Most observers would agree that the American health care system can’t sustainÂ the continuing rise in costs. But figuring out how to “bend the cost curve,”Â as the phrase du jour describes it, is not going to be easy if we can’t agree on whose responsibility this is supposed to be.
Blogger/physician Kevin Pho is featuring an interesting poll on his site. He asks readers, “Who presents the biggest obstacle to cutting health care spending?” The poll allows you to pick one culprit: the government, physicians, or patients.
As of 11 a.m. today, 30.5 percent of the respondents blamed government and 54.2 percent blamed patients. Only 15.3 percent said doctors were the biggest obstacle to reducing health care spending.
I think Dr. Pho’s question is an important one. He writes:
Health economists estimate that 30 percent of annual health care spending is wasted money. That 30 percent translates to 700 billion dollars.
Why is cutting health care costs such a challenge?
Both Congress and the public are unwilling to admit that reducing health care is the only meaningful way to cut spending. Patients bristle at the suggestion of reduced access to an available test. This is partly due to the pervading belief that more care equals better care – when in fact, that’s not the case.
Dr. Pho points to the recent uproar over the benefit of mammograms for women in their 40s as an example of how difficult it has been to have this conversation. His observation: “This does not bode well for reformers who want to control costs by encouraging medical practices to adhere to the best available data.”
It should be noted that Dr. Pho’s poll is not scientific, nor does it indicate how many people responded. His blog also tends to have high readership and participation from physicians, so it’s possible the results are skewed. Nor did the poll include the health insurance system, which surely must be a significant contributing factor to the run-up in costs.
But beforeÂ anyoneÂ feels unjustly singled out as the source of the problem,Â take a look at this article that appeared last week in the Minneapolis Star Tribune. The story describes an end-of-the-year rush at Twin Cities hospitals for elective procedures among people who have met their insurance deductible for the year. Here’s the money quote:
Doctors report that deductibles do affect patient behavior. Many patients now ask about price. If in the past they demanded a costly MRI, now they’ll question whether they need one. The [high-deductible] plans’ advocates say this sort of engagement is a first step to curbing the nation’s runaway health costs.
But once the deductible is met, “they go right back to their old behavior,” said Maureen Swan, a principal at health care consultancy MedTrend Inc. The incentive then is to use as many medical services as possible at little or no extra charge before the new year.
Some years ago I covered a series of health care forumsÂ being sponsored around the state by Blue Cross and Blue Shield of Minnesota. At one of these meetings, someone stood up and described his “Cadillac” health insurance, how much he was paying in premiums and how he wanted to get his money’s worth from his coverage. He had full coverage for emergency room visits but, if I recall correctly, a co-pay for visits to the doctor’s office. So when he developed a bad earache, guess where he decided to go? That’s right – the emergency room, which clearly was more expensive but at least didn’t come out of his own pocket.
This person may have been gaming the system, but when the incentives are so perversely aligned, what else should we expect? And it seems as if the escalating cost of health care is becoming a self-fulfilling prophecy: The more it costs, the less the average person can afford it without the help of insurance, so the more likely they are to take advantage of their insurance as much as possible, which drives up the costs further.
I’m not sure how constructive it is to look for someone to blame. The fact is, there seems to be plenty ofÂ blame to spread around. But we have to acknowledge this first, and this means taking a long, hard look in the mirror – regardless of whether you’re “the government,” “insurance,” doctors or the public. I’m just sayin’.