Dr. Eric Novack, THCB’s resident orthopedic surgeon and spokesphysician is an angry man today. He is angry about people who go around blaming physicians for high healthcare costs. And he’s got something to say about it. What’s the real problem? Eric thinks its CYA healthcare. If you want to hear more from Eric, fire up your PC speakers and go have a listen to an archived webcast of one of his interviews on KKNT 960 AM radio in Phoenix.
Thanks to all who participated in the ‘debunking’ of the “3% Myth” about Medicare’s efficiency. In other earlier posts, I have tried to address other great myths and misperceptions about the US healthcare system—see “an outcomes primer” and “association v. causation.” Another source of confusion and misperception is the statement that “doctors perform unnecessary tests and procedures simply for financial gain.” Implied in this statement—and the basis for the ‘Stark Laws’ as well as single-payer proponents of government micromanagement of healthcare delivery—is that MOST physicians engage in this behavior MOST of the time, bilking patients and insurers, and substantially driving up healthcare costs.
I disagree. Before I get a wave of comments about how lab utilization decreased 25 years ago after Stark was introduced, read on. Did the introduction of Stark regulations (laws against self-referral for certain healthcare services) work? Answer—NO. If they did, why are we having the robust discussion here at THCB and throughout the country about healthcare? Healthcare costs have continued, with few reprieves, to increase at faster than inflation rates for years. The solution for the single-payer crowd—more regulation of providers and price fixing for service delivery. It has not worked until now, and will not work into the future.
A much greater driver of costs today are patient-demanded healthcare and CYA healthcare. It is difficult to quantify these costs, but the costs are huge. Patients often come in ‘demanding’ an MRI or other test. Accompanied with the demand is almost always the statement ‘well, I have insurance’, and ‘it is covered and will not cost me anything’. These demanded test and procedures dovetail with CYA costs—fear of not getting a certain test and then discovering later a condition or problem needs treatment. That ‘delay in diagnosis’ is one of the leading causes of medical liability claims.
The real culprit here, of course, is the 3rd party payer system that divorces patients from costs and risks—and places those risks squarely on the shoulders of healthcare providers. Even for many of the chronically ill, the knowledge that someone else is picking up the tab alters behavior.
Changing the system so that 3rd party (insurance, government) payment is minimized will provide real market forces to reduce excessive healthcare costs. Blaming doctors for the problem of ‘unnecessary’ healthcare, while failing to recognize the role of patients in driving costs is another area of distortion and misconception that clouds and confuses an intelligent discussion about healthcare.