My Babayaga sister in Taos, a loyal reader of The New Yorker, sent me an extraordinary article written by a Harvard surgeon, Dr. Atul Gawande (6/1/09). It’s a story about how a physician culture drove up the cost of health care in a Texas town.
There are some doctors who are diligently proactive in seeking answers to patient complaints and prescribing immediate relief. They order extra tests, services and procedures because the stuff’s all reimbursable and it’s also a defense against potential lawsuits.
Surgeons in McAllen, Texas, are operating a lot more than those in neighboring El Paso. Their justification is the belief that an obese 40-year-old woman in McAllen is not going to change her diet. If she’s in discomfort, why not simply operate and put her out of her misery. McAllen surgeons also do more cardiac procedures, hips, knees, and assorted biopsies than their neighbors (often in hospitals or surgical/diagnostic/and imaging centers in which they have a financial stake).
Healthcare costs are overwhelming us because we have the most wasteful and least sustainable healthcare system in the world. Unless we change this system, even universal coverage will fail because it will not control costs. We can change the system if we reward prevention instead of intervention. Let’s say we pay doctors more if they keep their patients out of hospitals. Reward doctors who spend a little time to develop a relationship with patients and inspire them to believe that they can become the principal agents in their own healing.
If we reimbursed on such a system, we would reduce by at least half the staggering cost to treat chronic diseases in America (85% of the healthcare budget).
Don’t knock the docs in McAllen; they are, like the overwhelming majority physicians in this nation, a knowledgeable, committed, caring group of professionals. And most of us would like to return to a profession we chose not because it was an industry, but because it was a ministry. For doctors to do that, patients (and lawyers) need to step up if we are going to get beyond finger-pointing blame reactions. Stop all the lawsuits, and stop settling malpractice cases because it’s cheaper than a trial. It perpetuates litigation, makes doctors order more tests, practice more defensively, and rack up the costs.
Universal coverage is possible if we can control costs. And we can if, as a nation, we step up and appreciate that the work of healing is a sacred profession based on mutual trust.