Health-care spending: Stemming the Flow
Written by: Dr. Michael Weiss
Suppose you’re a plumber.
You get called to a house and find a broken pipe. You make the repair using a new pipe that you pulled from the inventory in your truck.
Your customer is happy because his sink works. The government doesn’t interfere because it sees nothing wrong with the fact that you found and fixed the leak in the same visit.
Suppose you’re an orthopedic surgeon.
A patient comes to you with shoulder pain. You decide that the joint needs injected. You would like to treat the patient today, but this person works for the government, which doesn’t want to get hosed by having to pay for unnecessary care.
You tell the patient you need treatment authorization. You prescribe an anti-inflammatory to help with symptom control in the meantime, then send her on her way. Over the next four months, you and five members of your staff contact the government more than 20 times in attempt to obtain approval.
Why is it O.K. for the plumber to fix the pipe while it’s not O.K. for you to inject the shoulder?
There are more than 1.6 trillion answers to that question.
That’s 1.6 trillion in dollars — what the United States now spends on health care a year. It’s an amount that everyone agrees is way too high. How do you stem the flow? As the shoulder example shows, sometimes you don’t. Patching the small leak in one pipe may have the unfortunate effect of causing a bigger gush in another.
The cost of unnecessary shoulder injections is a small leak. The problem needs to be addressed, of course, but not with pound-foolish solutions, which only serve to create bigger leaks.
Then, there is the flood in the basement.I’m convinced that the reason we spend so much money on health care has comparatively little to do with things like cortisone shots, markups on chemotherapy drugs and freestanding surgical centers that turn a profit.
It has more to do with the fact that we as a population are just not very healthy. A study in the May 10 issue of JAMA identified the leading causes of death in the United States in 2000. Modifiable behavioral risk factors had a firm lock on the No. 1 (tobacco-related illnesses), the No. 2 (diseases caused by poor diet and physical inactivity) and the No. 3 (alcohol-related) spots. Death from conditions related to sexual behaviors and illicit use of drugs also made the list.
The key words here are "modifiable" and "behavior." This is code for "things a person can change."
Statistics tell us that treating preventable illness accounts for a huge chunk of our health-care spending. I’m not bringing this up to slam the smoker or criticize the person who loads his baked potato with sour cream. Human beings are psychologically complex creatures who have many tastes, motivational drivers, levels of willpower and degrees of foresight. As a physician, I’m committed to treating my patients skillfully and respectfully, no matter what lifestyle they choose.
I’m bringing this up because delaying a patient’s shoulder injection won’t knock much off the 1.6 trillion. To do that, you have to figure out why you’re spending so much on health care in the first place.
As a society, we’ve yet to make a meaningful connection between individual behaviors and their cumulative effect on health-care system economics. Instead, we look for new, inventive and not-always-effective ways of containing rising costs.
This is akin to building dams and piling on sandbags. Maybe what’s needed is to redirect the river.
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