Why does health care cost so much
Americans are desperate to discover the best way to reform our country’s broken health care system. But until we understand the forces driving American medicine and the real reasons for our system’s dysfunction, we won’t be able to effectively demand and get health care that truly heals.
Waste, misspending, and bureaucracy in health care routinely cause our loved ones unnecessary harm. We must pay attention to the stories of the many victims of our broken health care system if we are to going to find the path to better care and true healing.
Like the middle-aged mother with high blood pressure who suffers a massive stroke that destroys her life and costs taxpayers hundreds of thousands of dollars — all for lack of a simple blood pressure medicine that costs $4 a month.
Or the father with a little chest pain after eating too much who was rushed through the emergency department into an unnecessary heart catheterization procedure that exposed him to high doses of radiation and danger of heart attack — all for lack of a simple history that would have demonstrated his problem was acid reflux.
Or the 75,000 poorly controlled diabetes patients each year who have a foot cut off resulting in unnecessary suffering, disability, and tremendous costs — all for lack of robust and easily accessible primary care to treat diabetes before it causes nerve damage.
By focusing on expensive “too-late” hospital care rather than primary and preventive care we all suffer.
What can we do?
Stop paying for so-called “care” that doesn’t heal
One in five tests, procedures and surgeries performed in the U.S. are unnecessary or inappropriate. Many of the most expensive common procedures such as steroid injections, arthroscopic surgery for knee pain, and back surgery for chronic back pain have been proven not to work most of the time.
We can all get better care by asking many more questions before we agree to major tests, procedures, and surgeries. If you aren’t confident that a procedure will benefit you, just say no.
Avoid dangerous tests, procedures, emergency departments, and hospital stays whenever possible
The U.S. spends over $700 billion — one-quarter of all healthcare spending — for procedures, tests, and hospital stays that do little or nothing to improve health. We all foot the bill for costly emergency room care through skyrocketing insurance premiums and taxes.
Yet millions of people lack inexpensive and lifesaving preventive care. Demand that your clinic, health group, or health plan offer low-cost care when and where you need it.
Home visits cost far less than ER visits. Most countries in Europe offer doctor or nurse home visits after-hours. Why can’t we?
Demand dedicated “concierge” primary care providers for everyone
Most people think concierge doctors who know you and your family, who answer the phone and speak to you directly, and who make house calls when your child is sick are only for the wealthy. Yet in many countries, personalized care when and where you need it is the norm.
Concierge care costs far less than expensive ER’s. Demand that your state’s medical schools start graduating more primary care doctors and nurses. Insist that your insurance company and the government stop paying for expensive ER care for non-urgent conditions and start paying for concierge “patient-centered medical home” care first.
And get a dedicated primary care team to help you and your family get the primary and preventive care you need most, when and where you need it.
Get needed medicines for half the cost and make food our first medicine
The U.S. pharmaceutical industry is reaping exorbitant profits at your expense. Big Pharma’s research is mostly subsidized by the federal government. Pharma spends most of its money on perks, advertising and marketing, not drug development. And it gets to charge us whatever it wants. Medicare and Medicaid are prohibited from bargaining on drug costs.
Demand that your government be allowed to bargain with drug companies for the best price it can get (just as Walmart does) rather than paying “what is usual and customary” (i.e. whatever the pharmaceutical company wants). Get your medicines from other countries where the same drugs cost half as much or get less costly and equally effective generic medicines here.
Cut out insurance, pharmacy, hospital, and testing middlemen who profit at our expense
The U.S. spends $800 billion on health care bureaucracy and administration, far more than any other nation in the world. Giant insurance, pharmacy, hospital, and testing industry middlemen are getting rich through bureaucratic rules designed to protect their monopolies and profits rather than your health. And they are currently allowed to hide from you and your family what things really cost.
Demand that Congress focus on cutting bureaucratic waste instead of cutting people off from insurance. Ask what everything costs, and demand a better deal. Take charge of your own health care dollars by getting a health savings account. Know where your money goes. Decide for yourself what services are worth the money and which are not. All people deserve to have a say about how their money is spent for their health.
The U.S. is a prosperous country with plenty of money in the health care system to improve outcomes, cover basic services for everyone, and reduce costs — if we spend wisely.
Rather than cut people from insurance rolls, we must cut wasteful health care spending and invest the savings in health care that truly heals.
Dr. Jim Bailey, M.D., is Pearce Endowed Professor and director of the Center for Health System Improvement at the University of Tennessee Health Science Center, and author of the novel “The End of Healing: A Journey through the Underworld of American Medicine.” Contact firstname.lastname@example.org
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