The costs of health care

Why is health care so expensive and so unsatisfying? Just ask anyone who visits a hospital or a doctor and you will get the message. Ask anyone who has to pay for their health insurance and then copay for medications or visits. What are the root causes of this? DocBrain has been a physician for 36 years and can shed some longitudinal light on this. Here are some of the lies that drive health care in the wrong direction.

1. Doctors and hospitals are not looking out for your best interest. Gone are the days of Ben Casey, Marcus Welby, and Dr. Kildare. Doctors are portrayed as egotistical, self-centered, avaricious and uncaring. Hospitals are portrayed as disorganized, uncaring, and cold places. Yet, in all my years of practice, this has been the extreme exception and not the rule. As Larsen has pointed out in his cartoons, God has peppered the earth with a few jerks and they appear in every place, but for the most part, those who have chosen to be in health care do it out of a desire to help people.
2. Doctors and hospitals must be regulated. This is one of the centerpieces of modern medical management and has NEVER been proven to be the best method. The cost of all the regulations is enormous, creates friction in the health care system, and detracts from your care as a patient. When a child is "taught to the test" in order to do well on a standardized test, that child might not really be learning the subject matter. Similarly, when a doctor "treats to the reimbursement and lawyer" they are focusing on the chart and not on you. Yet, this is exactly what the doctor must do now to avoid culpability in legal action and to be paid for services rendered. If a doctor sits with you and helps you deal with a personal problem that you would not like written in a medical record, well, she will not get paid. However, if you come to your doctor about a headache and that doctor documents your response to questions about your skin and bowel movements, well, that will improve reimbursement. Doctors and hospitals need information, techniques and strategies to improve safety and delivery. We need data, not bludgeoning. We need systems for improved patient management and flow, not regulations.
3. Malpractice lawsuits help improve medical care for all of us. This is completely false and, if anything, can worsen care. True physician and hospital errors are almost always settled prior to court. Cases that go to court may be contraversial and the decision of the court can alter the practice of medicine adversely. The court decision that vaginal delivery is the main cause of mental retardation and cerebral palsy led to increased c-sections, with increased morbidity and mortality for women. And yet, the data then and now continues to show that MR and CP are rarely due to delivery, being due to intrauterine damage. The association of silicon breast implants with autoimmune disease led to bankrupting a company, many people losing their jobs, and many women after mastectomy suffering unneeded disfigurement. Study after study proved the safety of the implants, which have only now begun to be reintroduced into the medical arena. There are many other examples.
4. Big pharma is out to get all your money. Big pharma is actually out there to find agents that reduce suffering, disability, and cure disease. They may put a positive spin on their products, but that is their job. Physicians and pharmacists see what really happens and can act accordingly. Again, what we need in data and information, not regulation. FDA approval may be based upon hundreds of subjects trying a medicine. It then gets released and thousands take it. We need central data about evolving side effects, efficacy, and benefits. What we get is regulation and friction. Thanks to the government and managed care.
5. Doctors are well paid. This is no longer true. If your child is finishing high school and is looking for something to do, more financial success with less work and less regulation is available in many arenas. This will eventually lead to less competition for medical school places and lower quality physicians. It will also lead to physicians forming large, impersonal groups in an attempt to reduce unit costs, a trend which is becoming the norm. You will not have the one-to-one relationship of the past. You will be a number.
6. More to follow...also, feel free to add any observations of your own...