A recent conversation in a doctor’s office:
Well, Mr. Horner, the results of your colonoscopy are negative.
Aw, dammit! Another wasted medical test!
Virtually every person who has studied America's health system agrees that at least 30 percent of health spending is unnecessary and unproductive. More tests, more procedures and more doctor visits don't mean better outcomes.
A breathtaking statistic, Tom. Speaking of colonoscopies, that figure must have come from the same place that Rush Limbaugh gets most of his statistics! Who are these students of health care, Tom? Inquiring minds want to know.
If we quit giving flu shots, only a small percentage of people would die, or even be hospitalized. Does that mean we should quit administering them? Tom would say, “Yes, of course!”
Every time a medical test comes back negative, Horner and his buddies probably think it’s a waste, defensive medicine. But then, Tom has probably never heard of differential diagnosis, the systematic identification of unknowns used by doctors to determine cause.
In his own careful assessment of the health care patient, Horner says:
Providing access to the 45 million Americans who are without insurance -- and that's a competitive necessity, not just a moral imperative -- will require more efficient use of the resources already being spent. Some of the efficiency will come from changes in how we purchase our care, some of it will be driven by changes in how health providers are reimbursed and some will come from the technology adopted to make everything from access to recordkeeping more streamlined.
None of this will mean beans if we continue to off load a quarter to a third of our health-care spending on the insurance industry. Horner may be right about the percentage of waste, but he’s looking in entirely the wrong place.
The 45 million people without health insurance are a rather unlikely place to look for overuse, too.
For evidence that our problem is not in overuse of care but in the insurance system, one needs only to look at the recent OECD report issued on several measures of well being in the 30 member countries:
Infant Deaths: 28 out of 30 (Mexico, Turkey). [!]
Life Expectancy: 24 out of 30 (Mexico, Turkey, Hungary, Poland, Czech & Slovak Republics). [!]
Health Expenditures: 1 out of 30. [!]
Poverty Rates: 28 out of 30 (Mexico, Turkey).
Child Poverty: 27 out of 30 (Mexico, Turkey, Poland).
Income Inequality: 27 out of 30 (Mexico, Turkey, Portugal).
Obesity: 30 out of 30.
Incarceration: 30 out of 30.
Work Hours (ranked in ascending order): 30 out of 30.
Height (women): 25 out of 30 (Mexico, Turkey, Korea, Portugal, Japan).
Height (men): 24 out of 30 (Italy, Spain, Mexico, Portugal, Korea, Japan).
The countries in parentheses are the ones that the US bested in each category. We’re getting comparatively shorter, by the way, another marker of relative health, or rather declining health. It’s beyond the scope of this relatively short post, but studies do pretty consistently show that in several measures of outcomes, our system does not fare well compared to most other industrialized countries.
So, instead of blaming the providers, Spot says blame the politicians and the business people who are the ones responsible for the mess, including the (cough, cough) bright lights who invented managed care.