I could not agree more. We will spend $2.3 trillion on health care this year in the U.S., approximately $8,000 per person and twice the median per capita cost expended for health care elsewhere in the developed world. Yet we rank at the bottom of the First World in preventing deaths under age 75 amenable to health care.
Clearly we are wasting our resources. So here is a list of what we must give up if we are serious about health system reform.
Health underwriting: Every critically ill or injured person will be treated in our health system whether they have health insurance or not. Therefore, we should not waste resources trying to identify persons likely to have critical illness in order to exclude them by price or refusal from acquiring health financing. Community rating, guaranteed issue and risk-sharing will increase health system efficiency and eliminate the unfunded mandate that is cost-sharing.
Unsafe hospital practices: The fifth leading cause of death in the United States is preventable injury during hospitalization, which is associated with more deaths each year than are breast cancer, HIV or auto accidents. Caring for hospitalization-associated injury wastes $15 billion each year.
Inappropriate care: Back fusion surgery for uncomplicated degenerative disc disease occurs tens of thousands of times each year, but there is no clinical evidence that the surgery reduces pain or impairment more than nonsurgical care. Like all surgical interventions, back fusion surgery is associated with many complications, including infection, bleeding, device failure, neurological problems and clotting. Many other common medical/surgical interventions are likewise inappropriately used without basis in clinical science at great expense. We need a society-wide mechanism for applying clinical science to our health benefit.
Perverse incentives: From the Wall Street Journal on April 5: "Research at Dartmouth Medical School suggests that if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve. . . . Of course, not everyone can get treatment at Mayo. . . . But why [is] this example of efficient, high-quality care not being replicated all across the country? The answer is that high-quality, low-cost care is not financially rewarding. Indeed, the opposite is true. Hospitals and doctors can make more money providing inefficient, mediocre care."
Market-based health policy: If we are to eliminate the perverse incentives that lead to inefficient, mediocre care, we have to give up the cherished notion that health care is a commodity efficiently distributed by market forces. We do not principally fund health care through the private sector - 60 percent of revenues paying for health services come from taxpayers, making our citizens more taxed for health care than any people in the world. Beyond that, health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.
Benefit denial: Claims costs are at least 10 percent higher in Utah than would be optimally efficient. This is due primarily to the health insurance business model which features competition among health plans to most creatively deny payment for health services. In response, doctors and hospitals staff up their billing departments to fight for payment, leading to billions of wasted dollars in Utah alone.
A serious discussion by the Health System Reform Task Force requires attention to these six wasteful practices which we must give up. Let us fear the status quo in health care: billions in wasted taxpayer resources while patients die unnecessarily in the health system.
Those who oppose health system reform are really asking the taxpayer to fund corporate welfare while pretending to fight "socialized medicine."
---
* JOSEPH Q. JARVIS, M.D., is a public health consultant in Salt Lake City. E-mail: joseph.jarvis@msn.com
