There is More to Healthcare Reform Than Universal Healthcare

There are multiple issues that must be addressed in reforming healthcare if we want to end up at a better place than we are today. Determining who will be covered and in under what system is important, but that alone won’t reign in the skyrocketing costs. Along with healthcare insurance and accessibility, we must tackle what will be covered by insurance as well reform the structure of healthcare delivery.

Contrary to what we have been told, it is not only runaway costs by Medicare that is at the root of high healthcare costs in the U.S., but also the belief among the public that more healthcare means better healthcare. I am reminded of a story I read about a young cardiologist that opened a practice that was doing well, but, after a few months he noticed that fewer patients were referred to him. He didn’t understand what was going; he provided his patients with the right care. He asked another cardiologist in town why he thought his practice was shrinking. The second cardiologist said that people were expecting procedures to be performed; merely being told that everything was fine or just giving out a prescription wasn’t good enough these days. So patients wind up going  to cardiologists who do more angioplasties, bypasses, stress tests, etc even if it wasn’t warranted. You see, the young cariologist was practicing medicine the way he was taught; do what’s right by the patient and give only the necessary care. His practice won’t survive if he doesn’t perform those unnecessary tests. Those unnecessary treatments costs us $700 billion in healthcare costs each year! For example, there are 2million angioplasties performed in the U.S. every year; yet based on medical evidence, only 800,000 were found to be medically necessary. 1.2 million were elective surgeries. If you knew that there were 1 million preventable medical errors which resulted in 100,000 deaths each year in America would you have consented for that angioplasty? And it’s not just angioplasties, there’s unnecessary bypass surgeries, MRI’s, knee surgeries, back surgeries. $700 billion worth (1/3 of our healthcare costs). We have to do a better job at the community level educating the public about this and come to a decision on what insurance will cover, if we are to truly reform healthcare.

Just a few words about healthcare delivery. Currently our healthcare system is fragmented and this fragmentation is very costly because it results in duplication of care. How many times have you been to several specialists who order similar blood tests and x-rays? It seems like that if you don’t manage your own care, it kind of gets a life of its own. Elegant studies performed at Dartmouth found that the cost of healthcare varies up to 2-fold across different regions of the country. For example, the Mayo Clinic provides the same quality of care as the UCLA medical center at almost 1/3 of the price! The reason is because the Mayo coordinates care. The Mayo is a one stop shopping center for healthcare-everything is “under one roof”. It’s the medical home approach where primary care physicians with nurses and healthcare managers help the patient navigate the system which avoids duplication of care and centers the care around the patient. The medical home  helps the patients manage their disease which leads to higher quality less expensive and safer care. If the nation could bring its costs down to that of the Mayo Clinic it is believed that it could cut 20 to 30% off its healthcare bill.

I believe its self-evident that costs and delivery of healthcare must be addressed along with access and insurance if we are to be successful in reforming healthcare. To tackle it any other way would leave us pretty much in the same place we are now, with runaway healthcare costs that will bankrupt our economy.


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