MedSmarts

~ Becoming CEO of the rest of your life

Moving Beyond Obamacare’s Botched Roll-Out

Your Obamacare Politics
Don’t Matter

Most of our attention in America regarding our healthcare has been directed at Obamacare and its political opposite that would repeal it and replace it with more of a free-market, and less of a regulatory, approach.

But neither approach will make a significant impact for most consumers in the next few years on either costs of care – including both health insurance and increasing out-of-pocket costs – or on patient safety.

The latter is a largely hidden concern. Our medical system currently causes the premature deaths of up to an estimated 440,000 Americans every year – which makes it a crisis, even if it’s a poorly-recognized one.

The escalating costs of healthcare in America are better recognized, though no better understood. Most Americans simplistically blame health insurance companies and drug manufacturers for our unsustainable healthcare costs. There’s much more to it than that, however.

Watch Doctors, Not Politicians

The prime drivers of our excess medical spending are the doctors and hospitals that provide our medical care – often sloppily and almost always inefficiently. The system as a whole earns an embarrassing 51% efficiency rating. How long do you think any other industry that inefficient would survive?

But healthcare is unique in that the knowledge gap between doctors and patients is so large – and the “fear factor” so dominant (see “America’s Heath Scare System“) – that patients are in no position to demand efficiency or even to make truly informed choices about their healthcare.

The default is to defer to our doctor’s recommendations – to “follow doctor’s orders” – because that’s how it’s always been done.

That’s about to change. Whatever form healthcare “reform” takes from here – and Obamacare’s far from out-of-the-woods despite some improvements to its inept website launch –  the financial burden will increasingly shift to patients and consumers (future patients). Not only will healthcare costs keep rising at multiples of general inflation despite Obamacare, but more of these costs will be borne by consumers in the form of co-insurance, co-payments, and ever-higher deductibles.

This trend has been underway for years now (see “Bearing More of the Burden“). And the “bronze” health plans that are expected to be most popular under Obamacare because of their lower premiums – while better than no insurance – will only exacerbate this trend to under-insurance.

The response by many consumers in these high-deductible health plans has been to defer medical care unless it’s absolutely essential.

But this isn’t always wise and often proves counter-productive. Not only is disease that’s missed in its early stages more expensive to treat later when it’s more advanced – and patients will be bearing more of that cost directly – but there’s also the human costs of shortened lives and increased pain and suffering.

Fear’s the Wrong Framework

Fear generally drives our medical decisions – usually causing us to opt for more aggressive medical interventions when less aggressive approaches make more sense. But unless we’re facing a medical emergency, that fear can be trumped by financial necessity.

Neither of these – fear or cost – is the proper framework for making such crucial decisions. Both distort our critical judgment and skew our thought processes.

And with a healthcare system that’s as fundamentally broken as America’s (see Our Healthcare Sucks), skewed thinking can land you in a bowl of trouble.

To put it bluntly, the core problem with our healthcare system is a payment system that rewards and incentivizes more treatments than are truly necessary to fatten the incomes of doctors and hospitals. This isn’t in dispute.

And neither Obamacare nor a more free-market approach to healthcare will remedy this fundamental driver of inefficient care that’s more profitable the more inefficient it is.

What’s missing in our healthcare is that which makes other markets work efficiently – informed consumers.

A Healthcare Tipping Point

Think about the other things on which you spend comparable amounts of money. Would you buy a car or a house – or a television – knowing as little about your choices as you do about your healthcare?  Is there anything else where you’d buy a pig-in-a-poke, as most of us do with our healthcare?

We’re fast approaching a tipping point where those who wish to survive will have to make a choice: With the average American’s healthcare costs expected to double – and maybe triple for some – over the next decade, the only way for many to avoid bankruptcy, even if they have health insurance because of Obamacare, will be to learn how to make smarter medical choices.

That won’t always be easy, because those we rely upon for the information to make these choices often have a financial conflict of interest. Because of this, you’ll need to start “following the money” in evaluating your healthcare choices.

Redefining “Convenience”

You’ll also need to reconsider how important your conveniences are to you and your family – because convenience is often an enemy of good health. It’s not just the remote control depriving you of needed exercise or convenient packaged foods depriving you of needed nutrition. It’s also assessing whether the most convenient treatment choice is the right one.

In another post, I reviewed something called a “natural bypass” (see “Natural Bypass Better Than Chelation Therapy“). It’s a Medicare-approved treatment alternative to conventional angioplasties and open heart bypass surgeries. It costs only a third of an angioplasty and only one-sixth of bypass surgery – and it’s far safer than either.

But here’s the rub. It requires 35 one-hour visits to inflate cuffs around your legs that basically encourage new blood vessels to bypass your clogged vessels. That sounds pretty inconvenient, right? Most of us would prefer a good old-fashioned bypass that’s over in a few days, wouldn’t we? It seems so much more convenient, after all.

Seldom do we consider the high risk of permanent brain damage from bypass surgery or the 5-30% risk that angioplasty will cause a heart attack that’s often not recognized at the time. How “convenient” is a lifetime of brain damage or heart failure that could have been avoided with a bit more effort?

Or how about the fact that American children are prescribed antidepressant and stimulant drugs at three times the rate of children in other developed countries. Are our kids really three times more depressed and otherwise mentally disturbed or is a prescription just more convenient for both doctors and parents?

And what of the fact that these drugs promote weight gain that predisposes these kids to diabetes and heart disease as early as adolescence? And what of the increased risk of suicide among teenagers taking many of these drugs.

These are awfully steep prices to pay for convenience.

Getting Educated PAYS

Here’s the bottom line: If you’re willing to learn a few things – to reconsider and maybe redefine some of your conveniences – you can literally cut your healthcare costs, and your healthcare risks, in half.

And it has nothing to do with “death panels” or other ideology-driven canards that blur the issue and distract you from such learning.

Once you understand how poorly most medications work – and learn to evaluate them more effectively – and how little science there is behind surgical procedures we willingly submit to, you’ll start to see your medical choices in a whole new light.

Only then can you become the full and equal partner in your medical care you need to be if you hope to survive America’s healthcare crisis of both cost and safety – Obamacare or no Obamacare.

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2 Awesome Comments So Far

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  1. Phil Johnson
    December 16, 2013 at 1:31 pm #

    Hi!

    Wow: “Our medical system currently causes the premature deaths of up to an estimated 440,000 Americans every year” – it’s quite scary! What to expect in the future?

    • John Lynch
      December 17, 2013 at 6:23 pm #

      Well, Phil, the future holds conflicting trends for American healthcare. On the one hand, the move to Accountable Care Organizations that emphasize coordination of care should help reduce medical errors causing these premature deaths. On the other hand, more people insured under Obamacare will mean doctors will be under increased pressure to shorten office visits. This will mean even more reliance on prescription drugs to move patients out of the office faster and increased referrals to specialists, which increases risk for errors with more hand-offs between doctors.

      Only time will tell whether this nets out to more or fewer errors and medically-induced disease and death. I’d be more optimistic if there were even an inkling that the medical profession took this crisis seriously.

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