Mar 09

Can We Swallow the Bitter Pill?

by DrWolfe

In his Feb. 20, 2013, Time Magazine article, Bitter Pill:Why Medical Bills Are Killing Us, Steven Brill deftly outlines the disastrous state of the American healthcare industry.  Healthcare is costing the United States nearly 20% of the Gross Domestic Product andgrowing.  This is unsustainable and isbreaking the US.I highly recommend reading it.  It is very long but you get the gist relatively quickly.  Here it is:

This reminds me of a different scene involving pills--in the 1999 movie, The Matrix.  Morpheus (played by Lawrence Fishburne) is sitting across from us and offers the blue pill or the red pill.  Take one pill and the current environment continues.  Healthcare costs rise, the economy is dragged down, people are unable to afford healthcare premiums,companies cannot offer insurance benefits. Take the other pill, the one that delivers us from the brink of disaster,but there are other costs.  Worse access, rationing, loss of choice…?

In this movie, the shape changing Agent Smith represents the pharmaceutical and medical device companies.  They try to keep the population and the government under control. They hope to maintain the profits being made.  Exorbitant amounts of money are spent in marketing and lobbying.  Legislation, regulation and policy are manipulated to maintain advantages.  Well produced marketing creates a presumed necessity for medications.  We are told that we need a pill to enjoy life.  We are inundated with ads that show middle aged couples frolicking about in anticipation of another type of frolicking when the light go out-not all pillsare bitter.

Hospitals are the victims of much of this price gouging, but they are not innocent.  They too add a high profit margin to items used by patients.  Profits allow for expansion and growth, higher market share, larger scale.  Smaller hospitals are bought as competition is removed from the market.  Physician groups are bought-more doctors are forced to feed the machine.  This reminds me of yet another movie analogy-the Borg, seen in various iterations of the Star Trek franchise.  As small physician groups, multispecialty groups, and hospitals try to survive in the treacherous healthcare environment of increasing costs and decreasing reimbursements, they cannot stop being assimilated- "Resistance is Futile." Hospitals are able to maintain profits with commercially insured patients.  The main insurance companies pay the most forservices provided.  A patient enters the system and is then run through the machine, extracting whatever charges are possible.  In the healthcare industry,  we call this "churn."  Lab tests, imaging studies, specialty consults, and on and on. 

The consumer is not without blame.  We as patients, feel that better care comes from more studies and high priced treatments.  We demand the highest quality without reallyknowing what that is.  We want specialists.  We demand medications for colds that really only need a tincture of time. 

I am a physician--a high priced specialist--I own some of the blame. I am paid to work.  I get paid to do surgery. 

I would love to offer up a solution.  It will take a Herculean effort from all involved. There are medical institutions that are fighting an uphill battle against the large hospital networks and Big Pharma.  We have to learn that quality care doesn't just mean getting the best care.  It means the right person getting the right thing, at the right time, for the right reason, at the right price.

Dr. Michael Wolfe
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