Thursday, January 7, 2010

The Biggest Problem With the American Healthcare System... my opinion, is habitual overconsumption. It raises demand and prices, constrains supply, and makes us less healthy than most of the rest of the developed world.

Health care is like food. You need a certain amount to stay alive and fit. Consuming too much, or the wrong kind, will ruin your health.

Emergency room care is like fast food. Sometimes it really hits the spot, and sometimes it's the only thing available. But making it your only diet will send you to an early grave.

Americans have an obesity problem. We have become victims of our own prosperity. We are also highly susceptible to advertising.

The economic boom that followed World War II, as well as the medical advances that came about during and after the war, led to enormous gains in general well-being and life expectancy for the average American. We learned that modern science can always improve on nature.

Regular check-ups and diagnostic X-rays, just in case, are always a good idea, we were told (despite evidence that too many of those X-rays over a lifetime may actually cause more cancers than they detect). The flap over the federal government's new mammogram guidelines demonstrates just how well Americans have been convinced that if a little of something is good, more must always be better. Many doctors have been concerned for years about the cumulative effect of too many mammograms over a woman's lifetime.

Since pharmaceutical companies have been allowed to advertise directly to consumers, the industry has skyrocketed, as have deaths from prescription drugs. A great many people benefit from the proper medications in the proper dosage. Unfortunately, a significant number of people take medications that do more harm than good.

Doctors push them because their patients ask for them, and because they have been taught (at a medical education conference at a tropical resort hotel, sponsored by a drug company) that the latest colored pill has been shown to be 61% more effective than a placebo, with minimal side effects. They never hear about the studies in which the placebo performed better. That's because, unlike European regulators, the FDA does not require pharmaceutical companies to publish the results of all of the studies they conduct. Big Pharma gets to cherry-pick, and we all get the pits.

It is clear that our government lacks the political will to stand up to Big Pharma (which spends more on marketing than it does on research and development). What we need, independent of any bungling attempts at reform that our government officials may make, is a strong consumer education campaign. Maybe some NGO could get that ad agency that does the anti-tobacco "Truth" commercials to come up with something similar about prescription drugs.


Jo Egelhoff, said...

Habitual overconsumption - great way to say it. More consumer education will help - but ultimately, health care consumers need to be involved in paying for their health care, in understanding the tradeoffs and costs and must have access to price/efficacy/value information. Iwrite about it often - health reform is up to each of us.

Tim Morrissey said...

Part of the overconsumption of Rx meds is the change, a couple decades ago, from reimbursement to co-pay. Back in the day, you paid the full price for your Rx med, and then submitted the chit to your insurer -so you knew how much the drug cost. Now, for most people with insurance, it "costs" between 5 and 20 dollars, or whatever your co-pay is - often, $0.

Jo Egelhoff, said...

Exactly Tim. What more difference does it make for those with HSAs? Many pay for the first thousands of dollars of health expenses, certainly knowing exactly what a product or service is costing - and they can keep more of those dollars if they spend/pay less for that product or service. Those folks (my husband and I included) must make wise decisions based on value - short term and long term.

Deekaman said...

One must know what the actual cost of the service is before one can determine it's value. It's difficult at best to find out what the cost of your doctor visit is up-front. Even more so if you go to the ER. And the bill? Unintelligible.

Fixing those things will go far in reducing healthcare cost.

Ordinary Jill said...

Educating consumers to be skeptical about prescription drugs and diagnostic tests will do more to control costs, in my opinion. What is the potential benefit in terms of improved quality of life? What are the potential side effects, both short and long-term? How invasive is this procedure?

ReasonableCitizen said...

Au contraire.
Habitual overconsumption, my foot.
How many people do I know that regularly go to the doctor because they want to? None. Nada. Zip and Zero.
You must be referring to them.You know, those other people that are always taking advantage of the system.
I have worked in the medical industry for over thirty years and the only people who go to the doctor regularly are people with some serious problems and senior citizens.
Serious problems like heart valve replacements, leaking blood vessels in their brains, and all the ailments of senior citizens. Seniors for whom the doctors order unnecesary tests because Medicare and Medicaid will pay for them and the senior citizens won't argue with their doctors because they don't know enough to argue about.

Ordinary Jill said...

I never said people go to the doctor regularly because they want to. They go because they think they should. And not just old people. Plenty of reasonably healthy adults with decent health insurance and disposable income (and therefore access to health care) go for routine physicals.

Women are told to go for yearly pap smears, even if they have been in a monogamous relationship for years. People with slightly elevated cholesterol are steered toward Lipitor, despite the danger of liver damage (particularly in Wisconsin, where drinking is so common). Ritalin and Prozac are seriously overprescribed.

Then there is the rapidly growing medical spa industry. Some people take a glaucoma drug they do not need simply because it will make their eyelashes longer (and they pay for it out of pocket, since most insurance will not cover cosmetic treatments). They get botox injections for wrinkles. There was a study not long ago that showed dermatologists make more room in their schedules for cosmetic patients than those who needed suspicious moles checked.

And I am not talking about "them" -- I am talking about my own friends and family. I have several friends and family members who took prescription drugs for years that they did not need, and which did lasting damage.

Those drugs were prescribed by well-meaning doctors who were not willing to admit that there was really nothing they could do. They felt the need to do something, and they had been taught that those drugs might help, so why not give them a try?

I have another relative who suffered complications from an invasive procedure that really wasn't necessary but was recommended "just in case" -- he bitterly regretted consenting to it.

I don't know what field of health care you work in to believe that only old people go to the doctor regularly. Have you never seen parents who bring their children in at the first sign of a cough or earache and demand antibiotics, even if the problem is probably viral? Have you never seen doctors dispense those antibiotics "just in case"? We now know how much damage can be done by that practice, but it has not completely died out.