Who's Responsible for Healthcare Costs?
In the current world of spiraling energy and food costs, health care costs seem to have temporarily fallen off the dashboard of important societal concerns. While that may make those of us in health care less visible for a moment, it doesn’t mean we should stop worrying about it. I do think we’ll all need to help our neighbors more this winter with the doubling of home heating costs for oil, but health care costs are still out of hand. With the demographics of our society, health care costs will suck the economic resilience out of our economy faster than energy costs. Health care costs are just too big a piece of the pie, and growing too fast.
So, who is responsible for healthcare costs? Everyone, that's who.
Over the next decade the baby boomers are moving from being the largest group of health care providers, to being the largest group of health care consumers, while leaving the supply of providers decimated. People over 65 consume health care at 4 times the rate of people under 65. And boomers have not shown ourselves to be patient or frugal. When my parents’ generation had sore knees, they took Tylenol. My generation wants new knees, after a $1000 MRI.
So who is to blame for all these high health care costs? We all are. It’s time to stop casting about for the bad guys and look in the mirror.
I am a health care provider and a health system executive. In both roles I am a problem. As a provider I tend to see one patient at a time, and not think about the system. I was trained to do that. What is best for the person in front of me? And cost? Well, that is not supposed to enter into my ethical obligation to do the best for this person. So damn the torpedoes — let’s scan this person to find out if that 1% possibility could be a reality! And if they are demented and don’t know me or their own family? Or have bad heart failure and are not likely to live for too long? Well, if the family wants it — we do it.
As a health system executive I make decisions about the application of resources across our communities. Several lines of evidence say health care today in the US wastes 30% of the resources. Wow — in Vermont alone the 3 billion we spend could be done with 2 billion? That 1 billion spent across a population of 600,000 people would be $5000 each. That would buy some needed heating oil, food, maybe even some bridge repair and educational expense.
So why am I wasting your money? Because the system is hard to change. We are doing so, though. By applying manufacturing principles to health care, some processes are being done with ½ to 2/3 the cost. Some changes require investment in new ways of doing business. In our hospital 20% of nursing time is spent moving patients. This is a completely non value added activity, but until we can renovate our facility to single use rooms we will have to move the guy out of one room to be a roommate of another guy to make room for the woman in the Emergency Room who needs a room without a male room-mate.
So how about everyone else? The insurance companies waste about 20% of the health care dollar on unnecessary administration and marketing. The drug companies spend more on marketing than on research, wasting billions. Politicians cannot figure out a way to have a meaningful conversation with the public about a long term problem that is unlikely to be resolved in the course of one election cycle, and that is so complicated that it’s hard to deal with in a sound bite.
Finally is each of us as patients. Forget investing in prevention. While it works great, it actually increases health care costs. Smokers cost society way less than non-smokers. (See New England Journal of Medicine, Volume 337:1052-1057, Oct. 9, 1997.) Although they get sick more than non-smokers and require lots of treatment, ultimately they die earlier than non smokers. Nonsmokers live long enough to get arthritis and dementia and fracture their hips and so on. Because smokers die earlier they cost society less in total health care costs over their lifetime. Don’t worry — I am not advocating smoking as a solution to health care costs- only pointing out that prevention makes for healthier and more productive people (which is really good), but will not save money — it will cost more.
We patients need to think about what we ask for. Do we need the drug we saw on TV last night? Can we exercise to lower our blood pressure and blood sugar? Can we let Mom go now that she has been hospitalized 3 times in the last 6 months and the doctors say she’s not going to do well? That means not bringing her back to the hospital next time she gets short of breath, but letting the hospice and home health caregivers keep her comfortable at home while she dies in her own bed….
None of this is easy. But if we blunder along the current path we will find health care just like that big Black Cadillac Escalade that looks cool, feels great, but we can’t drive because of $6.00 a gallon gas. It is time to downsize and get sensible.
Lisa ICU
Dr. Novotny, I've wondered why there isn't an urgent care center in our area to cut down on ER visits. Would there be any advantage to SWVHC having such an area for this purpose to give less expensive care appropriately and save the ER for the true emergencies? Lisa ICU
