We all know the bleak reality. The cost of healthcare is out of control. Many Americans cannot afford basic drugs and most struggle to pay medical bills. Is the problem that medicine is too expensive or are there insufficient funds to pay for needed care? Must we find more money or cut costs? Is the glass half empty or is it half full? I propose the answer is neither. The glass is the wrong size.
The Robert Wood Johnson Foundation released a survey last week of how patients viewed health expenses. 78% of respondents said the inability to afford drugs and tests was the major reason for quality problems in healthcare. Most blamed insurers for refusing to pay. In other words, most patients believed that if there were more money to pay for health care then there would be better quality medicine.
In the same week, the New England Journal of Medicine suggested there is a need to develop health care policies which slow the development of new therapies. According to the editorial piece by M.G. Bloche, the unstoppable force behind cost escalation was the development of too many health technologies. Therefore, to stop rising costs we must slow the introduction of new treatments.
I would suggest that both views are flawed. The survey patients believe in the glass is half full theory. If we pour in more money, we will achieve quality care. The NEJM commentator seems to believe the glass is already too full and we need to decrease demand. In other words if we have less technology we will have less cost. I believe what we need to do is redesign the healthcare glass, itself.
Every major industry in the world has long ago recognized that a quality product is generally the most cost effective and efficient. The telecommunications industry is based on the premise that if many consumers share the cost of quality technology, each can have the best for least. We might all desire a Rolls Royce but the safest and most efficient automobile costs one-tenth that of the luxury vehicle to purchase or drive. It might be interesting to guild our homes with gold, but paint or siding is easier to maintain. Mass agriculture feeds the world for incredibly low dollars and distributes thru an efficient market. No major business would last long with massive variation in quality, efficacy and cost. It is time for healthcare to learn that lesson.
The U.S. Preventive Services task force this week announced their recommendation that healthy men age 50 and older should not have routine PSA testing. This recommendation was based on a sophisticated analysis showing the PSA test results in harmful medical care. If you spend money on the test, you are going to find “problems” that were not likely to hurt the patient. Then you are going to spend more money on further useless testing, often ending up with unneeded treatments. A treatment that does no good can only result in harm. Spending more money results in worse care.
On the other hand, there are technologies like the expensive cancer treatment drug Neupogen. This medicine stimulates the bone marrow to recover after chemotherapy. The immune system is strengthened and patients do not get infections. Even though this drug costs almost $3000 with each treatment of chemotherapy, it prevents complex long life threatening hospitalizations, which would cost tens of thousands of dollars. This is a technology that saves dollars, as well as lives. Spending less money results in better care.
These are examples of changing the glass, not blindly pouring in money or preventing new ideas. In both cases data was carefully analyzed to find the most effective medical result. In turn, this yields the least costly alternative. It is critical to remember that by costly we mean not just dollars but human suffering. We must aggressively pursue this model. Health care consumers must insist on careful analysis of disease and treatments to determine the most efficient and highest quality result. We must not rush unproven treatments into the market, nor shovel useless dollars. Both yield waste and suffering. The use of research and information to design efficient medical care is not rationing, it is medical and financial common sense.
In the future, we must refuse crystal Champaign flutes filled with Dom Perignon. They break too easily and the beverage goes flat. Instead, we must seek solid stone mugs, filled with hearty beverage. By demanding quality, we can save the dollars which will make medical care affordable for all.
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