| Lifelong Health: Health Care Overhaul Tied to Medical Basics Politicians have been battling the issue of health care overhaul for the past year, and frankly, resolution on the horizon is unlikely. Until our legislators can offer true solutions to curb costs, improve health outcomes and help every American live a healthier life, the responsibility to improve health care lies squarely with patients and physicians.
In America, a significant fraction of health care is often excessive, unnecessary and too aggressive. Plus, there is a clear tendency to use more expensive, newer technologies over cheaper, older approaches. Controlling quality of care can go hand in hand with curbing the rising cost of care.
Recently, some of the wisest advice has come from Dr. Howard Brody, a leading bioethicist from the University of Texas at Galveston. In an editorial published in the New England Journal of Medicine, Brody shows that the medical profession has made little effort to reduce health care costs, claiming that some medical groups have made their support of change contingent on continued reimbursements rather than quality care. Brody believes that the only way there will be constructive and viable improvements in our health care system is for physicians to take the "high moral ground" and direct reform toward improving the practice of medicine.
To this end, Brody proposes a "top five" plan, in which every medical specialty would employ a blue-ribbon panel of experts to identify the top five procedures in their field -- carefully defining the indications to justify each treatment. Once this is made available to physicians and the general public, it will establish a baseline of expectations, making it difficult for a single physician to recommend a procedure for which there is no benefit. By eliminating unnecessary treatments, physicians could save one-third of health care costs without depriving patients of beneficial care. Brody believes that "we may astonish everyone by changing the entire reform debate for the better" -- I agree.
The data is compelling that physicians can control costs. To better understand how cost of care can fluctuate, take a look at the regional studies that compare the annual price of health care in different cities and counties. The cost of health care is substantially higher in communities with physician-owned hospitals. These doctors not only profit from the care they deliver, but they also profit from tests, procedures and hospitalizations.
In these scenarios, the physicians are more likely to treat patients with inappropriate, unnecessary and expensive health care. There is also evidence that hospital groups save money when they insist that care be based on sound scientific evidence of benefit.
Brody also faults physician groups for blaming the costs of care on others. For example, the American Medical Association suggests that high costs are due to litigation and malpractice. While this is certainly a concern for physicians, malpractice plays only a small role in increased costs. Similarly, there is little evidence that high insurance rates are at the core of America's enormous health care costs. Tighter controls might prevent excessive profits, but the idea that American health care can be saved by increasing insurance competition is preposterous.
Yes, insurance companies play a huge role in health care change. But rather than addressing policy rates and competition, the insurance industry should change the way physicians are compensated. Currently, doctors are paid by the number of patients seen and tests performed, which creates a terrible incentive structure. Reimbursement should be tied to quality of care, rewarding physicians for managing a patient's chronic illness, preventing further disease and eliminating unnecessary tests. This is particularly important as Medicare plans to cut payments to doctors by 21 percent. This disastrous approach to controlling costs will either force primary care physicians out of business or intensify the already out-of-control tendency to do more tests and more procedures simply to make a decent salary.
Health care change does not have to be complicated. We need not discuss government takeovers, death panels or health savings accounts. Instead, help physicians practice quality care and pay them well for having healthy patients.
Teach patients that sometimes less is more and newer does not mean better. It is simple: Get back to the basics of medicine.
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Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com. Copyright 2010 Creators Syndicate Inc. |
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