Seven Reasons Why Americans Spend a Crap Load on Health Care

In the June 18 issue of the Journal of the American Medical Association there is a nice opinion piece that summarizes some key points about why health care is so expensive and ineffective in the US compared to other industrialized nations. Check out the stats in the table above.

In brief there are 7 points why health care is so expensive in the US:

1. A physician culture that privileges meticulousness over effectiveness.
   The Hippocratic oath, ingrained in every doctor and medical education system, values thoroughness of medical investigation regardless of cost. I am trained to order as many tests as necessary to eliminate every diagnosis possible, regardless of how likely they are. A patient with a "slam-dunk" bedside diagnosis of appendicitis will still get a $1500 CT scan in most hospitals to confirm what what was already known.
   
2. Fee-for-service system that provides economic incentive for providing care.
   As long as doctors have practices that are run like businesses (most are) this will always present a potential conflict of interest. In reality many doctors rationalize care that may not be necessary by the above principle of "meticulousness." Doctors need to be compensated for results not just for providing care. A very good article in the New York Times on CT angiograms is an excellent example. Economic incentive further hurts our system by irrationally over-compensating procedures compared to non-procedural cognitive aspects of medicine, resulting in a flood of doctors toward specialties and a brain drain away from primary care.
   
3. Pharmaceutical & medical device marketing to physicians.
   The medical world is awash in information that is impossible even for the most recluse speed reader of medical journals. Anything that gives busy doctors a summary or this information and how it may change their practices is very attractive, and this is precisely the role that marketing reps from the industry fill. The problem is that this information is crafted to buoy sales.
   
4. Fear of being sued.
   There is some debate over how much malpractice lawsuits actually increase health care costs. Doctors point to this as a major factor, but it is likely exaggerated. Nevertheless, I see doctors making "cover my ass" decisions to do a test all the time. And these are rarely for the patient's benefit, although many patients think they're getting better care, and they always add more costs.
   
5. Patient preference for new fangled technology regardless of proven efficacy.
   Americans are addicted to technology, especially when it presents an easy way - or the illusion of one - to solve a problem that is really behavioral or cultural in nature. My favorite example is narcotic pain pills for chronic pain. And doctors feed this desire with enthusiasm. It is a pathetic co-dependent relationship.
   
6. Direct-to-consumer marketing.
   The drug industry has been very successful at convincing people that if anything stands in the way between their right to total joyous bliss every second of their lives then there is a pill. Aging has become a disease. Suffering has become a disease. Not getting a hard on and the snap of one's fingers, has also become a disease. It is becoming commonplace that the patient comes to the doctor asking for a drug for a problem they think they have because of a commercial.
   
7. Shielding the true cost of care from patients.
   Few people understand what anything really costs in medicine, including doctors. When it comes to our health our attitude is, like the Mastercard commerical, "priceless." Over fifty percent of the health care resources a typical patient consumes is in the last 1-2 years of life. That's a whole lot of money spent on keeping very sick, frail people on the cusp of death from dying. Personally, I think a lot of this has to do with our Christian values, which have been perverted by contemporary politics, selfishness of the aging babyboomer generation, and over-confidence in medicine. We have a very poor understanding of death as a culture. We don't accept it, much like our attitude towards debt (thanks again to Mastercard). The thinking from "life is sacrosanct" easily leads to "life at all costs" and then to "death is a failure of morality."