(The following is excerpted from MedSmart Patients – the next eBook in the MedSmart series that will be released shortly.)
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 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 an estimated 100,000 or more 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.
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 – 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, the financial burden will increasingly shift to patients and consumers (future patients). Not only will insurance premiums keep rising at multiples of general inflation, but more of these costs will be borne by consumers as co-insurance, co-payments and ever-higher deductibles.
This trend has been underway for years now. The response by consumers to date has been to defer medical care unless it’s absolutely essential.
But this isn’t always wise and may often prove 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 bear more of that cost directly – but there’s also the human costs of shortened lives and increased pain and suffering.
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, 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 (see Our Healthcare Sucks). This isn’t in dispute.
And neither a more regulatory 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.
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? Anything else where you’d buy a pig-in-a-poke as most of us do with our healthcare?
A Healthcare Tipping Point
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 over the next decade, the only way to avoid bankruptcy – even if you have health insurance – 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. You’ll need to start “following the money” in evaluating your healthcare choices.
And 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 chapter 11, I review something called a “natural bypass”. 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?
The Steep Price of Medical Convenience
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 doctor 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.
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.
Are You a Patient or a Medical Consumer?
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.
It’s not just medical overtreatment you’ll need to be aware of as a newly-empowered medical consumer. There’s plenty of medical under-treatment and just plain mistreatment going on in American healthcare. Prescribing practices can best be described as incoherent – sicker patients are often undertreated and low-to-moderate risk patients are too often overtreated with drugs and interventions they don’t need.
This book is designed to give you the evidence-based knowledge to differentiate one from the other – to turn you from a “patient” into a properly cautious and conservative “medical consumer”. Sometimes this will mean rejecting medications or invasive procedures your doctors recommend. Other times – as in some emergencies (see Chapters 4-6) – it may mean being more assertive to get needed care you or your loved one won’t otherwise get.
The goal isn’t to downsize your healthcare, nor to upsize it. It’s to “right-size” it so you and your family get only the medical care you truly and objectively need – independent of the financial objectives of your doctors; no more, no less.
Which will leave you with not only more money in your bank account, but greater peace of mind that you’re not being ripped off by a medical system that’s designed to maximize profits, not to maximize health.
The chapters that follow provide you with the foundation for getting greater value for your healthcare dollar – healthcare that’s better, cheaper, and safer – and the skeptical mindset you’ll need to never again be exploited in your medical care.