WHACKED FACTS about Health Care
Peter Glickman, MD, Do No Harm Productions, LLC. Follow us on Facebook at The Open Healthcare Project!
…Because “Nobody knew health care could be so complicated” — a notable figure in current politics
The recent attempts at repeal of Obama’s “Patient Protection and Affordable Care Act” (to date unsuccessful) have had one good unintended consequence: more people than ever now realize that health care in this country is just ridiculously complicated. I’m a practicing radiologist in Manhattan, trained at Harvard Medical School and Harvard hospitals, who came to medicine after working in business for years as a management consultant, and before that as a student of philosophy at a small liberal arts college. Over about a decade of practice, and a decade of training before that, I’ve become fascinated with how our health care system works, and doesn’t work. I’ve been lucky enough to have lived and worked abroad too, in countries where the systems certainly have their challenges, but are seriously not nearly as whacked — namely Japan and Bolivia. I did a health policy fellowship in Washington DC during my training too, where I learned how our laws and regulations actually get written (short answer: lobbyists), which is a big part of why the system is so whacked. After a bout with a potentially serious illness myself, and helping numerous friends and family members navigate our system, and I decided to write “Whacked Facts” (broken up into 3 parts here, for easier digestion).
I believe I’ve learned some important lessons, and write this as a resource for the countless hapless patients in this country, as we struggle to understand and deal with our system. The whacked facts I write about here are, moreover, largely independent the details of Obamacare, or the alternatives advanced recently, and instead will probably remain true regardless of what happens with those efforts. That is, unless we implement a more radical reform, more sweeping than anything we’ve EVER seen here, such as single payer (although in other countries that type of system is so normal as to be ho-hum). As you will see, if you don’t know it already, American healthcare is truly WHACKED.
WHACKED FACT #1: Medical errors are estimated to kill more than 250,000 Americans every year (1). Yes, the equivalent of 5 Vietnam wars every year. If you don’t believe me, read reference #1. Some estimate the number of non-fatal errors to be up to 40 times that. This is not meant to scare you, but is related to something you should be aware of, something every doctor already knows: More medicine does not mean better medicine. While medical errors are of course not unique to US healthcare, there are arguably more opportunities for error here simply due to the sheer volume of medical procedures and treatments occurring in this industry that makes up 1/6 of our economy, which is much larger than in any other country. This leads us to the next whacked fact.
WHACKED FACT #2: The more tests and procedures you get, the more likely you are to have an abnormal result, just by statistical chance, since EVERY test has a small error rate. If your doctor isn’t careful about not over-interpreting the result, the more likely an error is to be made in treating you. The chance of an error is even higher if you’re not in a high risk group, i.e. not in a group that has a reasonable chance of having a given condition (because this was likely the group that was used to develop the test in the first place). This is why you need a good primary care doctor who won’t just test you for everything and automatically react to every abnormal result. In this sense, medicine is truly an art, rather than just a science. A test result is more likely to be valid, and interpreted correctly, when a doctor has taken a good medical history and examined you thoroughly before deciding to order a test. Sadly, our current system often does not allow for the time it takes to do a proper job of this. More on time pressures in a future blog.
WHACKED FACT #3: In some parts of the country, and even some parts of some cities and communities, patients get up to 10 times more medical treatment than in others. Now that you know the previous 2 whacked facts, you can predict this one: some studies show that the patients who get 10 times more medical care generally ARE NOT any healthier, and DO NOT LIVE LONGER than the patients who get less (2). In fairness, it’s not exactly so simple, and there are SOME relatively modest differences in outcome breaking down mostly along demographics and access issues, but it’s clear that simply getting more care doesn’t improve outcomes (3). So why do some patients get so much more care, if it doesn’t improve outcomes? Funny you should ask…
WHACKED FACT #4: The reason some patients get way more health care than others is mainly because the health care is simply more accessible in their areas, both because they may be more affluent, and because there are more services available (with an obvious connection between these two factors). Health care is really the most bizarre of businesses, where more supply often seems to simply generate more demand (4). For example, if a hospital in your area opens up a new cardiac catheterization lab (place to treat heart conditions), suddenly the rate of cardiac catheterizations will go up in your area. Not because more patients necessarily need the procedure, but simply because it’s now available, and doctors will start to refer patients to the center. Why does this happen?
WHACKED FACT #5: While I believe most doctors are good people and really try to help their patients without thinking too much about cost, the HEALTH CARE SYSTEM in this country is, at bottom, PROFIT-DRIVEN. In order to survive in our system, doctors and hospitals need to make profits (not just balance their books), often for shareholders who want a quick return on their investments, to stay in business. While business itself isn’t evil (unless you’re a communist, which I’m not), and of course works very well for all sorts of commodities like cars, airplanes, pork bellies, airline travel, electronics, etc., HEALTH CARE IS DIFFERENT.
Please continue to Part 2 for more Whacked Facts…https://medium.com/@donoharmushealthcare/whacked-facts-about-health-care-part-2-88d01bc330b3
1. Medical error — the third leading cause of death in the US http://www.bmj.com/content/353/bmj.i2139
2. The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care http://annals.org/aim/article/716066/implications-regional-variations-medicare-spending-part-1-content-quality-accessibility
3. The Elusive Connection Between Health Care Spending And Quality http://content.healthaffairs.org/content/28/1/w119.abstract
4. Mahar, Maggie. Money Driven Medicine, interview with Thomas Rice, p. 169. Harper Collins ebooks, 2006.