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A doctor's Rx for cutting health costs

To revamp health care costs, look at what motivates doctors and patients

Date published: 10/26/2008

IT'S LIKELY you have noticed there's an election about to happen. Whichever candidate gets in is going to have to deal with a broken and very expensive health care system and a huge deficit. Not a good combo. They will be trying to make a silk purse out of a sow's ear.

This prompts me to give them my take on how to reduce costs.

There's a lot of noise about malpractice insurance, inefficient insurance companies, cost of drugs, poor communication systems.

But the effect these have on the cost of care is chicken feed compared with the money that doctors have control over, especially with hospitalized patients, in an environment where there is no incentive to save costs.

SOARING COSTS

Let me present you a few depressing statistics. Health care costs have skyrocketed--the U.S. spends twice as much per head as France, for example, and this has doubled between 1970 and 2006 (from 7 percent to 15.6 percent of GDP). It is projected to double again in the next 10 years.

We spent $2.3 trillion in 2007--making the bailout look paltry by comparison. But the U.S. health care system is ranked 37th by the World Health Organization--France being No. 1. And there are those oh-so-troublesome 47 million uninsured still, all in the wealthiest country on the planet.

Of all these big bucks, 80 percent are spent on 20 percent of recipients--the sicker, usually hospitalized patients. And who mainly controls the purse strings here? Doctors. Doctors receive or control an estimated 87 percent of health care spending, according to a report by Alan Sager and Deborah Socolar of the Boston University School of Public Health.

We doctors are a capricious lot, or so it would appear from the likes of journalist Shannon Brownlee, whose book "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer" seems to jibe with my own observations.

We do what we do in large part due to attitude and tradition, she claims. She cites a study by Dr. John E. Weinnberg of the Dartmouth Institute for Health Policy and Clinical Practice. In the study, two towns, with no significant difference in health profile, showed 10 percent of children in one town had had tonsillectomies, versus 70 percent of children in the other--just because that was the culture in the second town.

Motivated by the madness and expense of health care and insurance, some people can't wait for the politicians. Two such groups that I have been involved with are the Fredericksburg Regional Chamber of Commerce Health Care Council, which is trying to put together a group insurance plan to give small employers the bargaining power of big companies. The other is the Rappahannock Healthcare Repair, working under the auspices of the Virginia Organizing Project (an organizations that helps empower local communities). The group has scheduled a forum for Wednesday, Nov. 12, at 6 p.m. at The Free Lance-Star building on Amelia Street in Fredericksburg to hear what you think of the health care system, in the hopes of coming up with some grass-roots solutions.

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Date published: 10/26/2008