From: nyeda@cnsvax.uwec.edu (David Nye)
Newsgroups: sci.med
Subject: Re: Reliability in medicine and engineering  (was: ... incomes)
Date: 23 Dec 92 17:26:09 -0600
Organization: University of Wisconsin Eau Claire

[reply to labiche@bnr.ca]
 
>If capitalism isn't affecting the cost of medical care why do we pay so
>much for it?  Is it because we've got so many middle-men collecting
>processing fees?
 
There are several reasons why medicine in the US costs so much.
 
1)  We provide more care and more expensive care.  All other systems
have some form of rationing (actually, we do too, it's just on the basis
of class).  Here, whatever the patient wants, we provide.  If the
patient can't pay, it is charged to other patients or taxpayers.  We
seldom practice truly cost-effective medicine.  We have, as someone once
remarked, "the best system money can buy".
 
2)  A smaller percentage of the money coming in actually goes to health
care providers than in other countries.  Much of it goes to the
insurance industry, the legal system, administrators, and clerical
workers.  Physicians are paid better, twice the median income of
Canadian physicians.  I think it can be fairly argued that some
physicians make too much.
 
3)  More money is spent on defensive medicine, tests with a small chance
of uncovering any useful information ordered to "cover the ass" in case
of a lawsuit.  I have heard this estimated to be as much as 40% of the
cost of medicine, although that seems a little high to me.
 
4)  The elder population is swelling.  The elderly need more care and
because of Medicare don't pay full price, so the cost of taking care of
them is increasingly shifted to other patients.
 
The big question of how to cut costs without cutting quality depends on
what you mean by quality.  If we continue to insist that quality means
unlimited access when we want it to all health care resources, then it
can't be done.  If instead we decide that we really just want reasonable
care for everyone, we can have it for much less than we currently spend.
It will mean that some die who could have been saved.  It will mean
rationing, such as no CPR for patients over 60 in an out-of-hospital
arrest, (but less than 5% of those patients make it back, and at an
exorbitant cost).  It will mean either eliminating medical malpractice
or never finding against the physician when he follows standard approved
algorithms for diagnosis and treatment (since nothing short of these
will stop physicians from practicing defensive medicine).  It will mean
that the insurance and legal industries will be cut out, which will put
many lawyers and insurance industry people out of work.  It will mean
that some physicians will lose their houses, and fewer qualified people
will be attracted to medicine.
 
I'm skeptical that Clinton's plans will do much to reduce the cost of
health care.  Most of these painful and politically unattractive points
don't seem to be getting addressed, except perhaps the last one.
Unfortunately, we no longer have a choice about radically altering the
health care system because it is getting to the point where employers
can no longer afford to provide insurance for their employees.  It has
been estimated that the current system without major alterations will
collapse sometime within the next 5 years.

David Nye
nyeda@cnsvax.uwec.edu