Discomfort and Change in Health Care

The problem is that the institutions most comfortable with the current system will not change unless forced to do so. Physicians will continue to game the system to ensure their incomes; insurers and their investors will continue to expect cost plus profits which are the highest in the world; suppliers and patent holders will continue to overcharge and obfuscate the actual benefit of their advance.

Physicians:

• Previously the emphasis on cost containment focused on physicians. They were individuals and small groups for the most part; had limited resources for lobbying; and indeed are the door keepers for the system
• These efforts failed and resulted in distortions as doctors gamed the system to increase income. Medical students funneled into the high income, lower contact fields and practices found ways to incorporate high income technology, that doesn’t necessarily improve outcomes into their practices. Consider the proliferation of MRI’s in orthopedists offices, CT scanners in group practices, etc. These techniques are like the proverbial hammers looking for “nails’ to hit. At some point these costs will have to be approached.
• Part of the utilization fix will have to be a redistribution of fees to emphasize primary care. Cost efficacy of interventions will need to be analyzed compared and incorporated into our best practices.

Insurers:

• Insurers need competition from an efficient, non-profit competitors. Hopefully there will be a public option in the forthcoming reform to keep them honest.

• Technology patent holders have taken advantage of desperate and sick people gouging them by charging outrageous amounts to access their technology which in many cases offers small incremental, if any, improvement over previous approaches. Our costs are twice that of other industrialized countries in part because of these inefficiencies.
• These companies even oppose comparing newer expensive treatments with standard therapy to see which works best and oppose studies to understand the true cost of a therapy both in terms of it’s price to the individual and to the system. (cost efficiency)
• Patent holders in medical fields have violated the public trust. Their government provided patents have given them a generation long monopoly–it’s anything but a “free and open market.”
• One would think that being in a altruistic endeavor, health care, advances would be priced reasonably. It’s hard to imagine a single drug costing more than the median and average incomes in our country, and over a lifetime more than our home. Or a single imaging procedure that costs more than the entire care plan for a cancer patient 20 years ago. But that’s what’s happened. Cost-efficiency is not in a concept honored by these folks as they take advantage of the infirm and dying. I’ve long felt we need to change the terms of patents to encouraging responsible, realistic, sustainable pricing.