Tuesday, March 5, 2013

Money-Driven Medicine

Time magazine recently published a massive article on health care, “Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill, that should be read by every citizen of this country. Prepare to be disgusted and outraged as you read it. The noble field of medicine has been turned into a machine to manufacture profits.

I have had a couple of personal experiences with this machine lately.
Last fall my husband had a respiratory infection he just couldn’t shake. When he went to his doctor he was given a chest X-ray and the technician who read the X-ray said there was a strange spot on his lungs. Later that day the doctor called Arthur and suggested he have an MRI the next day, as if this was a matter of life and death.
Arthur didn’t go for the MRI right away, but after a couple of weeks, when he still felt bad, he went. Maybe the doctor was right to be so emphatic about getting the test, we thought, maybe there really was something seriously wrong in his lungs and it would be crazy to ignore it.
Arthur’s doctor is associated with our local hospital system, which is connected with the huge diagnostic center where he had the MRI. The test was negative; there’s nothing wrong with his lungs.
Mr. Brill wrote about the part that diagnostic machines play in medicine’s manufacture of profit:
According to a McKinsey study of the medical marketplace, a typical piece of equipment will pay for itself in one year if it carries out just 10 to 15 procedures a day. That’s a terrific return on capital equipment that has an expected life span of seven to 10 years. And it means that after a year, every scan ordered by a doctor in the Stamford Hospital emergency room would mean pure profit, less maintenance costs, for the hospital. Plus an extra fee for the doctor.
Another McKinsey report found that health care providers in the U.S. conduct far more CT tests per capita than those in any other country — 71% more than in Germany, for example, where the government-run health care system offers none of those incentives for overtesting.
Before the MRI Arthur was injected with a chemical that caused a very uncomfortable feeling of heat in his entire body. He probably had pneumonia and was subjected to this MRI for very dubious reasons if you were just considering his health. But there was nothing dubious about the reasoning from the point of view of our local medical profit-factory: Arthur has insurance so he should be fed into the machine.

Last fall I went to the eye doctor for a routine checkup. Over the last year or two, my eyes would sometimes seem sticky. When I asked the doctor about that, she replied, “Oh that’s just dry eye. Try these drops.” And she reached into a drawer and pulled out a couple of little boxes; free samples of a commercial eye drop product.
I was already aware that my body was very dehydrated. Some mornings I would wake up and it would feel like my mouth was a dry riverbed, as if there wasn’t an ounce of spare moisture in my entire body. A friend who is knowledgeable about alternative medicine told me that the adrenal gland, which helps the body stay moist, doesn’t work as well as we get older, and that’s why we can easily become dehydrated. We say “old people are wizened,” and by that we mean dried up like a shriveled old apple.
So I had already started a campaign to hydrate myself before I saw the eye doctor, and the visit just confirmed me in the wisdom to keep working on it. I never did use any of the eye drops.
Three months have gone by; yesterday I was a little dehydrated and I could feel my eyes were a little dry, and it occurred to me: my eyes haven’t been sticky for months. My hydration campaign solved the problem.
But: Why didn’t the eye doctor tell me to hydrate myself? Was she not aware of the link between dry eyes and a dry body? How could my eyes be healthy if they aren’t getting proper moisture from my body? The doctor didn’t help me attain health and thereby solve my problem; her “solution” was to mask the problem. Coincidentally that would have pushed me into the profit-machine—I’d have been buying eye-care products for the rest of my life. What kind of health care is this? It’s money-driven medicine, that’s what. It’s not about health. It’s about profit.
When the Affordable Care Act (aka Obamacare) was being debated I wrote a column that quotes from a book entitled Money-Driven Medicine: The Real Reason Health Care Costs So Much, by Maggie Mahar (a financial journalist since 1982). The title of her book says it all; she shows how, in too many cases, the profit motive trumps the well-being of patients in this country.
For example, a Dartmouth University study published in “Health Affairs” in 2004 showed that there was an inverse relationship between quality of care and money spent. That is, in regions where more procedures and tests are done the medical results are worse. The researchers concluded that one-third of American health care spending is wasted.
If you’d like to read an in-depth look at this study, Atul Gawande wrote about it in the New Yorker in 2009 (“The Cost Conundrum).

It's unfortunate that this Time magazine article didn't appear three years ago when the debate about Obamacare was going on; maybe we'd have had a better chance at getting the public option included in the final bill. My dream since the passing of Obamacare has been that this is just the first step on the path to universal health care. Perhaps this article will help speed that day's arrival.

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