In the midst of sluggish economic growth, finding a sector of the economy growing from 15 percent of the economy up to 19 percent would normally be a cause of celebration, except that this is health care. The lack of good cheer about this growth is an indirect acknowledgment of a stark reality: We are not realizing much increased value as we spend more on health care because too much of our health dollars are going to ineffective (and often harmful) procedures.
Estimates of the waste from this overconsumption of health care range from 30 percent to 50 percent. While all of the experts talk about reducing this waste (the phrase of the day is “bending the cost curve”), the reality is that hospital administrators, pharmaceutical companies, device manufacturers, insurers, consultants, think tanks and government bureaucrats all are seeing their power, control and financial remuneration increase due to this medical-care consumption growth.
All of the reformers’ trendy ideas have failed and will likely continue to fail in spite of the experts telling us they will soon figure it out. Electronic health records are a hugely expensive disaster. So far, they decrease doctor efficiency, reduce quality and increasingly make patients fearful of sharing sensitive information with their doctors for fear hackers or others will access their private data. Accountable Care Organizations turn doctors into rationers, introducing a conflict of interest between doctor and patient. Price controls by Congress or bureaucrats or oligarchic insurers only reduce access to care, demoralize doctors and introduce the risk of game playing by health systems by “upcoding” (labeling a doctor visit as more complex than it is).
Too often doctors are portrayed as the source of the problem, exploiting patients with unnecessary tests and procedures. But our doctors are buffeted by demands from patients who see more “free” treatments as evidence their doctor “cares,” by administrators who like seeing health system revenues increase and by fear of malpractice lawsuits if an MRI is skipped and a 1 in a 1,000 malady appears later.
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Most prescriptions of health-system experts call for replacing private-practice physicians with doctors as employees in huge health care institutions where they can be monitored (using data mining) and controlled (using rewards and punishments based on metrics extracted from electronic health records). Too many doctors are fleeing independent practice to escape the onslaught of demands from the legions of bureaucrats from above.
The only way to reduce the waste of overtreatment is to free patients and doctors from the onslaughts of the “reformers” and allow patients and doctors to work together in a trusting relationship to improve the patient’s health. This will happen only when we patients can directly reap financial benefit by reducing the billions being wasted via overconsumption of health care services.
All of the experts, however, seem to postulate that patients are too dumb or too unsophisticated to wisely consume health care. The reality is that these are fat times in the health care sector, and the giddy insiders don’t really want patients to bring about an end to the party. The next time you hear an “expert” talk about “bending the cost curve,” your first instinct should be to check your purse or your hip pocket to make sure your wallet is still there.
Paul Slobodian, Ed.D, of New Bern has served as a mental health provider and administrator, corporate purchaser of health plans and board member of a nonprofit medical insurance company.