So you see the news every day, healthcare is more expensive. More unnecessary tests are being ordered. More medications are more expensive. Seniors are getting less health benefits. Baby boomers are requiring more health care. The nation is more obese than last year. Less doctors are going into primary care. Insurance premiums are going up. Businesses cant afford to offer insurance.
Do you ever stop and wonder why? Do you ever wonder what doctors are talking about en masse?
Well, sit back, and grab a cup of coffee. Let me tell you about the medical world.
There are 4 reasons for the rising cost of health care.
1. An aging population- older people need more health care, its that simple. If more baby boomers are getting older, they need more health care, and thus, costs will rise. Nothing can stop it. Otherwise, its like saying 100 people should cost the same to care for as 200. It doesnt make sense. More care costs more.
2. Medical litigation- Something the politicians try to hide or dismiss this. And something doctors cringe to talk about, and look the other way. But defensive medicine is real. It costs hundreds or thousands, even millions per year to insure a single doctor. And its imputed into aggregate medical cost. Where does this cost come from? What is malpractice so high? It is this cost for absolute certainty. We all learn volumes and volumes of medical knowledge. We know the rules and presentation of disease. But medicine is an art, not a science. 95% of medicine follows the rules, 5% of medicine, does not follow the rules. The population and lawyers are not happy with being 95% sure. They want 100%. This degree of certainty comes with a cost. Diagnostic testing and labs. Sure we could avoid it, but then what happens when a diagnosis is missed? You got it. Lawsuits and legal fees.
So yes, defensive medicine is real. Its a bad word, but it drives up medical costs in three ways, malpractice insurance cost, additional testing, and litigation costs. Often times bad outcomes are just as bad as bad care. For example, I know of several instances where smoking patients were told numerous times to stop smoking. Then they got lung cancer, then the families sued. And won. Does that make sense? Is that really a physicians fault? This cost is being passed back on to you, in the form of hospital costs and fees.
For the record, yes, I agree there are some bad doctors, but an overwhelming majority (read as greater than 90%) of physicians got into this for the right reasons, always try to do the right thing, and care deeply for our patients.
3. Obesity and poor diet- If you dont already know this youre living under a rock. I could talk for days about this, but its this simple. We are unhealthy. We continue to grow larger, and get more unhealthy. Here is the key to solving this. Ready? Personal responsibility. Without it, nothing changes. We preach all day long about health, smoking, exercise, etc. But if that device is not heeded, as it often isnt, health gets worse. Its not our fault, we do instruct. Its the recipients fault, for not caring about their health, and making real changes. We cant spend all day with you, choose your foods, prevent you from overeating, from taking your meds incorrectly, from not exercising. And we cant tuck you in at night either. At some point you must accept personal responsibility.
4. Cost of innovation- new tests, new procedures, better drugs with less side effects. Theyre great, and they are funded by NIH grants and private corporations, but they drive up cost. Older generic meds may be just as effective, but they arent advertised, and some are being manufactured less and less, to make room for more expensive drugs.
Congress has by and large failed to address these issues. They are often funded by big corporations that support drug makers and drug manufacturers. Isnt it ironic? Dont ya think? Meanwhile, they try to cut health care services to their populous each year. What has been done about malpractice at a national level? Nothing. What has been done to incentive patient health at the national level? I am not referring to “exercise campaigns” in January. I mean hitting people in the pocket book if they are unhealthy. Nothing.
The leaders talk all day about what doctors need to be doing. Ordering less tests. Educating patients on obesity and diet. I have news for you *and them*.
We do. All day long. It isnt heeded. It isnt working.
How do we solve this? Incentivize health.
How? I’m glad you asked.
1. Everyone pays something. Many people get totally free healthcare from uncle Sam. Approximately 20% of the population. Seriously. No copays, no medication costs, no cost for equipment, no cost for studies. Zero. And you know what? They are the unhealthiest among us. Paying something, anything, for healthcare puts you in the game. If you pay for your insurance, you tend to take better care of yourself, you use less services, and go to the ER less. If healthcare is free, you have no concern how much healthcare you consume. Life is a medical buffet. You can noshow your appointments (as they often do), miss taking your meds (even though you have them for free), and show up at the ER for toe pain (happens all day long).
2. The unhealthier you are, the higher your premiums should be. Aetna, Kaiser, and other insurances have started doing this. If you smoke, your cholesterol is high, you are obese, or have high blood pressure, you pay more. Its that simple.
We dont discount car insurance to bad drivers, so why do we do so for bad patients? Let me put it in perspective for you. When a healthy, non smoking, marathon runner with a BMI of 24 pays the same as a morbidly obese diabetic who had a stroke last month, and was admitted for 4 days, it doesnt make sense. The second person is utilizing far more services. And they are likely to continue using more services. The marathon runner gets no discount. His insurance funds the obese persons medical utilization. Doesnt make sense does it? And guess what. If premiums went up for the obese, and down for the healthy, our nation would get alot healthier. Fast. And health care would be affordable. For the healthy.
So there you have it. Perhaps Ill tell you more in the future. But chew on this for now. Let me know what you think in the comments.