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Healthcare’s Endemic Problem, Part One

March 17, 2016

The American health care system is touted as the best in the world.  This is a lie.  Certainly it has the resources and the potential to be the best, but the current system, on many levels, prevents this from being the case.  The system is broken, spoiled, fermenting from within, and drunk on its own excess.  Unfortunately, what Congress is presently debating, on both sides of the isle, is merely how best to fund the acquisition of more spoiled grapes when the issue should be: How can we dispose of the rotten and yet retain the good?  In its present, fermented state, the more money we give to health care, the more gluttonous it becomes.

The problem with health care is not how to fund it, or even who should receive it; the problem is what we are funding.  For what we are funding is a system bloated with excess; a system that relies upon its own failure and the employment of misallocated and superfluous billable procedures.

Of course we will not hear the American Medical Association (AMA) or Big Pharma divulge this problem, at least not publicly.  But behind those double doors where “Staff Only” is permitted, these issues of failure, overutilization and misallocation are well-known facts.  The industry relies upon them.  Overutilization and misallocation are so common that if they were to cease, the fiscal foundation of the entire health care industry would crumble.  Therefore, rather than expose this very real problem, the health care industry uses its bully pulpit to cover it up; even to tout the excess as necessity and thus they cry out for even more money.  Sadly, Congress listens.

A fairly recent article in The New England Journal Of Medicine (NEJM), stated, “It has been clear for some time that the primary hurdle to enacting health care reform is figuring out how to pay for it.”[i]  It is this argument upon which the government’s the Affordable Care Act is based.  I take issue with this argument, for it assumes a false premise.  It is based upon the presupposition that the vast amount of health care services currently provided have intrinsic value.  But this presupposition is without support, as noted by the renowned (or infamous depending upon your profession) Robert Mendelsohn, MD, who warned Americans years ago that they did not need “ninety percent or more of Modern Medicine.”[ii]

Until he published this opinion Dr. Mendelsohn had been a well-respected member of the medical community, filling many prestigious roles beyond his pediatric practice.  He had been chairman of the Medical Licensing Committee of Illinois, an instructor at Northwestern University Medical College, an associate professor of pediatrics and community health and preventive medicine at the University of Illinois College of Medicine, president of the National Health Federation, and national director of Project Head Start’s Medical Consultation Service.  Of course, even with these creditials, once he criticized the system, he was immediatelly ostracized.

I do, however, agree with another observation in the NEJM article, “great savings could be achievable in two areas: administrative costs and unnecessary care.”[iii]  Where I differ is the nature and volume of the administrative costs and unnecessary care that could be purged.  The article’s focus is limited to extreme clinical misallocation and fraud, which is estimated at $830 billion (30%) and another $500 billion (20%) in administrative costs.  I, on the other hand, focus on the routine, ubiquitous excess that drives the current medical system, that which constitutes its financial backbone, the 90% of unnecessary care Dr. Mendelsohn discussed.  Using these figures, controlling this waste could realize a savings of perhaps $2.5 trillion in clinical costs and another $2.3 trillion in administrative costs. If orchestrated effectively, the savings generated by eliminating this waste would be such that health care cost for the entire nation would be but a small fraction of its current expenditure.  From this premise, it is clear that true health care reform must take place at the clinical level, not the fiscal.  Reforming insurance policies and tax codes will only further exacerbate the problem of overutilization and fraud which are consuming our fiscal resources faster than we can produce them.

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[i]. RA Levine, “Fiscal responsibility and health care reform,” The New England Journal Of Medicine, Vol. 361, Issue 11 (Sep 10, 2009) 1533-4406.

[ii]. Robert S Mendelsohn, Confessions of a Medical Heretic (Chicago, IL: Contemporary Books; 1979), xiii.

[iii]. RA Levine.