Thursday, August 13, 2009

Why medical care costs a lot

There are doctors who treat medicine primarily as a business. In our community I think they are a small minority. In other communities there may be a different culture. Of course in medicine, just as in any other service business, you must make a living by providing a service and the dividing line between what is absolutely necessary and what is simply hand-holding is somewhat blurred. The real problem here is that in medical care there is no counterbalancing force of the customer's interest in getting the best value for his money so that for the guy who wants to make money by doing a lot of remunerative tests it's like shooting sitting ducks.
What's the solution. First of all to consider this as the only or even the primary cause of high health care costs is foolish. Secondly, can the government set out regulations that determine what test in necessary and what isn't? Impossible. That is the route to medical insanity -- rationing on the basis of what costs the most or which group has the most political power.
Here's what I think is the clear answer. Patient power and competition. If the patients think that the Mayo Clinic concept is the best value then that is the mode that will dominate. The medical profession will be come along and be convinced by the power of the purse. Here is a response I sent to a doctor friend of mine who was, like Obama, touting the Mayo clinic and similar institutions as the easy answer to health care economic problems.
The big medical groups that you are so fond of obviously have their place. They're kind of interesting in that they're kind of second tier in the academic area but have great reputation in the practice area because of their ability to super-organize. This puts them in a leadership position in things like surgical specialties but from my observation their efforts to extend their systems into the community are lacking. For example there's no way the local Geisinger clinics, with their high doctor turnover, can offer the service that a good devoted established primary care doctor can provide to his patients. I'm also not very impressed with the care my patients get at the Mayo and Cleveland Clinic satellites while they're in Florida in the winter. The big organized "Clinics" are the Walmarts and the Lowes of medicine. They certainly have their place and may even become dominant, especially if medicine becomes more market oriented, but they're never going to eliminate the good local stores with their personalized service. >>

What I really wish you would look at is the attached essay on this whole subject that I wrote almost 20 years ago when I was president of the local medical society. It's a bit outdated in parts, but I'm amazed that the great majority of the piece still holds true today. The problem is getting worse and we're still not facing up to the solution.