“It is difficult to rationalize the goals of a system that
invests in the most sophisticated and expensive neonatal services to save
premature, high-risk infants while cutting back on the relatively inexpensive
and effective prenatal services that would have prevented many of those poor
birth outcomes in the first place” (Sultz & Young, 2011).
Let that statement sink in for a minute. Do you understand
that this is a major problem that is contributing to our outrageous cost of
health care? Why is it we often spend hundreds of thousands of dollars to
prolong end-of-life care by 2 weeks, 4 weeks, 6 months or even a 1 year? While
recently watching a documentary on Medicare reimbursement, an older, 87-year-
old gentleman, who had liver failure, kidney failure, and was on the verge of
heart failure was asked by a physician if he wanted to initiate “DNR” orders or
consider his other options. In the case that the patient’s respiratory status
started to deteriorate, the hospital and its personnel would do whatever it
took to keep this man alive, even if this meant spending hundreds of thousands
of dollars to do so. The elderly man opted for the more expensive route. About
a week after the discussion with the physician, the patient’s health status
started to seriously deteriorate. He was then transferred to the ICU where he
was kept alive on a respirator, given multiple expensive drugs to regulate his
circulatory system and had specialized care from physicians and nursing staff.
After about 3 months, the man passed away. The cost of his treatment? Well over
$800,000. The worst part is that this man was delirious, had no form of
conscious thought, and remained in a vegetative state in his last months. In
school, we’re often inculcated that quality is better than quantity. These are
the incidents that pervade our medical system that contribute to the high
rising costs.
In David Goldhill’s book, “Catastrophic Care”, he blames a
lot of wasteful medicine, such as in the example provided above, by society’s
lack of knowledge that is often blocked by insurance companies serving as
intermediaries. If one knew that the cost to keep himself alive would place an
$800,000 financial burden on his family, do you think he would have wanted
alternative options? These decisions are often difficult to make when family is
making these decisions. I love my father, but I highly doubt my mother would
want my father to live his last few months in agony, and better yet, I highly
doubt she would consider the financial burden worth it. In fact, she may be
more inclined to yank the plug than the physicians! Joking aside, my mother
knows the piecemeal aspects of the health care system. She may be a little more
educated than most when it comes to deciding what care should be delivered and
what care should not be delivered. Goldhill emphasizes that the reason consumers
and health care industries are so out of sync with one another is because
insurances serve as the intermediaries. Somehow, insurance companies (i.e.
private and public) know how to better spend our money than we do. Granted,
insurance companies can serve as a safety-net for some individuals, such as in
the case of serious trauma resulting from a car accident, but who decides when
and how to keep someone alive when costs far surpass the quality of life. Additionally,
as provided by the opening statement, there is always a trade off of that price
and other people’s health care. Interestingly
enough, Goldhill states that, through basic principles of free enterprise, that
these costs would significantly drop if insurances were taken out of the
equation altogether. An example of this
was well illustrated in an article put out by the NYtimes last week.
The article, which can be found here: http://www.nytimes.com/2013/12/19/business/shake-up-at-big-co-pay-fund-raises-scrutiny-on-similar-charities.html
describes the profound effect that Medicare has on keeping drug prices high. The
investigator discovered that in a charity fund, which is used to help Medicare
patient’s pay for out-of-pocket costs, drug companies were major contributors.
The advantage the drug companies had were that by donating a small portion,
they would ultimately receive a large portion. Additionally, the article illustrated that a drug
company, known as Questcor that sells a drug that was approved more than 60
years ago, has raised its price since then from $40 to more than $28,000/vial.
The company only sells it at such a high rate because they know that Medicare
will reimburse it. However, if insurance were not serving as a intermediary,
the company would be forced to sell at a much lower rate. Consequently, if
people decided that this lower rate, whatever it may be, did not meet its
expectation (in this case extending life by a certain time frame), the drug
company would be forced to come up with more creative alternatives or suffer
the consequences of a failing market.
Lastly, the rate and growth of cost, with the addition of
trying to control the ‘cost curve’ through budget cuts, has caused us, as
consumers, to look at what exactly the reasons to our rising costs are. No one
wants to be confronted with the idea that they’re behind the decision of
potentially prematurely ending someone’s life, but when confronted with the
cost, one might seriously consider the consequences or alternatives. For all
extents and purposes, the lack of transparency of the health care system, as
blocked mainly by its interest groups (other than consumers) has lead to these
sky-rocketing costs. To be quite frank, the other interest groups want to keep
it this way. The health care industry does not profit off of you being healthy,
but has a perverse incentive to keep you sick. Even with Obamacare, better
access to health care, through insurance markets, does not equate to better
health. The whole system needs an overhaul. I would like to end this blog with
a recent joke I read the other day:
Two New Russian businessmen encounter each other at the
airport in Zurich. The first says, “That’s a nice tie.”
“Thank you,” responds the second man. “It’s an Hermes.”
“May I ask,” says the first, “how much did you pay for that
tie?”
“A hundred and fifty dollars!” answers the second man proudly.
“You idiot!” says the first man. “I bought the exact same
time, but for two hundred and fifty dollars!”……
I hope this joke doesn't overemphasize my point about cost
and quality in health care, but to some extent there lays a hidden truth.
References
Goldhill, D.
(2013). Catastrophi care: Why everything we think we know about
health care is wrong. New York, NY:
Vintage Books.
Pollack, A.
(2013, December 18). Drug maker's donations to co-pay charity face scrutiny. Retrieved from http://www.nytimes.com/2013/12/19/business/shake-up-at-big-co-pay-fund-raises-scrutiny-on-similar-charities.html?pagewanted=1&_r=0
Sultz, H., &
Young, K. (2011). Health care usa: Understanding its organization and delivery. (7th ed.). Sadbury, MA: Jones & Bartlett
Learning
