In America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes
16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved
outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third
in terms of life expectancy, infant mortality, immunization, cancer screening and the like.
Many economists and other researchers ponder why we have not been victorious against cancer and heart disease, for example.
One could argue that our attention has been distracted by the need to fight wars against heretofore unknown and insignificant
enemies in the hopes of achieving victories. These enemies are less consequential conditions that challenge our way of life:
Restless leg syndrome, erectile dysfunction, fungal toenails and others that consume vast quantities of our healthcare attention
and resources.
ENEMY CONDITIONS
Rather than focusing greater efforts on diabetes, asthma, heart failure and others, we are distracted by fighting against
new enemies about which we know little, and what little we do know seems to be discerned from Internet reports from the front.
As more of these healthcare enemies emerge, they divert scarce resources, causing us to fall farther behind in the healthcare
wars. We are not always clear about where the true battle is. In the past, when patient copays were minimal, it didn't cost that much to start a new healthcare war. All you needed was
a few well-placed headlines, a cute animated critter symbolic of the condition, a surf-and-turf dinner for doctors and a promise
to patients that they could be saved through a prescription or test with a $25 copay.
Many times, it didn't really matter to patients whether or not they were war victims. It became socially acceptable to announce
that you too suffered from one of these terrible conditions. As long as the rules of engagement required only a modest copay,
few patients cared what these wars cost and whether these wars were worth fighting.
FEELING THE PINCH
But now, with the advent of high-deductible health plans, higher copays and greater patient financial responsibility, the
battleground is beginning to change. It's one thing when the barrier to entry costs no more than a beer and lunch. When the
price of joining the war costs patients $500 or $3,000, signing up doesn't look as appealing. In the meantime, though, legions
have been committed to fight the war.
Wars cost money and consume resources. As our top generals are distracted, we have elected to fight the day-to-day battle
with troops more focused on reacting to the patient's perceived "needs," rather than ascertaining what truly needs to be done
to return the patient to health.
Perhaps the question isn't whether we are winning the healthcare wars, but rather whether we are fighting the right wars.
MHE Editorial Advisor Joel V. Brill, MD, is chief medical officer of Predictive Health LLC.
Dennis A. Robbins, PhD, MPH, an MHE editorial advisor, serves as an advisor on ethics and related issues for national organizations,
law firms, hospital systems and government.
