Healthcare Performance Anxiety?Sunday, April 30, 2017
This summer seems to be ending on a dour note for America’s healthcare system. The past week has seen a spate of reports about lingering problems across many fronts.
Let’s see if I can do them justice…
in Name Only
First up is a report by the estimable Sarah Clift at Vox.com entitled “8 facts that explain what’s wrong with American healthcare“. Unless you’re new here, much of it will ring familiar…
Medication prices at 4-5 times what other developed countries pay for the exact same drugs;
Medical errors contributing to the deaths of up to 440,000 Americans year in and year out;
A third of our healthcare spending wasted on unnecessary care, fraud, and other system failings; and
Discriminatory political decisions that exclude millions of Americans from needed healthcare services.
Still, this is updated data from what I present in Our Healthcare Sucks, though it amounts to merely more of the same. If nothing else, it’s clear that Obamacare is unlikely to make a major dent in this sorry state of affairs.
As depressing as all this is, maybe this satirical video, also shown in the vox.com article, will help you see this medical mess from a lighter perspective - if it doesn’t send you into apoplectic fits...
Then there was the lengthy report in the weekend edition of The Wall Street Journal entitled “Our Ailing Medical System“. This one, however – despite its title – was less about the healthcare system and more about the toll it’s taking on our doctors’ collective psyche.
Adapted from a new book by Dr. Sandeep Jauhar entitled Doctored: The Disillusionment of an American Physician, this report delves into what it perceives to be rampant dissatisfaction with the practice of medicine by America’s doctors.
And while it notes that doctors have, to some degree, themselves to blame, the emphasis is clearly and predominantly on doctors as victims of the overarching bureaucracy that now governs medical care in America. This and the squeeze that it’s producing on physician incomes has left us with a shortage of physicians just as Obamacare is expanding patient demand for their services.
Yet it oversimplifies what’s truly ailing healthcare in America. For one thing, it lumps all doctors together in a unified plight. The reality, however, is that we have a shortage of only primary care physicians, hardly one of specialists -where the real money is made, and wasted, in our healthcare.
The excesses described in the article – “shotgun” CT scans for every ER bellyache and millions of unnecessary surgeries every year – are largely specialty excesses, not those of primary care. No one’s forcing surgeons to apply their scalpels to arthritic knees when their own specialty society says they are worthless. (Of course, if we stopped paying for useless surgeries, they’d dry up quickly).
Just as our patient population is divided between those with insurance and those without – the overtreated and the undertreated – our supply of doctors is likewise split between specialists and generalists – the overpaid and the underpaid.
The saddest part of this is that the overpayments are due to both often outrageous and non-transparent prices and overtreatment, while the underpayments are depriving millions of Americans of care that’s actually needed.
My sympathies are reserved for the underpaid generalists and their underserved patients. On the rest – where simple greed is too often the dominant force – little sympathy need be wasted.
This view is shared in another article on The Daily Beast – “How Being A Doctor Became the Most Miserable Profession” – which includes this memorable line:
“Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.”
And This is Going to Rescue The VHA?
So amid all this wailing and gnashing of teeth about how dismal and abysmal is the state of America’s private healthcare system, I found it almost surreal that two doctors took it upon themselves to suggest – in The New England Journal of Medicine – that the answer to our Veteran’s Health (VHA) problems is to dump it into the private sector.
I was heartened to see, however, that the physicians commenting on this article were in general agreement with my own comment there – which was to the effect of, ah, “no thanks, fellas”. It seems they recognize the self-interest of the authors and want no part of such a “solution” – a thinly-veiled attempt to argue for yet another privatization of public services.
I especially liked this comment from Dr. Ricardo Limos – maybe because it echoes views I’ve expressed here before:
“The VA is an awkward duckling in the country’s haphazard and for profit health care structure, but certainly the most transparent and less costly. May be (sic) the rest of the health system should attempt to mirror the VA rather than the opposite. Then we could start talking about savings, not only for tax payers but for everybody.”
It’s disheartening, however, that doctors from prestigious organizations can have such unfounded blather as found in this article published in such a prestigious publication. While it’s obviously a byproduct of it bending over backwards to give vent to politically-driven views in an effort to appear bipartisan, articles like this should still be required to meet some kind of evidentiary threshold before seeing print.
This one met none.
Indeed, their entire premise can be turned on its head by simply looking at the many studies done on the subject of VHA vs. private sector healthcare in America.
VHA patients are older and sicker – presenting with three times the co-morbidities as private sector patients – yet have better treatment outcomes for even highly invasive procedures like open heart surgeries. It has specialty expertise in the areas of rehabilitation and PTSD, for example, that private sector medicine could never approximate.
Their premise is not just flawed – it’s contradicted by the evidence. It’s a false premise that never should have found its way into print.
It’s bad enough that our primary care doctors are besieged as it is while their specialist brethren often make out like bandits – as the article in The Daily Beast put it – without inflicting this additional burden on them.
It’s simply too tempting, it appears, for pundits to take pot shots at the VHA precisely because it is so monolithic that it makes for an easy target – especially when so many private interests are salivating over the profiteering opportunities they foresee (look to our privatized prisons for sorry precedent).
Our private sector healthcare, however, is so diffuse and non-transparent by comparison as to effectively defy solution.
The VHA’s biggest problems can be fixed with more funding – and its relative transparency can be used to assure it’s properly deployed.
Private sector remedies know no such easy solution. Throwing more money at our private sector healthcare has served only to compound its problems – and its utter lack of transparency makes accountability virtually impossible.
We’ve got plenty to fix on that side of the fence. Let’s not let political and economic interests distract us from the task by pretending that our badly broken private healthcare system is in any position to rescue anyone else.
And it’s sheer hubris to suggest otherwise.