I’ve written about this before myself, but Robert Reich absolutely nails it in a recent blog post. Our health care system is so expensive in large part because it’s designed to be: if there’s more money to be made in expensive treatments that don’t really solve the problem, it will arch towards those treatments. We know how to help people much more than we do, but the current system isn’t set-up to recognize the best treatment as the best option.
Reich’s extended riff is below.
Almost 95 percent of cases of lower back pain are best relieved by physical therapy. But American doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. There’s not much money in physical therapy.
Another example: American doctors typically hospitalize people whose diabetes, asthma, or heart conditions act up. Twenty percent of these people are hospitalized again within a month. In other rich nations nurses make home visits to ensure that people with such problems are taking their medications. Nurses don’t make home visits to Americans with acute conditions because hospitals aren’t paid for such visits.
An estimated 30 percent of all healthcare spending in the United States is pure waste, according to the Institute of Medicine.
We keep patient records on computers that can’t share data, requiring that they be continuously rewritten on pieces of paper and then reentered on different computers, resulting in costly errors.
And our balkanized healthcare system spends huge sums collecting money from different pieces of itself: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.
A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.
Cutting or limiting Medicare and Medicaid costs, as entitlement reformers want to do, won’t reform any of this. It would just result in less care.
In fact, we’d do better to open Medicare to everyone. Medicare’s administrative costs are in the range of 3 percent.
That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
Healthcare costs would be further contained if Medicare and Medicaid could use their huge bargaining leverage over healthcare providers to shift away from a “fee-for-the-most-costly-service” system to a system focused on achieving healthy outcomes.
Medicare isn’t the problem. It may be the solution.
It’s worth adding that the journal JAMA Internal Medicine is actually publishing a series called “Less is More,” highlighting cases when “the overuse of medical care may result in harm and in which less care is likely to result in better health.”