THE $20 ASPIRIN

THE $20 ASPIRIN

 

People often ask, " Why is medicine so expensive in the United States?" This simple question requires a complicated series of answers.

 

As recently as 60 or 70 years ago, if you were sick, there was relatively little the medical profession could do to diagnose and treat your ailment.  Beyond some simple x-rays, a few antibiotics, and some rudimentary blood and urine tests, the armamentarium of the physician was relatively bare compared to what it is today.  Our science has developed noninvasive ways of looking inside your body such as ultrasound, CT scan, MRI scan, and PET scan.  The cost of each of these machines runs from $100,000 to several million dollars.  Each require technicians with specialized training to run them, and physicians with specialized training to interpret the results.  As expensive as these machines are, they quickly become obsolescent and require replacement due to the demands of the public as well as the newly minted doctors trained in their use.

 

While we are a long ways away from finding the cure for cancer, there are number of cancers today that actually can be cured with a combination of available treatments.  For many others, there are treatments which can slow down the progression of the disease.  Unfortunately, the cost of these therapies runs into the hundreds of thousands of dollars and more.

 

The public appears to have an insatiable appetite for news regarding health care.  Newspapers, magazines, television, books, and the Internet have combined to provide a prodigious amount of information regarding health and disease.  Unfortunately, the media approach is often sensationalistic, and designed more to generate fear leading to more media consumption than to the dissemination of the real facts.  For those without medical or scientific background it becomes difficult to separate the wheat from the chaff.  Nonetheless, most doctors will readily tell you that their offices routinely have to deal with the worried well.  These patients consume significant health care dollars in their recurring need for more tests to reassure them they are not suffering from an as yet undiscovered malady.

 

The ever-looming threat of malpractice motivates doctors to order more and more tests from an ever-growing armamentarium.  Because there are few studies that can be considered 100% conclusive, there is continued escalation of tests driven both by patient demand and malpractice worries.  The growing intrusion of both courts and legislatures into the practice of medicine fuel this process.

 

We have both a mobile society as well as an insurance system that forces patients to frequently change doctors.  Since we lack a system of readily available health records, and because patients are often ignorant of what tests they already had done nor the name of the facility which has performed them, there often results duplication of studies.

 

We as a society have done a very poor job of accepting the reality of death, and have failed to parse the distinction between the prolongation of life and the prolongation of death.  There’s a poor understanding of the hospice movement not only by the general public but also by many physicians.  Despite the fact that it has been around for over 30 years, and that 98% of families have given high marks to hospice and would recommend it to their friends and family members, the program remains underutilized.  This is a topic that deserves its own discussion, and the one that I will address in a following piece.

 

People are justifiably outraged when they receive a hospital bill showing a $20.00 charge for an aspirin.  The fault, however, lies within the arcane system of charges forced upon hospitals by the bureaucracy of insurance companies and the government.  There are a large number of unfunded mandates such as laws requiring hospitals and doctors to provide care to any one walking through the doors regardless of their ability to pay; state mandated staffing ratios; state and federally mandated utilization review programs, infection control programs, quality control programs with increasing number and complexity of reporting requirements – all of which require significant expenditure of staff time and effort.  As there exists no direct means by which hospitals and physicians can bill for these services, the costs of these unfunded mandates get bundled into other allowable charges.  Hence, the $20.00 aspirin.  If grocery stores were required by law to provide food for any one who was hungry regardless of their ability to pay, if hotels were required by law to provide shelter to any one unable to afford it, then the cost of these services would rise exponentially, or it’s providers would go bankrupt.  With 40% of the population having no health insurance, we are seeing evidence of both of these consequences.

 

If the picture I am painting looks bleak, indeed it is.  I sit on the financial committee of the board of a nonprofit three-hospital system in a reasonably affluent area.  For four years we have lost considerable amounts of money, and only in the last two years following staff and program cutbacks have we been able to eke out a 1% margin.  Unfortunately, while this is an improvement over our past performance, it does not allow us to even replace worn out equipment and infrastructure, much less build for the needs of the future.  Based on the experience of other facilities near us that have been forced into bankruptcy, there’s no one in the public or private sector who will take over our operations should we fail.  If we close our doors, we can expect that 150 to 200,000 people in our geographic area will have to find healthcare much further away.  The domino effect of such an influx on the already strained resources of our neighbor hospitals is all too predictable.  While the crisis in our community is perhaps slightly greater than the rest of the country, we all face the same challenges.

 

In my next several offerings on this topic I will endeavor to give you a better insight into the physician side of this problem, as well as talk about some potential solutions we need to consider if we are to avert a total melt down of our healthcare system.

  

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