I believe healthcare in the U.S. costs too much.
I believe the excessive cost of healthcare is a significant burden for American businesses and governments. For businesses, this leads to reduced wages, fewer available jobs, and millions of Americans stuck in jobs they don’t like merely to keep their health insurance. For governments, this leads to budget deficits and requires revenue to be generated from other sources such as raising college tuition, cutting other services, and raising taxes.
I’m a family physician and I believe physicians are part of the problem. I don’t think any physician organization has engaged the American people in a serious discussion about the appropriate role of the healthcare system in our society.
I believe health comes from many other sources than the formal healthcare system. The solution to someone who’s depressed because he’s been out of a job for nine months isn’t an anti-depressant pill, it’s a job.
I believe there are many special interest groups in U.S. healthcare that perpetuate the status quo and block meaningful reform efforts. They do this because of a complex blend of heartfelt beliefs in the importance of their causes and blatant protection of their self-interests. The primary reason U.S. healthcare costs have risen faster than the general inflation rate for four decades is that all these special interest groups think alike. But their beliefs are sometimes wrong.
I believe the special interest groups commonly scare the American people into buying healthcare services they don’t need. I am calling for “health scare” reform.
This website and blog are for people who believe American healthcare costs way too much and are willing to consider a few radical ideas on how to fix it.
The primary solution to expensive healthcare is that the relationship between doctors and patients must change. The current relationship between doctors and the American public – that all possible healthcare services be provided no matter how rare the benefit or expensive the service – is unsustainable. Until we accept this reality, healthcare costs will continue to rise faster than personal incomes and soon health insurance will be available only to the very wealthy. The great American healthcare irony — we spend the most but get the least — will only get worse.
The two important questions that must be answered are — What level of risk is too low to worry about? and When does a healthcare service cost too much to provide? Until we answer these questions, rampant medical inflation will never end.
When a patient sees me for a new symptom, should I order every test that could possibly diagnose the symptom or initially focus on the most common causes. When a patient has finished two rounds of debilitating chemotherapy without much success, should I encourage more treatments or say, “Pam, I think it’s time to focus on keeping you comfortable and getting the most out of the time you have left.”
These are difficult questions, but they must be answered to bring a sense of proportion to our dysfunctional healthcare system. Thank you for your time and thoughts.
Richard Young, MD
Richard,
this is one of the replies:
He is correct on some points, but is off the mark on others.
I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have NO symptoms. If I wait for their heart attack or stroke – it costs a WHOLE lot more.
The real problem with our healthcare system is not enough well-trained primary care doctors. Our top-heavy (specialist) system is very costly and inefficient. Unfortunately $ and greed drive the system.
Mitch
Mitch,
Your comment about heart attacks and strokes is common among family physicians. However, it’s a common misconception that all the lipid testing and treating we do saves money. I’ll explain this reality in more detail in my next post.
Richard
I can agree with the thoughts he is trying to convey, They are not going to change overnight though.
Another part that is going to have to be considered is Mal Practice insurance and suit happy consumers. Somewhere there has to be limits but that also opens up another issue of the ethics vs. greed of the Insurance co. and the Dr. who took the oath to help and heal the sick or hurting, not to get rich overnight and run people through like cattle.
Also the mega amounts the Insurance companies are hauling in from the consumers who are spending ¼ to ½ of their earnings just to keep insurance that will barely cover them but that is all they can afford and survive.
Pharmaceuticals is a whole other issue.
another reply:
Where does the vicious cycle begin and end. Who will take the first hit to stop the cycle that has evolved. The trend has started toward forgetting insurance just because you cant afford it and going to county health and taking your chances because that is all you can do. Who is going to pay for that? You and me again with taxes.
Interesting article and one which should be more widely known about in my view. Your level of detail is good and the clarity of writing is excellent. I have bookmarked it for you so that others will be able to see what you have to say.
Lynwood,
Thanks for your kind words and for helping me spread my message.
Richard Young
Hello there, it’s a nice post! I’m looking forward to your next posts. It’s getting very hard to find such info.Keep doing the impressive work 🙂 and I’ll be back surely
Wonderful Post
The OP said: “The primary solution to expensive healthcare is that the relationship between doctors and patients must change.” But he didn’t say how that relationship should change. What does that mean exactly?
The truth is that doctors are bit players in this drama. They really aren’t the problem. The doctor’s portion of these $5000 bills people get for a few hours in the ER is miniscule. It’s everything else that needs to change radically. There’s no reason on earth for there to be more MRI machines in Salt Lake County Utah, then there are in the entire country of Canada. If they weren’t so profitable, that wouldn’t be the case.
Medicine doesn’t belong in the for-profit sector, period. That is the beginning and the end of what’s wrong. It’s not like buying a plasma TV. You can put off purchases of consumer goods. You can shop around for months to get the best deal. You can’t shop around for the best price when you’re having a heart attack.
The squeals of “socialism” that Big Insurance and Big Pharma paid so handsomely to provoke in the easily misled, are ridiculous. It’s one of the most embarrassing idiocies about our public discourse in a long, long line of them. Medical care reimbursement in this country is the most socialistic aspect of our economy and it has been since the 60’s. Those two programs could be administratively pared down by 25% almost overnight there’s so much profligate waste in them, and patient care wouldn’t have to be touched. The rest of us, who don’t have government subsidized health care need to take it back from the private sector who has turned it into the money machine of the century, which it simply should not be.
Henry,
Great thoughts, and I mostly agree with them. First, let me answer your question.
The current relationship between doctors and patients is that every medical service be provided (ordered) by a physician, no matter how rare the benefit or expensive the service. This relationship is unsustainable. All the other countries of the world have developed ways to balance the needs of the individual patient with the needs of the greater system. This is the direction we need to move to have significantly more affordable healthcare.
A perfect example of our inability to hold down medical expenditures is Medicare’s recent approval of the new vaccine treatment for widespread prostate cancer. It costs $93,000 per treatment and extends those patients’ lives by about 4 months. This means we’ll spend roughly $300,000 per year of life extended, which is more than six times the average income of an American worker. I have no doubt that unless the drug company vastly lowers its asking price, all the other developed countries will simply say, “No, we won’t buy it. This drug costs too much.”
I also believe part of a long-term solution is the return and support of non-profit insurance companies. In the 1970s, about 95% of their revenue went to medical expenses. That ratio is down to about 75% now with dominance of for-profit insurance.
Your thoughts about MRIs is also valid. However, the primary reason their are so many MRIs is that GIMeC (the special interests) has convinced everyone early detection prevents all bad outcomes. And remember, no MRI happens without a doctor signing something.
I hope I answered your question. Thanks for wrestling with these important issues.
The first thing that should be eliminated from the US healthcare system is routine infant circumcision, a surgery most of the world has never even considered. Cutting off a normal part of a male’s organ of pleasure and procreation without that male’s permission is a human rights violation. A Cologne Germany High Court said in 2012 that circumcision is harmful, irreversible, denies a child the right to his own body, his right to choice, and his freedom of religion. Non-circumcising countries do not have higher rates of urinary tract infections, foreskin infections, or penile cancer. Circumcision is a primal wound to the body and psyche that affects a male throughout life. Our job is to love, respect, and protect our children, allowing them to grow up and decide what body parts they do or do not want. Their body, their choice! This is a billion-dollar-a-year industry. European doctors tell me I won’t be able to stop circumcision in the USA because doctors here are too greedy. I’ve been working on this issue for 38 years. It’s time to prove European doctors wrong.