The forces that shape heatlh care

Thinking about the programs for health care reform proposed by the three Presidential candidates highlights a distinct peculiarity of American style health care.

American health care is shaped to an unprecedented degree by five forces:

1) The drug industry

2) The health insurance industry

3) Hospitals

4) Fear of litigation

5) The uniquely American attitude of refusing compromise in access to health care services or products, regardless of the cost (for those who can afford health insurance)

All five of these unique forces have created this thing (monster?) we call health care. Remove or modify any one of these forces, and the health care landscape would look dramatically different.

The drug industry has recently been on the receiving end of plenty of negative press. This warms my bones. Decades of heavy-handed lobbying, sleazy marketing to physicians (all too willing to be wined and dined), and behind-the-scenes manipulation of clinical data are coming back to bite them. Sadly, the drug industry is so powerful that this bit of fuss is not likely to substantially change their ways.

I am thrilled that all three Presidential candidates agree that reimportation of drugs from outside the U.S. is a good idea. While the shrug of the shoulders federal and state attitude towards importation of drugs from Canada has not resulted in cost savings sufficient to impact on overall costs, it surely will lead to savings when practiced on a broad basis by pharmacies, distributors, and other bulk buyers of pharmaceuticals.

Senator Obama, in particular, has used strong language in his criticism of the health insurance industry, tough talk that is needed in an age in which insurance executives bring home salaries in the hundreds of millions of dollars and stock prices are climbing due to substantial profit gains within the industry, going against the grain of increasingly costly premiums. However, the Clinton experiment of federalizing health care during Bill Clinton's term that caused all the big boys to band together (most notably health insurance companies and drug industry) has tempered enthusiasm for attacking the insurance industry head-on. In both Democrats' health care reform proposals, the option of private insurance is preserved, as it is in the McCain proposal.

How about hospitals? Hospitals, though on a smaller scale than the nationwide reach of the drug and insurance industries, aim to maintain health service delivery in hospitals. For instance, the high-tech bypass service in the hospital gets plenty of local media coverage, as does the newest DaVinci robotic surgery, bariatric surgery, and other revenue-rich services. Many hospitals have forgotten that their mission is delivery of health, of which revenue creation and profiting from disease should only be part.

How big is fear of litigation? Estimates vary, but several have quoted numbers in the neighborhood of 20 to 30% of overall health care costs. At the street level from what I see, I'd say at least that much. Fear of litigation is rampant, often unrestrained, and sometimes leads to the craziest, illogical sequence of testing. Chest pain, for instance, no matter how trivial, will typically trigger around $5000 worth of testing (nuclear stress test, echocardiogram, laboratory work, etc.) Emergency room visit for a minor injury? CT scan of head, chest, abdomen. A formula to minimize this aspect of fear in health care delivery would generate enormous savings.

The last issue, the uncompromising nature of Americans in health--always wanting the latest new drug, new procedure, "best" surgeon--often simply causes the health care consumer to fall victim to marketing. If a hospital advertises the newest procedure, people want it regardless of whether it represents genuine improvement over the older procedure. The newest sleeping pill, antidepressant, antihypertensive, etc. replaces the old yet equivalent product, but at considerably greater cost.

I am optimistic that, regardless of which candidate gains the White House, that some reform is on the way. I do fear, however, that progress will be small and incremental, since major change of the sort that would slash hundreds of billions of dollars in costs would rouse the powers-that-be (drug industry, health insurers, etc.) to once again combine forces and combat the disruption of their franchise.

Until you and I see real change and cost savings coming through either legislation or free market advances, we need to continue to make full use of the self-empowering health information that we gain through venues like the web.

Copyright 2008 William Davis, MD

Comments (5) -

  • Anonymous

    5/9/2008 12:25:00 PM |

    I know some ladies at my barber shop that will enjoy reading this article.  2 hair cuts ago I mentioned the TYP program to my barber.  To my surprise when i came in for my last cut 5 hair cutting ladies began questioning me about heart health, and wanted my opinion on the up coming Presidential elections and what it means for the health care industry.  One lady asked questions about where can one of her customers be tested for lipoprotien A.  I was impressed.  

    I recently mentioned to my father what happened so he decided to try the same with his Florida hair cutter.  Same interest from all the barbers in the shop happened to him  he told me last night.

  • vin

    5/9/2008 2:49:00 PM |

    You can add GREED to the list.

  • Anonymous

    5/10/2008 4:36:00 PM |

    I have thought for some time that the medical services industry resembles a 3 headed dog (providers, pharma and insurance companies): all 3 heads snapping away for their piece of the poor consumer....
    Many changes need to be made but there is so much pressure (money) to maintain the status quo that I don't think it will ever happen.
    What would shake up the industry would be for more people to take responsibility for their own health and not put so much trust in the system!

  • Anonymous

    5/12/2008 11:56:00 PM |

    Isn't it strange how our government supports expensive treatments and drugs needed AFTER one gets ill?  Once we are in trouble, we are generously allowed to claim tax deductions or pay for drugs and treatment out of tax free Flexible Spending Accounts.

    It would make more sense to allow us to use those tax free Flexible Spending Accounts to help pay for the supplements and life style choices required to PREVENT getting ill in the first place.  --- Too bad:  supporting prevention does not generate useful cash flows for the health care industry, it does not generate incomes for lobbyists, and it does not generate campaign funds and votes for politicians.

  • kamagra

    8/15/2010 6:10:48 PM |

    I have thought for some time that the medical services industry resembles kamagra and cheap kamagra(providers, pharma and medicine ):