High Medical Costs, Poor Medical Care

Cost and Conundrum in New Yorker is hopefully pointing out to everyone factors that need addressing if we really want to fix the health care system in the US. The author also addresses followup questions .

The focus right is now is the large number of uninsured. But the problem is much deeper - the whole system is a mess.

A system is healthy if there are counter-balancing forces that prevent any tilt towards excess. As the article above points out, we have lost that. Doctors have a financial stake in pharmaceuticals, in medical labs, in hospitals, and their income is tied to the number of high-cost procedures performed. So naturally, these will tend to go up and up, which should not be a mystery at all.

Nowadays with the economic slump the GDP number and its percent decrease is getting a lot of attention. The perverse thing about this is that if a primary care doctor helps patients so that they don't need high cost operations later on, the GDP goes down. While ignoring preventive care, and focusing on expensive care for patients results in a higher GDP. And when the country is worrying about decreasing GDP numbers, one has to wonder whether that in itself indicates bigger problems and no hope for ever fixing this issue.

Another article claims that ... discouraging demand for such coverage ... is the answer. Those ideas are quite common on the conservative political wing, and they are completely unrealistic, regurgitating the same old ideas of applying free-market economics to medicine. It proves that when all you have is a hammer, everything looks like a nail.

These business experts claim that if only patients paid the full cost, they will avoid expensive alternatives and go for cheaper alternatives. This makes no sense - we are not talking about comparison shopping for a car or a vacation. If a doctor tells you - well, we need to do this operation, are you going to stop and get a second opinion? If the dentist tells you, we must do this now or else your teeth will be in bad shape in old age, are you going to argue that you read somewhere that it would not be cost-effective? Let alone the desire in everyone for personal self-preservation, does anyone think that a patient could argue about such a topic with their doctor and possibly mess up their relationship? This just makes no sense. Patients are not going to be in the right conditions to ever get second opinions. The doctors need to be honest and not have to focus on their own financial well-being - and doctors are in the middle of the entire chain, and are the key players who could help control costs.

Secondly, the medical industry has shown it is incapable of lowering costs. There are so many people without insurance and there are many personal bankruptcies due to medical bills, and yet, this has not resulted in any pricing pressure for anyone providing a medical service or product. Just compare that with the current 2009 state of the auto industry or the real estate industry. People stopped buying cars and houses, and the sellers have focused on providing a more cost-effective product, or lowered prices. This kind of behavior has never been seen with the medical industry.

Any for-profit motive in the medical industry will never be balanced out by any opposing incentives since both the buyer and seller want more than they can afford or should charge. If this aspect of the system is kept, which is quite likely given that the lobbying power is with the powerful - insurance agencies, pharmaceuticals, agencies like the AMA, all of whom have proved themselves useless and and incapable of doing anything helpful, this problem of high medical costs and poor medical care in the US is not likely to be fixed. Unless of course, a miracle happens - or things get so bad, that people finally stop listening to those who insist on saying money is the answer to everything.

On rationing - it needs to part of the solution, but is a very emotional issue. Issue clearly described, with a proposed possible solution in NYTimes Why We Must Ration Health Care.