I sometimes think that there are as many explanations for why healthcare costs are as high as they are in the United States as there are explainers. Somehow each and every explanation rocks the hobbyhorse of the person doing the explaining.
That’s what I thought when I read this post from primary care physician Andy Lazris at RealClearHealth:
The Institute of Medicine estimates that in 2009 alone Americans spent $750 billion in unnecessary care. Atul Gawande’s article, Overkill, reveals that 25-42 percent of patients receive care that is either ineffective or harmful. Virtually all of this low-value care occurs in the hospital or is specialist derived. A cardiologist can open an artery with a stent whenever she decides it is appropriate, generating a large profit and satisfying a patient who often feels his life has been saved. But studies show otherwise; stents often lead to more harm than good. Bloomberg News estimates that the cost of unnecessary stents alone is $2.4 billion a year, and patients receiving stents often have worse outcomes than had they been treated more conservatively. This is true of many high-paying procedures performed by specialists, including spinal injections, meniscal repairs, and kyphoplasty for compression fractures. In regions of the country in which there are higher proportions of specialists than primary care doctors, outcomes are consistently worse, cost is higher, and hospital rates escalate.
Hospitals similarly deliver low value care at high cost. As a doctor who takes care of the elderly, I often have no choice but to hospitalize patients who want to stay home and who I know would have much better outcomes at home. The rules of insurance simply do not allow for reasonable home care. Studies consistently demonstrate that for many illnesses home-care is safer and far less expensive than the hospital for the elderly population, and it is what most elderly patients prefer. A recent study showed that 50 percent of elderly leave the hospital more disabled than when they came in and 25 percent suffer actual harm at a whopping cost of $4.4 billion a year.
He continues in that vein.
You know? He might be right. I just don’t know. What I do know is that we’re spending a lot on healthcare, not getting nearly enough value for our money, the rate of increase in healthcare spending is unsustainable, and spending on healthcare insurance is sapping investment from other sectors of the economy that’s needed to put more people to work.
Make of that what you will.
I’ve now had three prostate biopsies performed by three very fine medical institutions. (UCLA, Hopkins, Stanford.) Why? Because of PSA tests.
So on round one I get some high PSA numbers and go to UCLA. Negative. I get a second round of PSA numbers and decide fuck it, I’m going to the number 1 guy who is at Hopkins. Negative. Third round of PSA tests. Third biopsy. Negative.
Now, being a rational human being it began to occur to me after Round #1 (UCLA) that maybe the lab was wrong or. . . just spitballing here. . . the PSA test is a lousy predictor. But it’s not easy to resist the worried looks and urging of your primary care doctor. So a couple years later it’s off to Hopkins. (On the plus side, I got some good Maryland blue crab, infinitely superior to the crab we get on the west coast.)
On round three I finally said OK, look, this is it. If this is negative you don’t order any more PSA tests. I’m pretty sure I’m gonna die eventually, maybe even from prostate cancer, but enough.
No idea what it cost because I’m insured. Yay! But had to be at least 2-5 grand a pop, right?
So long as some person with an MD tells you they can maybe save your life if you just do X, Y and Z, it’s hard to refuse. People want to live and when the witch doctor says you should kill a wart hog and drink its blood at midnight of the solstice. . .
I thought I’d mentioned this in the past. Some years ago the chap who invented the PSA test wrote an op-ed saying that the test doesn’t test for cancer or determine whether the cancer you have will kill you. It’s most likely to indicate an enlarged prostate which nearly all men of a certain age have.
He is right about a lot of what he says, but he does go overboard and undercut his case. Yes, many of our elderly are more “disabled” when they leave the hospital. When you come in for a total joint replacement of major abdominal surgery it usually takes a while to get back to your prior level of ability.
A point he makes, amidst all of the verbiage, is a good one. An awful lot of what we do in medicine is determined by what the insurance companies are willing to pay for, which is not necessarily what is best for our patients. I now spend a lot of time trying to find ways around that problem.
Steve
might just be easier to count the working class dead annually. we used to know our doctor by name, and get an appt. the next day.
now we lay at bed, stare at the ceiling, and wait for the last gasp.