Why is it so damn expensive?
The high cost of health care is not reducible to a single problem; it is multi-factorial. Malpractice, expensive brand-name medicines, and over-paid hospitals are contributing factors but probably not the real drivers, which are
- Over-dependence on specialists (Bend, Oregon, I hear has 7 MRI scanners!)
- Complex third-payer system (private insurers) which adds bureaucratic and inefficiencies, not mention a profit-seeking middle man
- Costly chronic diseases like obesity and diabetes that have become epidemic
- A large pool of uninsured individuals who use costly visits to the emergency room in lieu of less expensive office visit
- Medical errors that result in prolonged hospital stays
- Poor adherence to evidence-based medicine that leads to costly medical interventions with unproven outcomes
Given the complexity of the cause, there will not be a simple silver bullet, and the problem will not be solved during the next few presidencies. Nonetheless, it is exciting (and sad), that things have become so unsustainable that many people are talking about the issue of health care reform. What I think needs to happen is this -
- Promote primary care and decrease our dependence on specialists (many studies have shown that health communities which depend more on primary care doctors cost less and have equal health outcomes as communities with high use of specialists)
- Find some way to get everyone insured, whether that be through a socialized system that is used throughout most of the developed world, or through a mandate as in Massachusetts
- Incentivize doctors to follow evidence-based guidelines (doctors need to take an active leading role in establishing quality metrics)
- Fund more research looking into the cost-benefit ratios of medical interventions, then incorporate these into the above guidelines
- Tort reform that provides some protection to doctors from frivolous lawsuits
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