Last week, one of my best friends visited me in Vermont.
His name is Brett, and he's also one of the brightest
people I know… 1600 on the SATs, Dartmouth for undergrad and med
school. He's now an internal medicine doctor in the Pacific
Northwest, and has some real concerns about the state of health
care in America.
It was after dinner when the kids were asleep that we ventured
down to my wine cellar. We saddled up at the tasting table
and began enjoying a 2009 Ken Wright Pinot Noir - a great wine
from one of my favorite vintners.
We quickly got into a discussion of Obamacare and the
government shutdown. But I was most interested in his
thoughts on the state of U.S. health care system.
Dr. Brett shocked me when he said that the entire health care
system in this country is unsustainable. I knew it was bad… but
not this bad.
He went on to tell me about the "over-testing" that happens
every day. Today there are far greater numbers of medical
tests available than ever before. And thanks to the Internet,
patients are better educated than ever before.
Now there is nothing wrong with informed patients. But
as a result, some are second-guessing their doctor's
recommendations and often requesting additional unnecessary
Dr. Brett tries to avoid ordering excessive tests. But
when a vocal patient is demanding more, it's easy to cave in.
With a busy schedule, most doctors can't take 30 to 60 minutes to
meet with a single patient.
One additional aspect of the system even encourages more
testing. Litigation in health care is rampant. That means a
doctor who failed to order a specific test could be sued if the
patient subsequently gets ill or dies. As a result, it's safer
for doctors to err on the side of caution by ordering more
And financially, neither the patient nor the doctor has any
incentive since they're not paying for the test. And in most
cases, they don't even know what it costs. Insurance companies,
Medicare or Medicaid will simply pickup the tab.
But the result of all these tests is that more potential
health issues are discovered. And those findings lead to more
Some of those procedures are required, and lead to positive
health outcomes. But large portions are completely
unnecessary… and costly.
Over the next 10 years, health care costs are expected to rise
at 6.2%. That's more than twice the rate of inflation. And
means that in just 10 years, health care costs will equal
one-fifth of our entire country's GDP. I have to imagine
excessive screening and more procedures are a big part of the
I also talked with Dr. Brett talked a bit about cancer
patients as one example. He says if people live long
enough, cancer will almost always kill them.
More frequent testing of patients leads to more cancer removal
procedures. For some of these people, their cancer was
benign and never would have affected their health. Or it would
have killed them when they were 80 or 85 years old. Yet doctors
and patients are choosing to remove cancerous cells even if they
don't appear risky.
Cancer testing is just one example of types of tests that lead
to unnecessary and invasive medical procedures. Not only is this
costly, but they can actually have a negative impact on an
But this is one of many factors contributing to soaring costs.
The unfortunate part is that high health care costs aren't
translating into longer lives.
In the U.S., we spend $8,233 per person on health care. That's
2.5-times the spending in the average developed
Yet, life expectancy in America is far from the top. In fact,
America currently ranks No. 33 among the world's nations for life
So when you look at the return on that incremental health care
spending per capita, it's clear that we're not getting better
The fact is that Obamacare will bring some reform to the
health care system. But it does little to create incentives for
insurance companies, medical professionals and patients. And it
won't curtail excessive testing and procedures that are just one
part of soaring health care costs.
The health care system in this country is deeply flawed.
I'm not a doctor. And I don't have the answers.
But it seems that if we want to change behaviors, we need
to change incentives. Unfortunately, politicians on both
sides have been unable to take the required steps to reform a
I want to hear your thoughts on the health care system. Please
send me an email at firstname.lastname@example.org. I want to
hear your thoughts on how we should tackle this