My Doctor Says Health Care is Doomed

Last week, one of my best friends visited me in Vermont.  His name is Brett, and he’s also one of the brightest people I know… 1600 on the SATs, Dartmouth for undergrad and med school. He’s now an internal medicine doctor in the Pacific Northwest, and has some real concerns about the state of health care in America.
It was after dinner when the kids were asleep that we ventured down to my wine cellar.  We saddled up at the tasting table and began enjoying a 2009 Ken Wright Pinot Noir – a great wine from one of my favorite vintners.  
We quickly got into a discussion of Obamacare and the government shutdown.  But I was most interested in his thoughts on the state of U.S. health care system.
Dr. Brett shocked me when he said that the entire health care system in this country is unsustainable. I knew it was bad… but not this bad.
He went on to tell me about the “over-testing” that happens every day.  Today there are far greater numbers of medical tests available than ever before. And thanks to the Internet, patients are better educated than ever before.  
Now there is nothing wrong with informed patients.  But as a result, some are second-guessing their doctor’s recommendations and often requesting additional unnecessary tests. 
Dr. Brett tries to avoid ordering excessive tests.  But when a vocal patient is demanding more, it’s easy to cave in. With a busy schedule, most doctors can’t take 30 to 60 minutes to meet with a single patient.
One additional aspect of the system even encourages more testing.  Litigation in health care is rampant. That means a doctor who failed to order a specific test could be sued if the patient subsequently gets ill or dies. As a result, it’s safer for doctors to err on the side of caution by ordering more testing.
And financially, neither the patient nor the doctor has any incentive since they’re not paying for the test. And in most cases, they don’t even know what it costs. Insurance companies, Medicare or Medicaid will simply pickup the tab. 
But the result of all these tests is that more potential health issues are discovered. And those findings lead to more medical procedures.  
Some of those procedures are required, and lead to positive health outcomes.  But large portions are completely unnecessary… and costly.
Over the next 10 years, health care costs are expected to rise at 6.2%. That’s more than twice the rate of inflation.  And means that in just 10 years, health care costs will equal one-fifth of our entire country’s GDP. I have to imagine excessive screening and more procedures are a big part of the problem.
I also talked with Dr. Brett talked a bit about cancer patients as one example.  He says if people live long enough, cancer will almost always kill them.  
More frequent testing of patients leads to more cancer removal procedures.  For some of these people, their cancer was benign and never would have affected their health. Or it would have killed them when they were 80 or 85 years old. Yet doctors and patients are choosing to remove cancerous cells even if they don’t appear risky. 
Cancer testing is just one example of types of tests that lead to unnecessary and invasive medical procedures. Not only is this costly, but they can actually have a negative impact on an individual’s health.
But this is one of many factors contributing to soaring costs.  The unfortunate part is that high health care costs aren’t translating into longer lives.
In the U.S., we spend $8,233 per person on health care. That’s 2.5-times the spending in the average developed country. 
Yet, life expectancy in America is far from the top. In fact, America currently ranks No. 33 among the world’s nations for life expectancy.
So when you look at the return on that incremental health care spending per capita, it’s clear that we’re not getting better health outcomes.  
The fact is that Obamacare will bring some reform to the health care system. But it does little to create incentives for insurance companies, medical professionals and patients. And it won’t curtail excessive testing and procedures that are just one part of soaring health care costs.
The health care system in this country is deeply flawed.  I’m not a doctor.  And I don’t have the answers.  But it seems that if we want to change behaviors, we need to change incentives.  Unfortunately, politicians on both sides have been unable to take the required steps to reform a flawed system.
I want to hear your thoughts on the health care system. Please send me an email at [email protected].  I want to hear your thoughts on how we should tackle this problem. 
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