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Posts published in “Day: August 8, 2019”

We have met the enemy …


Everyone rails against the cost of healthcare in these United States, but honestly, we have done just a little to address the problem. I’m not sure things are bad enough yet for us to have the motivation to look in the mirror. Because, for healthcare to cost less for all of us, some of us, maybe all of us will have to give up something, and right now we Americans are blaming everyone else for our problems. Americans aren’t really in the mood for any small sacrifice, no matter if we would all be better off; just look at Congress’ and our President’s spending habits of late.

No, this mess is wholly ours. It’s not Muslims, Mexicans or the Chinese who have driven our healthcare costs to be unaffordable to middle income Americans; it is us.

If we are going to start laying blame, we can all bear some.
We have come to expect medicine to solve every problem, from our kid’s behavior to the existential malaise of working hard at a thankless job. Pharmaceutical companies are glad to profit greatly off this desire for peace. And we are happy see our 401K’s swell as Pharma stock climbs.

More, we don’t have the patient understanding that most ailments are self-limited; many things resolve with “benign neglect”. And the medical profession responds happily to these instant needs with instant access: Redicare, QuickCare, UrgentCare. But the continuity of care is missing and tests are piled on tests. Treatment pleases most consumers more than watchful waiting, so medications, quick fixes are prescribed.
We value “the best” when often “good enough” will do, so specialty care is well-compensated and much desired by both patients and practitioners, when primary care has been shown time and again to be the most cost-effective care.

We avoid difficult conversations, with our healthcare providers or even ourselves about painful, but health-affecting behaviors. We should reflect on our weight, our exercise, our diet, our habits, our sleep, our spiritual and interpersonal relationships. Sometimes we pretend our deaths are not inevitable.

How does the truth that 50% of health care costs can be attributed to 5% of the population strike you? If you are in the less costly 95% do you feel lucky for your health, or are you angry that you are paying for someone else’s greater needs? Do you find yourself questioning their treatment choices? Would you like to be a part of the discussion around their bedside about the chemotherapy, the transplant? If you see the sick 5% as the enemy, then I challenge you to define who is “us”.
There are things public policy can do to pinch the costs of healthcare. The Affordable Care Act did a scant few.

Hospitals were not paid for any costs of complications they caused. Guess what, complications went down.

Taxing medical appliances was another attempt to make the highly profitable medical appliance market more competitive, but it quickly got overturned by Republicans.

Fees proposed on “Cadillac Health plans” to pay for the costs of health insurance subsidies on the individual health insurance exchange was another attempt to even the health care benefits playing field. But Democrats and Republicans are going to throw this under the bus and the Federal deficit will balloon another $400B. No, there’s not a lot of courage out there in the healthcare discussion right now.

We cannot expect our elected representatives to have courage in the face of these difficult policy decisions when we aren’t prepared to have these cost discussions with ourselves; in the mirror, with our family, with our doctors. Don’t be afraid to know yourself. Please; the only way to defeat a strong enemy is to know them well. In this instance, they are us.