Health care . . . ad nauseam
Forty-six million Americans are without health insurance. For many uninsured people, emergency cash loans and payday cash advances take the place of health insurance. Health insurance premiums, co-payments, and deductibles are on the rise. Medicare will be a financial disaster within a decade. Health-care reform has been a political issue for decades. But how can we provide health care for everyone if we can barely afford the system we have now?
Health care expenditures vary from region to region within the United States, but as the Obama administration has stressed, more health care within a region does not lead to improved health. An obvious conclusion to be made is that Americans could spend less on health care without endangering their health.
Health care expenses . . . ad infinitum
Elliot Fisher was a practicing physician for 20 years and is now the lead investigator for a project called the Dartmouth Atlas of Health Care, which documents imbalances in health-care spending across the country. Fisher believes that if doctors were rewarded for providing good care at low cost, the United States could afford to insure everyone.
Recently, Fisher spoke with Money magazine contributing writer David Futrelle about what’s gone wrong with health care and how to fix it.
What’s the evidence that we spend too much on health care?
We’ve looked at regional differences in Medicare spending and asked ourselves, What do you get when you spend more? What we found is that in higher-spending regions almost all the extra spending is on discretionary service. What that means in practice is unnecessary days in the hospital, unnecessary referrals to specialists, and unnecessary diagnostic tests.
How do you know the spending isn’t making people healthier?
Survival following a heart attack or a hip fracture, or after a diagnosis of colon cancer, is no better in the higher-spending regions than in the lower-spending ones. More health care doesn’t necessarily mean better health care. In fact, mortality rates in higher-paying regions are actually a little bit higher. Hospitals are dangerous places to be if you don’t need to be there.
. . .
Where is there the most overspending on health care?
Miami, Manhattan, and Los Angeles are expensive. Large Eastern urban settings seem to be particularly high cost, especially those that have a lot of medical schools, like Philadelphia. But they’re not all urban areas. Eastern Long Island is one of the highest-cost places in the United States.
One driver of the differences in health-care spending is the local capacity. How many hospital beds – and how many beds in major medical-center hospitals – does an area have? How many physicians? Physicians must always stay busy to keep their practice profitable. Likewise, in hospitals a bed you have is a bed you fill. And in order for hospitals to offset the cost of caring for the uninsured, they must offer more highly profitable treatments to those who can pay. They’re competing with one another to build the fanciest atriums, and they look like five-star hotels. They’re bidding up orthopedics and cardiology salaries because those are revenue centers. That’s what’s driving up the costs of American health care.
So where is spending lower?
Minneapolis, San Francisco, Rochester, N.Y. You can find pairs of communities within the same state – such as Miami and Orlando – where the spending is radically different. It’s very idiosyncratic.
Spending for Medicare would fall by about 20% if everybody practiced medicine the way the lowest-spending fifth of the nation does. The question is, How do we get there from here? We need local accountability, so that doctors and hospitals work together to provide better care at lower costs. We need to reform how providers get paid.
Under the system we have today, health-care providers are rewarded only for doing more stuff, not for providing better outcomes. And we need performance measures to show that the doctors aren’t stinting on needed care to save a few bucks.
But what makes you think you know better than doctors how best to treat their patients?
None of us want the government telling physicians how to do their job. We want better information about the risks and benefits of specific treatments, and we want patients to be empowered to make better choices.
There have been plenty of examples over the past 20 years of treatments being recommended by physicians that turned out to be riskier than we thought. Hormone replacement therapy for women is the poster child for this.
That’s absolutely right – more health care doesn’t mean better health care. For instance, MRSA outbreaks. MRSA is incredibly preventable, and one of the biggest preventions is hospital staff simply washing their hands. (Apparently it’s that hard to use a little hand sanitizer.) However, it’s hard to reconcile incentive to profit, and incentive to provide better quality care. Doctors aren’t automatically the moneybags we assume they are – firstly, medical school is terribly expensive. It costs over $100,000 to attend. Then, you have to get licensed, complete an intern rotation (lasts a year), a residency (two years or more), residency in a specific field (several more years) and you can maybe begin a practice by 35 or 40. And then you have malpractice insurance, the costs of which have skyrocketed thanks to the litigious nature of our citizens. (Granted, there are merits to some lawsuits.) And then, once you come out of that, you have to deal with annoying patients, annoying staff, and then if you happen to be a pediatrician, annoying child patients and their even more annoying parents. If that was what you went to work to every day, you’d stop caring, and want to just do what you could to make a lot of money to make it worth it too.
Ya what you said is true, more health care doesn’t mean better health. But health care is important because there are thousands of people around the world who don’t get good health care facilities just because they can’t afford it and have to suffer a lot. And somehow i don’t agree with peter stone, ya agreed doctors are not moneybags, they have to spend a lot to become doctor. But that is what they want to be and its their choice, so that doesn’t mean doctors charge more and more fees to get their expenses. And if they are dealing with annoying patients, then its their choice, they are doctors, its their duty.
I agree, health care can still be improved. People should rely more on caring for their bodies on a daily basis.
The emptying of the pockets of physicians begins from the day they graduate from high school and doesn’t stop till the day they retire. Even before considering medical school an aspiring physician must go through 4 years of undergraduate course work that is entirely unrelated to medical practice save a few courses. The cost of this comes out of their pockets unless they have scholarships. Then, applying to medical school without any guarantee of even getting a seat costs several thousand dollars between test fees, application fees, and traveling to interviews, etc. Once you get accepted to medical school, like Peter Stone has mentioned, you must pay over 100k to attend. During the subsequent years of post-graduate training you are looking at earning minimum wage. When you are finally done with all your training you now have to pay malpractice insurance just to do what is is you originally set out to do. In Medical care’s post above s/he suggests that somehow physicians are asking for it when they decide to enter their line of work, “its their duty.” I think that physicians are carrying out their duties just fine but the problem is that they are being robbed blind in the process. Health care reform is certainly needed but physicians should not be the ones getting the short end of the stick. Physician salaries have been steadily declining and insurance companies’ profits have been soaring yet all the while many American citizens are left without adequate health care. How can any rational person point their fingers at physicians for this mess?