The Reason Our Health Care System Needs Reform, Summed Up in a Single Word – GREED
Talk all you want about the wonders of modern US health care: the incredible advancements in technology, the excellence of our best practitioners and hospitals, the wonder drugs, the transplant miracles……it does not make up for the fact that we have 43 million citizens who are uninsured, the most expensive system of health care in the world by far, and a less than stellar record in terms of lifespan, prenatal care, health care outcomes, preventative care, and the like. Undoubtedly, there are all sorts of reasons why our health care system is, to be frank, such a great disappointment; but is there a single underlying root cause, a common element, a theme underlying the multitude of failings in the midst of such a plethora of resources and piles of money? I believe there is, and it is called GREED.
Greed is at the heart of the failure of our health care system. It is what undermines all of the promise of our advances, our technology, our professionalism, and our national will. No, I am not a Communist, far from it – I have put a tremendous amount of time and effort into securing fair payment for emergency care providers (including myself, my partners, and all others so engaged); and though I do not begrudge for a minute the hundreds of thousands of dollars, make that millions of dollars, in charity care I have provided over the last 33 years, I would rather have been paid for this service so I didn’t have to cost shift to make up some of the losses. Still, I think what bothers me about our health care system the most is that we don’t get what we pay for, even if we have great insurance coverage. In a market-based health care economy, we should be able to get what we pay for, get what we need, get what works, get what we hope to receive. GREED is why in the US health care system we get what we don’t need, what doesn’t really work, what we grossly overpay for, and what we really don’t want.
By now you have probably gotten defensive (if you’re a provider, or a patriot, or a grateful patient), and come up with a host of very reasonable explanations for why care in the US is so expensive, or why our infant mortality rates are ‘third world’, or why we are so often over-treated, over-tested, over-medicated, and over looked by our health care system. Too many lawyers (we certainly need liability reform), too much fast food (we certainly are overweight as a nation), too little common sense (our educational systems also need reform), too much (or too little) religious influence on our culture, and so on. I will grant you all of that, but if you burrow past all of the ostensible causes of our system’s shortcomings, I think you will find that GREED is the major culprit.
What makes a hospital CEO go to the medical director of an ED and say: I need your docs to lower their threshold for admitting insured patients, and raise their threshold for admitting uninsured patients? What makes a cardiologist cath every patient he sees who has had chest pain? What makes a health plan withdraw coverage from a patient for failing to report an episode of otitis on his enrollment application the week after cancer is diagnosed? What else (besides the fear of malpractice suits) encourages us to order more tests, knowing we can charge a higher E+M code if we ‘take these complaints seriously’ rather than address the patient’s underlying anxiety? What drives medical groups to routinely underpay provider claims while they grossly overpay their CEOs? What drives the drug companies to put two cheap generics together in the same pill in order to get a new patent? What is really behind all those adds for laser eye surgery and Viagra (and the warning about erections lasting more than four hours)?
Uncommon events, you say? Not representative? I have experienced or heard of at least six different CEOs urging their ER docs to violate Medicare laws against providing medically unnecessary services, or EMTALA regulations requiring appropriate stabilizing care to the under- or uninsured. If I have heard of that many instances myself, it must be a daily occurrence nationally. ACEP actually had to create a policy to try to ward off attempts to institutionalize deferral of care as a national ‘dump the uninsured on the street’ practice by hospitals eager to shift the burden of caring for the poor. Entire hospital staffs in several states have come under scrutiny for ignoring gross patterns of over-utilization, self-referral, and unnecessary open-heart surgery. The frequency of these issues drives guys like Pete Stark to distraction. So many health plans have been fined for inappropriate recession of health care coverage I have lost count. Drug companies in the USA pay three times more for advertising than they do for new drug development, while in most developed countries direct to consumer drug advertising is banned. You think they are warning the public about prolonged erections because they want the public to be ‘informed’? GREED in the US health care system isn’t an aberration, an occasional slip, a few bad apples – it is as pervasive and enduring and imbedded in our health care system as are the cotton ball and bedpans.
But we have the Hippocratic oath, we are professionals, we care! Oh, get over yourself. Yes, we care, we ALWAYS want to do what is right for our patients; but we are also human, and the Hippocratic Oath can never fully immunize physicians from the subtle incentives that are built into the coding and reimbursement system, or from the economic pressures applied by the for-profit US health care machine, which drive our behavior. Even if we can manage to turn our backs on free drug company dinners, ignore over-motivated hospital CEOs, and direct our consult requests to less aggressive specialists; the system we work in has embraced GREED so thoroughly that even the most ethically motivated and grounded amongst us gets recruited to the cause.
Even our patients have been taught to be greedy about health care; which may be why few US citizens seem willing to make any sacrifices to ensure that everyone has health care coverage. In my opinion, the difference between our system of health care and those in other countries is directly related to the extent that GREED has infiltrated into everyday patterns of health care economics, politics, and practice. Not to imply that GREED only exists in our system; it’s just that in other countries, they have managed, to a lesser or greater extent, to suppress the caps. We could live with ‘greed’. We could all live longer, and healthier, if health care reform in the US manages to acknowledge, and address, this single word.