Just what the doctor ordered
Spending too much on health care that does too little
DYSPEPSIANA | James Krohe Jr.
When it comes to their health – and eventually, everything does – Americans’ motto is, “Too much is never enough.” That phrase ought to be printed on every test report, every insurance form, every hospital receipt generated by a national health care system that spends more and gets less for it than more advanced nations do because it buys not good health but “health care services.”
As I noted in a previous column published about two trillion dollars ago (“Living too high off the hog,” March 3, 2011), the way we pay for health care encourages gluttony among those lucky enough to have insurance. Both public and private health insurance uses a feefor-service model that pays physicians for treatments rather than for cures. The result is suggested by the recent U.S. Justice Department investigation into HCA Holdings, the nation’s largest for-profit hospital chain. Cardiologists in some of its hospitals, mainly in Florida, were found to have performed questionable cardiac procedures between 2002 and 2010. This is only the most recent case of its type. Health insurers are routinely charged thousands of dollars for heart procedures that didn’t need to be done.
It’s not cheap to staff and equip a heart clinic, and the smart operator makes sure his doesn’t stand idle. I have no local statistics, but other parts of the country that have a lot of catheterization labs also have more catheterizations done compared to areas with fewer of them, even though the rates of heart disease is the same in both.
If all this story needed was a villain, I would stop there. But reality is complex. Of course physicians respond to a system of perverse incentives in perverse ways. So do patients; the federal tax code fails to tax as compensation employer-paid heath insurance premiums, which disguises the true cost of going to the doctor and encourages overuse of the service. Of course some MDs over-test if they fear getting sued by patients not only for doing a wrong thing but for not doing the right thing. And yes, it is easier to order a test than to talk with patients; specialists in particular are trained to fix broken organs, not to cure sick people. In fact, a lot of them became specialists to avoid being doctors.
And considering how many patients give doctors a pain, who can blame them? A lot of tests are ordered to placate frightened patients who need to feel that “something is being done.” Ignorance of health is general among Americans, and people who don’t know even the basics of how the body works are prey to all manner of alarms. The “worried well” in particular suffer from too much information about illness and not enough knowledge, a condition aggravated by self-obsession and the TV shows that feed both. Only in America do millions of people without basic care suffer from untreated health problems that are killing them while billions are spent treating wellinsured people for imagined health problems that are worrying them.
There is no human weakness so pathetic that someone can’t exploit it for profit. As was revealed recently in a good piece by the SJ-R, St. John’s Hospital has lent its name to a company that conducts cardiovascular screening tests. The American Heart Association and federal health experts say such screening is pointless for the general population. The company’s spokesperson (citing no sources) does not agree, saying, “Vascular screening can make an enormous difference.”
There is no doubt that vascular screening makes an enormous difference in the profits of companies that do vascular screenings. (This particular firm targets people 50 and older, a group that not only is most likely to have heart problems but is the best-insured segment of the American public.) The rest of us might ask whether screening of this kind makes enough of a difference often enough to justify it in cases in which it encourages a patient to seek unneeded and risky care? As the SJ-R pointed out, the firm has no data about how often its tests fail to detect problems or how often they “detect” problems that aren’t there.
I hope I do not offend by suggesting that there might be teeniest weensiest chance that maybe there is a possibility that the goal of its service is to find heart patients at an earlier stage. St John’s, which has earned a good reputation for taking good care of central Illinois hearts so their owners don’t have to, has been careful to say that the hospital did not endorse the firm or its procedures, merely lent its name to their promotional efforts. Why? The screening company’s website offers a clue when it explains to hospital officials that such deals are a “customer acquisition tool to help you retain and grow your market share.”
The good Hospital Sisters of St. Francis couldn’t have said it better.
Contact James Krohe Jr. at KroJnr@gmail.com.
