Health Care in Crisis: The Cure for Health Care?
Editor's Note: This is the epilogue of a five-part series on the health-care crisis.
President Obama recently said of his plans to reorganize health care in America: "I want to get it right, but I also want to get it done promptly." In this case the President is wrong.
Sorting out the expensive shortcomings of the practice of medicine, treating as it does the biological complexities of human life, will demand time. It will take hundreds of individual studies to determine how to improve our health-care system while lowering its costs. And because this issue deals with the quality of our lives, assuming it's not the saving thereof, we are talking about a resolution that should take years of thoughtful investigation. Therefore, one can either "get it right" or "get it done promptly." Not both.
This series of columns was not a scientific study. It was simply a retelling of a few of the cases reported to me from the immediate families of my closest friends and associates. Only half of the medical case stories told to me wound up being included; I chose to use these stories because I felt they would resonate most with readers' fears and concerns and might remind them of events in their own family medical histories. In many of the cases we published the final bill for treatment, highlighting the high cost of medicine today.
Because of the HIPAA Privacy Law, many of the physicians involved can't comment on the cases involving their patients. But I want to thank the families who allowed me to tell their stories, some related while the family was still grieving. Moreover, most people consider medical care and its costs among the most private of family matters. It took great courage to let me relate their experiences, but they did so in the hope that their stories might focus and improve the national discussion on health care.
Facts and Findings
Here's what I did not find. With two exceptions, no one complained about the physicians, treatments, or operations, even when the outcome was a loved one's death. No one complained about the reimbursement from their health-care provider; in fact, many said that "I didn't have to pay a penny." Most did raise the concern that any changes to health care like the ones planned today could have made their family's situation worse.
Here's what I did find. When I related these stories to others with whom I came in contact, they immediately would tell me a similar story from their family history; members of the Baby Boom generation seemed especially concerned about the vast assortment of medications being prescribed for their parents. Doctors shared concerns about patients demanding medications they've seen touted in pharmaceutical ads on TV. The number of individuals who related stories of friends and family who had died from cancer was high, and they struggled to think of anyone they knew who has survived that dreaded disease. I personally know only four living cancer survivors today.
In all these stories, unnecessary or financially questionable surgeries seemed to lead the list of things raising costs, and in this I include operations made necessary by earlier treatment errors. Unnecessary prescriptions or treatments came in a distant second. But the most troubling issue I perceived was the lack of communication between two or more physicians in different locations treating the same patient. The next most troubling was medical professionals missing the most obvious issue when diagnosing new and sudden serious medical problems—that being known side effects of recently prescribed drugs.
And did anyone else notice how many lifetime nonsmokers and nondrinkers in this group developed serious medical problems that are often publicly associated with those vices?
Be Careful What You Ask For
This has not been a series on how to fix America's crisis in health care. That cannot be done in the 12,000 words allotted for this series. It is doubtful that, if anyone truly explored all the issues involved, everything could be covered in a single book. This series simply pointed out medical case histories of people close to me and the cost involved. It's my hope that the national discussion can become more pragmatic and deal with the real medical issues that Americans will all one day face.
After researching this issue for some time, however, I believe I know a great place to start reforming the system. It's with the physicians and their medical staffs. Yes, doctors and their staffs have offered well thought-out suggestions on how to improve health care in America while lowering its costs. Certainly a few doctors or insurance companies have strong financial vested interests in keeping the system in place as is. Good for their bottom line, but probably not good for America. That is not the view of the majority; most medical professionals I talked to explained to me that they well understand that the expense of our current system is not sustainable, and changes will have to come.
This undoubtedly requires a long-term study by teams of efficiency experts and medical professionals; their knowledgeable eyes would be needed to detect and sort out all the errors and waste. After reaching conclusions, they could collaborate with health-care professionals on guidelines that eliminate miscommunications, overly zealous prescription demands, unnecessary testing, and most unnecessary surgeries. One might well start at the Mayo Clinic, one among many, to understand what works well.
In the end, maybe our financial crisis in health care simply mirrors our demands on the system. We have all come to believe that no matter what our lifestyle is—whether it is our eating habits, our sedentary habits, or smoking or drinking to excess—some doctor, some surgery, some medicine will save us from ourselves. Further, many Americans have come to believe that health care paid for by "someone else" is our entitlement. In that respect, Americans today have exactly the health-care system we have demanded: It has the highest costs anywhere—and we have shorter life spans than citizens of most other industrialized nations.
There is one statistic I would caution everyone on: "Eighty percent of all health costs in America go to only 20% of the population in the last two years of their lives." While that statement is true, it immediately conjures up the mental image of our oldest Americans suffering from the ravages and diseases of aging. But just as often the statistic embraces a much younger person, possibly the victim of a major automobile accident, whose life the trauma surgeons saved immediately—even if the patient still died soon after. Eighty percent of that victim's lifetime health-care costs were also spent at the very end of his or her life.
A Blue-Ribbon Panel
Four years ago, Rick Wagoner, then CEO of General Motors, and I sat in the executive conference room at GM to discuss the high cost of health care, which was causing the automaker tremendous financial pain because of all the retirees it then supported. My suggestion to Wagoner was that we needed to create a blue-ribbon panel of experts in the field. It should include physicians, hospital administrators, and representation from both business leaders and the insurance industry. Yes, the most respected American leaders pooling their brilliance to tackle one of the most pressing issues of our time.
The focus of their report, I urged, should not be on how to change the system, but just on identifying why our costs are twice what other industrialized nations spend per capita. I went on to suggest that the report be released without prejudice: A simple explanation of the facts, but with no conclusions on how to fix the system. That would remove any suggestion of vested interests' hijacking the report at the same time giving the American public an idea of the real costs we are facing.
Only then, once all of the facts are known, can reasonable plans be drawn up for our future and for health care. Wagoner dismissed the suggestion. Let's hope wiser heads won't.
Note to Washington: You probably can change the system promptly—but you definitely can't do that and get it right.