The Elephant in the Room
Most of us Americans are blessed with too much health insurance, and we do not use it wisely. The insured demand the most expensive treatment without a thought to how much it costs. We too blithely say, “my insurance will pay for it” without realizing that, in the end, we all pay for it.
The patient has an ethical responsibility to maintain or improve his or her own health as well as control costs. While it would be impossible to implement a program that forces people to live healthy lifestyles, it is reasonable to assume that healthier living would lead to lower healthcare costs.
The United States spends 18 percent of its GDP on healthcare, and the rate of increase far exceeds the rate of inflation. This trend is unsustainable. Healthcare economists estimate that between 40 and 50 percent of annual cost increases can be traced to new technologies or the intensified use of old ones. Economists say the control of technology is the most important factor in bringing costs down.
The problem is that patients expect high tech health care; doctors are primarily trained to use it, medical industries make billions selling it and the media loves to write about it. Technological innovation is as fundamental a feature of American medicine as it is in the industrial sector.
While doctors are often accused of over-prescribing diagnostic tests, this practice may be the result of patients who demand multiple tests – even if some are unnecessary. As health care technology innovates and its use increases, patients with insurance want the newest, most advanced and expensive treatments that insurance will cover. The most expensive treatments are not necessarily the best, and the patient has a duty to participate with the physician in making reasonable and cost-effective choices.
However, there is fierce opposition to any limitation in the use of medical technology; its use is deeply rooted in American culture. And politicians are reluctant to buck public opinion. Under the previous administration, Congress, with the support of physician groups and the health care industry killed two federal agencies designed to assess medical technology from a scientific and economic perspective.
Controlling healthcare costs requires a change in American culture. Since many of the effective means of controlling costs will be painful, due to our love affair with technology, resistance to change will be formidable. Effective control will force patients to give up treatments they think they need, doctors to sacrifice to a considerable extent their ancient tradition of treating patients the way they see fit, and industry to reduce its drive for profit. The fact that European countries can control costs and limit technologies without harming health is a patent rebuke to our way of doing things.
I worry about the Generation Y students in my college classroom. Upon graduation they’ll enter the workforce. Social Security and Medicare payroll deductions and escalating health insurance premiums will shrink their take-home pay each year. Today’s workers are paying the healthcare costs of today’s retired community. Will the money be gone when Generation Y reaches retirement?
Traditional virtues still receive attention in American culture, but discussion of one virtue-thrift-has all but disappeared, as affluence and extravagance have taken center stage. Perhaps we should reflect on the advice of the American Apostle of Thrift – Benjamin Franklin.
Old Ben would view our current healthcare reform discussion as a clarion call to change our ways and embrace the old-time virtue of thrift. If all new diagnostic tests, procedures and treatments were subject to the rules of evidence-based medicine – objective evidence of superiority as opposed to traditional practice – that would be thrift. If pharmaceutical firms were required to prove the superiority of new and more expensive drugs over older and less costly ones, that would be thrift. If medical equipment companies, which design new gadgets before the old ones get cold, were required to meet the same test, that would be thrift. If insurance companies were regulated more strictly and less ruled by the bottom line, that would be thrift.
Politicians are reluctant to propose any legislation that would place limits on the consumer. To do so, they fear, would be political suicide. Are they underestimating the virtue of the American people? The healthcare debate is a “test of the national character. Perhaps the words of Ben Franklin have something to teach us: “Be industrious and frugal, and you will be rich”. If we elephants accept our duties and responsibilities in the healthcare reform process, our thrift will ultimately enrich us with affordable and high-quality healthcare.