Who's Performing Your Walletectomy?

Today’s Chicago Tribune editorial, titled " A Cure for the Walletectomy", is part of a series of pieces about health care reform and "transparency". A title reflecting the current health-care spending panic, shared by those who have been stunned after receiving their recent hospital or outpatient health care bill. Certainly, carefully considering the proposals discussed in the editorial and how they affect each and every one of us is a good thing.

Americans clip coupons, bargain hard for cars and other big ticket items, search the Web for the best airline fares. Most, however, have never even considered shopping around for medical care. They get a referral from their doctor and they follow it. They don't really wonder if they could get a better deal because, in most cases, the insurance company is paying.

That's changing now. It must. The Bush administration and the insurance industry are pushing low-cost, high-deductible insurance tied to accounts that let consumers save tax-free for their health bills. The concept is simple: If more of their own money is at stake, patients will shop for health care, the same way they shop for cars. They'll find value. The better they shop, the more efficient the market will become, eventually driving prices down.

The problem is, in order for that concept to have even the slightest chance of working, people need to know what they're getting for their money.

But how many people understand what is required for making proper medical recommendations? How, exactly, will patients "find value?" Is the cheapest health care always the best? Is the doctor who tackles complicated cases or has the most experience or training the "worst," because he’s most expensive? Will the average non-medical patient understand or comprehend what tests or procedures are needed to confirm or reject a diagnosis in the first place? Most people I know don’t have a clue about what I do. "The heart has electricity?" they say.

The thesis of today’s editorial is simple – in laymen’s terms it’s about health care cost transparency. I’ve discussed this is in my previous post. What interests me now: who’s working to stuff this transparency thing down everyone’s throat? It is not difficult to foresee: anyone who stands to benefit from its implementation. In other words: Big Business.

You see, doctors are really excluded from any meaningful discussion about health care policy. We are the worker bees. Oh sure, there are physicians spouting the benefits of transparency in controlling healthcare dollars. But if one takes a closer look, most promotions of this policy are non-physician CEO’s of these new commoditization corporations. Others stand to profit handsomely from book royalties or speaking fees as they flit from one policy conference to another. Think tanks hover over their every word. After all, health care is big business, consuming 15% of our entire gross national product. Thousands of corporations (with many more dollars than physicians) stand to win, or lose, on the basis of such public policy and turn to these activists to create a "solution." From the Wall Street Journal:

Aetna, UnitedHealth Group Inc. and other insurers already offer in some markets quality and cost-effectiveness information on some physicians, plus rough cost estimates of certain services. And health-information companies such as WebMD, HealthGrades and Subimo supply information such as physician information and hospital data on complication rates, estimated costs and available technologies.

Do we really think Marcus Welby, MD is making such policy? And where is the American Medical Association in this debate? Unfortunately, their ranks have been so diminished by their displays of self-interest and corporate co-mingling that many physicians have fled their ranks. Front line patient-care doctors look toward their physician leadership with a jaded eye.
Doctors are not scared about having better-informed patients as the editorial suggests, rather we’re scared of whose making the policy.

It’s a shame. Where are the policy makers who advocate for the patient? With all the pomp and circumstance of this Great Reform in health care, who will guide the patient through the bureaucratic nightmare that is sure to follow? Who will help the patient decide which health care treatment or test is most "cost-effective," has "value" or which center has the most doctors with the best "performance" record. It will be the same person they’ve turned to in the first place.

It will be the front line patient-care doctor.

Or worse: a representative from Big Business – like a Walgreens pharmacist. The bureaucratic "money saving" transparency ruse will be complete.

And the patient-care doctor will be paid even less for those advisory services in the interest of "cutting costs."

You can bet on it.

--Wes