality to prove that the accidental findings are innocent. While the doctor may be relaxed during this exercise, the patient is anxious suddenly believing that he could be harboring a serious condition. Physicians' reassurances may sound hollow to our vexed patients. ”Doctor, I know you said I shouldn't worry, but then why do I need to repeat a CAT scan in 4 months?”

Why can't we get to the end zone on controlling medical costs? To do so would require some businesses and industries to disappear, some occupations to end and many incomes to decrease. Think of your own profession. Would you be willing to lose your job or take a 30% pay cut to reform your profession? I have found that it's easier to ask someone else to sacrifice for the greater good than to do so yourself.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.