The top graph tells the story. The relative cost of medical care in the United States has doubled [since the days I first heard of Managed Care around the late 1970s]. And the reasons are obvious everywhere you turn. Fee churning Emergency Rooms in for-profit Hospital Corporation owned facilities; Direct-to-Consumer ads increasing drug sales six-fold; inflated guidelines fueling unnecessary testing and treatment; controlling Managed Care monitors demanding evidence of efficacy but giving no evidence of their own [efficacy]; abusive pharmaceutical advertising and pricing; the constant whirr of the MRI machines in the background pouring out normal studies. The sick and those of us who treat them are a captive audience with no clear alternatives in sight. We’ve been an easy mark for decades. And it’s as if there’s an inertia from a more benevolent time, memories of a different ethic – something that keeps us naive about the impact that the business·i·fi·ca·tion of medicine has had on our lives and our healthcare. And speaking of evidence, the bottom graph is one of the many that make the same indictment – it hasn’t been worth it.
It’s funny, the cynicism in that last two paragraphs is evanescent. I can get to feeling it in spades, work myself up into a righteous froth – and then watch it evaporate within minutes. It happened today. I hadn’t worked in a couple of weeks – weddings, funerals, other things – but when I went to the clinic today, the cynical gloom lifted and I had fun. Maybe that’s not the right word. I got into the problems that came my way and did what I’ve learned to do. Some might say I wrote too many prescriptions. Others might say I didn’t write near enough. Some would say I didn’t need all those years of training to do what I actually spent my time doing today. Since I don’t get paid, it would be hard to say I didn’t earn my keep. My point is that I felt none of that uncomfortable cynicism I can feel at other times. The Licensed Professional Counselor I worked with and I saw several cases together we pass back and forth in our version of Collaborative Care, the same with the Internist and the Nurse Practitioner.
But let’s not forget demographics. Health care is expensive now for the same reason crime was high in the 70s. Baby boomers were young and wanted everything then, now they are old and want everything.
Dr. O’Brien, I am not sure what you mean about baby boomers wanting everything. When I go to a doctor, I want what is necessary to treat my condition. No more, no less.
Today many doctors find no satisfaction in their work and reflect this with patients and coworkers. I see this as in part the reason for the disparaging comments many doctors make concerning those with other skill sets.
The ability to see what others bring to the patients issues and then reach a positive outcome is a sign that the system is working, and produces a better environment for all involved.
Many MD’s need to experience the joy of medicine again.
Steve Lucas
Boomers are like trust fund kids who went through the money and are now borrowed out:
http://www.forbes.com/2010/11/11/greedy-boomers-social-security-medicare-cuts-personal-finance-kotlikoff.html
And I’m one of them (but living within my means).
I have been impressed with the obsessive and compulsive traits which are widespread in our American culture. We cannot tolerate uncertainty, so we perform excessive tests (including the MRI’s). We need to feel in control of our health so we either obsess over our exercise and eating or we let those go and let our pill taking compensate for our general neglect of our health. As a result we pay more and get less than other countries.
Is this the fault of our citizens? Partly, I’m sure. Does our culture share any blame? Yes, I am convinced. The emphasis on high performance, efficiency, the supremacy of money as reward, and the insecurity of workers in their jobs lead to chronic stress and anxious avoidance of the important (but not urgent) task of real self-care.
Im curious, do you think there would be less stress in society if people, especially doctors, did not emphasize high performance or efficiency? The CDC isn’t doing either and creating a lot of stress.
In response to Dr. O’Brien: Yes, I believe that if people were left to flexibly manage themselves rather than being manipulated to meet someone else’s standard of high performance and efficiency, then there would be a marked reduction in stress. Doctors would be able to set their own standards for what counts as “high performance” and could practice their profession without constantly being pressured to measure up to some bean-counter’s definition of efficiency. It seems that I am always resisting efforts to “improve” my performance and be more efficient by cutting back on the time I spend with patients and do more medication management.
I’m sorry if the CDC comment was a joke. It seems that ebola is creating a lot of stress. The CDC seems to be trying to manage it without causing mass panic, but like most things that require human cooperation, it has produced inconsistent results. It seems (at least through media reporting) that our obsessive society is dividing into two camps — obsessive control and repressed nonchalance. I don’t envy the task the CDC has before it.
That Forbes article has absolutely nothing to say about boomer’s utilization of medical care. It’s an anti-Social Security screed.
In my opinion, that patients are responsible for U.S. overspending on medical care is a myth that supports the cult of the free market. It’s perfectly obvious what the causes are — Dr. Mickey outlined them above.
When demand is inelastic, the invisible hand offers no corrective. Vendors can raise prices as much as they like, consumers have nowhere else to go.
In most of the other countries on the excellent charts Dr. Mickey provided, government much more actively regulates the business of medical care. In this (and other areas), business has rigged the U.S. political system to tie the government’s hands — and run away with public funds.