A doctor who’s in the thick of the current health-care debate made a crucial point when he told me that the real issue shouldn’t be limited to medical insurance reform rather an entire medical-care reform. It’s been rightly said that the most expensive technology in American medicine is the doctor’s pen, because with a flourish of the hand he can order an unnecessary test or surgery. Some kind of insurer must pay for that, so simply providing more coverage will not bring healthcare costs to economically sustainable levels, nor will it ensure better health to society.
It’s estimated that 2.5 million unnecessary surgeries are performed each year, with hysterectomies, heart bypass grafts, lower back surgery, and angioplasty leading the list. Just two procedures alone, coronary artery bypass grafting (CABG) — known in the trade as cabbage — and balloon angioplasty cost $100 billion annually. With long waiting lists for CABG, you’d think it was vital for prolonging the lifespan of heart patients, but that’s a mistake. Current statistics suggest that about 3% of bypass surgeries extend life expectancy, with angioplasty scoring even lower at zero percent.
On all sides the “more is better” cult cripples and bankrupts the American health-care system. If you pay your doctor a visit tomorrow, you have a 43 percentchance of being given an unnecessary test. Stress-related chest pains that are muscular in origin can still wind up leading to a battery of expensive cardiac tests, including risky catheterization. If you have a cold or flu, there’s a 73 percentchance that you will be prescribed an antibiotic, which is useless against viruses, including cold and flu viruses, but which carry risks of allergic reactions and other side effects, not to mention weakening of the immune system.
The U.S. ranks 37th in overall health system performance in the world by the WHO while paying far and away the biggest bill. What we need is not more unnecessary tests, which cost an estimated $700 billion dollars a year, but more intelligence. The Obama administration has rightly focused on the three main points of reform:
1. Provide coverage for the 47 million citizens who don’t have insurance. Their health care is being paid for through public funds when the final bill comes due — no one gets treated for free — so it’s absurd to hide the cost when it can be borne by those who need the care and have a duty to pay for it.
2. Provide a public option so that private insurers don’t have the profits game entirely to themselves. Not only will a public option be cheaper, but it starts to remove the cutthroat profit motive in healthcare insurance to a more sensible and ethical motive of improving people’s health and wellbeing.
3. Bring down medical costs, which involves two main fronts of attack. First, stop the “more is better” ethic (or rather, lack of ethics) that is tied to doctors’ profit motive. Second, bring malpractice coverage and lawsuits into line with reality, since many medical tests are motivated by physicians protecting themselves rather than protecting the patient’s health.
A great deal of fear and misinformation has been stirred up recently about end of life care in regards to health care reform. From my experience as a physician, efforts of extend life indefinitely through resuscitation and respirators usually only extends the patient’s suffering and extends the hospital bill thousands of dollars a day. While there are important exceptions, nevertheless it is vital that patients have the opportunity to discuss and make these critical decisions for themselves before they are incapacitated and force their families into a decision fraught with guilt and uncertainty.
Anyone who wants to delve into the truly dismal state of health-care economics has a wealth of sources at hand. Read the excellent articles now online at the Atlantic Monthlyand The New Yorker magazines for a starter. You will quickly realize that this isn’t an issue where the already insured are altruistically passing reform to benefit “them,” the incapacitated elderly, the chronically ill, and the under-insured, all of whom have the smallest voice in Congress while health-care lobbyists actually outnumber members of Congress six to one. We have arrived at a generational crossroads where wasteful, inefficient medicine meets an aging population. We must make it through to the other side as a whole nation.
Otherwise, consider what looms ahead. The present generation of young children might become the first to live shorter lives than their parents thanks to runaway childhood obesity and lack of exercise. Fast foods continue to zoom in popularity, and sodas and sugary drinks are now the main source of calories in the American diet . Health-care costs could cripple American industry by amounting to 50% of overhead by mid-century. Even if those dire possibilities don’t faze you, consider one of Pres. Obama’s most basic points: compared to other countries, the richest nation in the world is paying more for less when it comes to health care. That alone is reason enough to quash the myth of “more is better” right now, while we have the best chance of real reform.
Published in the San Francisco Chronicle

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