Cost of Progress

I’ve never been a big fan of Senator Rand Paul, however he made a recent statement that I agree with completely.  Senator Paul (who is also a physician) stated that he has never known the cost of medical care to decrease in his career as a physician.  The American economy thrives on competition between businesses, but when it comes to medical care, competition is nonexistent.  All things being equal, most of us would choose a lower price for a given product or service.  It may seem to some that if we joined the ranks of countries with a nationalized (or single payer) healthcare system that costs would be lowered.  What experience has taught us, however, is just the opposite.  In a single payer system such as in Canada, costs have increased and care has been rationed due to prolonged wait times.  We have an prime example of that in our VA system of care.  Wait times for both routine and specialty care are often unacceptably long.  Prolonged wait times ultimately affect patient outcomes.  With a single healthcare system there is little incentive to innovate and provide better care because patients have no other options available to them.  In our healthcare market, if you are unhappy with your care you may take your business elsewhere.  Even the concept of “second opinions” is open to us whereas this isn’t possible in a single payer system.

Our healthcare system is among the most advanced in the world.  The technological advances in diagnosis and treatment necessarily make our medical care more costly.  “Build it and they will come” applies to high-tech scanners and high-priced medications.  We all want the best care available and these innovations improve our diagnostic acumen and produce a higher level of treatment success.  Take away the profit margin and these innovations don’t occur.  Hospital stays are shorter today than in past years which should lower costs but the treatments delivered within hospitals are pricier.  It would be helpful in limiting costs if patients could “price shop” among medical doctors and medical facilities.  Health savings accounts give patients more of an impetus to seek a “lowest bidder” approach to their care.  The same goes for pharmacies and if provided a price list (either in print or online) we could choose the pharmacy with the best prices on our drugs.

Tort reform must be addressed if we are to ever slow the rise in medical costs.  Many tests and procedures are performed “defensively” for fear of a lawsuit.  Physicians pay thousands of dollars each year for malpractice insurance.  Many lawsuits have no sound basis but are nonetheless expensive to defend and harm the provider’s reputation.  It is not unusual for physicians to leave medicine altogether over this issue alone.  Specifically certain specialties are subject to tort claims, especially Obstetrics and Surgical Specialties.  Texas has uniquely approached tort reform with commissions who determine the legitimacy of potential lawsuits before going to court.  Limiting settlements for “pain and suffering” would reduce costs to everyone.  Medical professionals can’t guarantee a “good” outcome in every case; they are human and therefore subject to mistakes.  Too many special interests, including those making our laws, are involved with our healthcare system.  It is unreasonable to expect significant changes to our healthcare anytime in the near future!

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