OPINION--As a longtime supporter of Health Care Transformation and an advocate for value and affordability for consumers, I was disappointed in the coverage of last Thursday’s roundtable held by the Portland Association of Health Underwriters. The piece is misleading and missed the opportunity to explore some of the most complex and important issues in health care.
It’s a false dichotomy – and self-defeating – to suggest or imply that we can’t simultaneously: 1) work to improve affordability, value and outcomes for individual consumers and patients; and 2) recognize health care as a source of good-paying, family-wage jobs in an era when the erosion of middle class jobs is an increasing focus for policymakers.
As we work to improve value on the individual level, the portion of the economy dedicated to health care will continue to rise in the near term for clear demographic reasons: 1) the country is both growing and aging, with those 65 and over among the fastest growing segments of our population (we all use more health care resources as we age); and 2) the Affordable Care Act unleashed pent-up demand for care among at least 16 million Americans who were previously uninsured.
The continued growth of the health care economy does not relieve us as an industry of the obligation to improve affordability and outcomes. If anything, it increases our responsibility. I’m certain that I could have been more articulate about these issues during the forum, but I’m also disappointed that the reporter made no effort to engage in a deeper conversation.
Dr. Joseph E. Robertson, an ophthalmologist, has been the president of Oregon Health & Science University, the state’s public medical school and largest hospital, since September 2006.
I do appreciate how what one says in one context can be interpreted contrary to the intended message. I can see validity, still, on both sides.
As is oft cited, the United States spends exorbitantly more than every other country in the world, yet achieves mediocre results - we have the least valuable system in the world with annual expenditures just under $3 trillion. Perhaps some of the large variation in costs is due to how each country calculates their expenditures, but for the sake of argument will assume these cost comparisons are roughly accurate. My experience as a physician fully supports that there is tremendous waste - essentially since we don't have adequate time to perform high quality history and physicals, we rely on very expensive and less informative tests, make inaccurate diagnoses, overtreat, overmedicate and overdocument. In general, the environment physicians practice in is highly adverse to performing to the best of our ablities.
Given that we have the least valuable system in the world, we can't define success by merely reducing or slowing future increases. Our overall costs are out of control, far beyond what is necessary to maintain excellent population health goals and must come down. Rationing isn't remotely necessary.
To have comparable costs to the rest of the world, 1/3 - 1/2 of the current expenditures would need to be trimmed, to around $2 trillion. This is just conjecture on my part, as we supposedly spend as much as the next 9 most expensive countries. That degree of reduction would no doubt result in the loss of many healthcare related jobs, but make health care much more valuable and reasonable. This can only happen if physicians were truly freed from the restrictions placed on us. That won't happen because those stakeholders deriving the most benefit from waste, have significant control of how the system operates, and won't tolerate meaningful and substantial reform to allow costs to come down.
The current dysfunction of the system relies on physician acquiescence and abdication of autonomy. Physicians must stop enabling this highly dysfunctional system - it is failing both patients and physicians. We physicians must realize that our good intentions of fighting the system, by becoming a martyr or hero to help patients, is just part of the problem and is the anticipated role we fill in this bizarre play.
So while we don't want to oversimplify and couch a complicated issue into a false dichotomy, I believe that the degree of change that needs to occur to optimize quality, will result in negative tradeoffs between Dr. Robertson's points. Rising costs are inevitable due to the aging population and pent up demand, but trimming the waste can more than compensate, and apparently isn't considered in his analysis. My question is, when will physicians muster the courage to fill the void of leadership?
Anyways, that's my two cents.
Dr. Mike Henderson