Wednesday, November 18, 2009

Health Care Attitudes Raise Costs

I attended a conference this week and during that conference I was able to hear a physician speak about health care reform. He spoke about the costs of health care, about Medicaid and Medicare, the bills in the house and senate, when issues stood the best chance of being addressed by policy, other countries health care systems, resources and attitudes and how it all impacted this "broken" system. The speaker was Robert Brooks, MD, MPH, MBA. He is an Associate Vice President for Health Care Leaders at USF. In other words, he was neither a politician or a slouch.

He spoke for over an hour, but the points that resonated with me and stayed with me, were these two. The first is that for something to change everyone has to see that there is a problem. Those same people have to see that there is a solution(s) to that problem and then there has to be a window of opportunity to address it. We have all three right now he said, but that last one, it is going to change as politicians start to worry about other things, like elections. Unfortunately, we will still have a problem even if they stop talking about.

The second issue that made sense to me is that we have great expectations and demands in this country and they are VERY expensive. We do not have the resources to maintain this level of health care but it is also very unlikely that we will change our way of thinking about this. For that reason, rationing may HAVE to take place. ( He didn't say that part)

He is referring to the idea that we need to have the most expensive drug or the newest drug even if it doesn't work better than the older drug. We want CTs and MRIs and PET scans even when the results won't change the treatment course. We want medical devices and other diagnostic tests and we want pills for everything. When we talk about comparative research the public, often stirred up by politicians, thinks it means that people will not get choices and the government is going to take away the better treatments. Comparative research is really the opposite of that. You have a right to know that the brand name drug ISN'T better sometimes. Or that yes, taking one pill a day may be easier than taking two, but if the long acting pill is quadruple the cost and no more effective, then we really can't afford that pill merely for convenience.

A perfect example is the research out this week that says women may be able to wait ten years (to age 50) before starting mammogram tests and then only need them every other year. Doctors, organizations, people in general are all aghast at this and before ANYONE said a word about the report, I thought, okay well, that makes sense. If the testing isn't changing the outcome then why are we doing it? And for everyone to scream about it now is just nuts. Yes, we always did it before, but maybe we don't have to now. I, for one, as a woman, was thinking, OH THANK YOU boob god... however, I may not get the reprieve some get because of my family history, darn it!

We do research to find out what is best for us. What prevents disease, like use of condoms, and vaccines - what prevents conditions from becoming diseases, like pap smears, PSA tests (sometimes) and blood work. What keeps a disease from killing us, like some medications, chemotherapy and surgery. We should then apply the research and if someone disproves it, then we have to act on that too. Really, is anyone griping because we don't do blood letting or leeching anymore?

Lastly, sometimes the treatment doesn't cost a thing, but you have to do it. Perhaps you have pain from arthritis or some form of insomnia and the recommendation for both is to increase physical activity or lose weight or lift weights. Maybe the person with a sleep disorder has to commit to a routine. Perhaps to prevent cancer the person has to stop smoking or tanning or drinking too much. Too hard you say, doc you say, just give me that pill I heard about on TV... well, if we keep it up, there will be no medicine and no doctors to dispense it. Which is another point. Specialists. We have too many specialists, ordering too many tests and doing too little communication with each other. Again, $$$$$$$$$$$$$$$$$$$$$

Um, so , yeah. Lost my train of thought really, guess this turned into a rant. Okay, then... have a good night/day. :)

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