The unspoken driver of health care costs and how to avoid a future shortage of doctors.
A huge driver of health care costs in this country are preventative procedures that the public has been told would help them live longer that never worked. In other words, the public has been convinced by the medical profession, the drug companies and the media that we needed all these tests, and to be fearful of our own health and ability to live our lives as long as our physicians made sure we were healthy. This became evident as 9 medical specialty councils presented their findings last May of 2012 that testing such as mammograms, PSA tests and other additional screens caused more harm than good for example.
The problem is that the medical profession did such a good job convincing the public about the need for all this, and that their prolonged existence depended on all these services that the demand for primary care increased exponentially as these health screens became commonplace. The overblown concerns about cholesterol, the cholesterol lowering medicines and the close monitoring while they created their damage to the liver and have side effects seen in our offices as muscle pain has raised these costs even further. Last week, cardiac screenings were also being questioned. The increased interventions, reliance in drugs and their inevitable side effects which far too often result in hospitalizations is both costly and expensive and in the long run yield a negative health benefit. When we realize that hospital deaths are the third largest killer of people in the United States as per consumer reports, our current health care paradigm in the US is badly in need of a reboot.
Disney had it right in the Lion King when it showed how each generation yields to the next in the great circle of life. they in their simple way told the truth. The truth is that we all will eventually succumb as the newer generation takes over and nobody knows how long anyone will live in most cases. While no one wishes to think this way, this is a fact that no matter how much technology we are using has yet to change, and quite honestly, when the quality of life is gone, and we are trapped in bodies that no longer function, it becomes torture rather than life, prolonging the inevitable with drugs, feeding tubes and other technologies in a nursing home or other facility is not living, it is simply waiting until the technologies themselves no longer work. One would have to ask about the ethics, especially when without those technologies, many of these same people, some of whom who spend their last months in nursing facilities miserable deserve a more dignified end. Of course, we pay through the nose for these technologies we may want, especially if we do not have a living will since the living will may dictate that persons wishes when they are unable to advocate for themselves. Most of these costs fall on insurance which pays for this expensive care which in the end does not change the end.
A convincing case can be made for less is more when it comes to medical care, especially when we look at other cultures who have health care systems based on that type of philosophy. Also, insurance interests with the help of the American medical Assn. convinced us we needed all these high priced specialists, as primary care doctors became referral doctors who no longer could afford to take the time to help someone figure out their problems. Instead, primary doctors who can no longer afford to spend more than 10 minutes with a patient they send them out to the pricier specialists who look at parts of the whole and pass the patient around while billing largely for many tests that simply come back negative. Also, many health care authors have said that if you test someone over the age of 60 for anything, you are bound to find something and in reality, does that something need to be treated or is it a normal variant of the aging process which should be left alone. Apparently, last May’s specialty announcements spoken about earlier in this blog brings this seriously into question.
The problems in our healthcare system are large and can be fixed by rethinking primary care and who can perform it. More groups of medical and other types of providers can give very good care and help reduce the cost. Reprgramming the mindset of the public will be harder, since the message will need to be become one of self reliance, and a rethinking of what is normal in aging, without aging becoming the disease process it is now considered by american mainstream medicine.
In Florida, concierge practices feed on the elderly who have been convinced their doctor is saving them, when in fact, the end is the same and comfort medicine is much more sensible that being tossed and spending each week in doctors offices who honestly, are not helping most elderly patients and have diseasified the aging process. When you ask many older people of all those doctor visits has changed their situations, most will tell you no and they will also tell you about the medications that they have gotten used to taking which seems like the norm for most.
The idea behind a concierge practice for older americans makes sense because it allows seniors to spend more time with their doctor and the doctor can help them figure out their problems without all the expensive specialty referrals and without worrying so much about time spent with a patient and the financial consequences if they do. Most Geriatricians (doctors who focus on the elderly) when they hear this totally agree that they need to spend more time and should be compensated fairly if they do. If we paid most primary doctors a global yearly management fee for each patient (not the dreaded starvation manged care model, but something more appropriate), most seniors would get better care and spend less of their retirement income on doctor visits as we educate them on palliative care (care that keeps them comfortable). Aging is a process rather than a number of conditions that require treatment and it is not a disease or series of diseases that require treatment or else. The doctor is not always needed if the patient has a better understanding of the aging process and what to expect.
Chiropractic can play a huge role in the health of seniors as well. Many of their joint problems can be helped with the chiropractor’s expertise in the musculoskeletal system. Chiropractors are primary care for the musculoskeletal system. Since most chiropractic physicians look at the body as a whole, many symptoms can be relieved through the skills of a chiropractic physician rather than their medical doctor less expensively.
A change in the paradigm would also change the financial incentives for specialty care, since now primary care would pay more appropriately, requiring fewer staff and allowing doctors to be more effective, while decreasing the demand on their practice induced by many preventative practices that simply do not work. A better educated public will be less fearful of health issues because the paradigm shift from to dependence to independence and a more appropriate health care paradigm will require fewer doctor visits.
This shift in philosophy of care would convince more specialists to become generalists because this would be where the financial incentives are. In the end, costs would drop, you would have fewer hospitalizations, and youwould not be concerned about a physician shortage and care in the USA.
The big losers of course would be drug companies (big pharma), big hospital chains (fewer admissions), nursing homes (fewer people would require these facilities) and overzealous specialists. The winners would be the public.
Let me know what you think. As always, I value your opinion. Also, read Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com as paperback and kindle formats.