How To Cut Health Care Costs Dramatically
My local newspaper reprinted a New York Times article (Kevin Sack, "Obama health care plan details debated", The Press-Enterprise [Riverside, California], Sunday, July 27, 2008, A10) on a debate within the Obama campaign over the estimated cost savings that could be obtained by more efficient delivery of medical care. This savings would be, Obama has repeated promised, applied toward the cost of insurance premiums for families that already have insurance and toward the costs of extending health insurance to persons and families that do not already have insurance. Savings in health management and insurance management are also featured in John McCain's health proposals, as they were incorporated in Hillary Clinton's health proposals.
I do not dispute the importance of making health insurance and medical management more efficient and using the costs thereby saved to lower the cost of health insurance and health care; but I do think such sources are vastly overstated and are inherently unobtainable. The notion that governmental regulated computerization of health records will save $50- or $100-billion is nonsense. Government has been systematically unable to take advantage of computerization to lower management costs. Government has botched nearly every computerization project about which I have read. California state's effort to computerize the Motor Vehicle Department registration records, the national government's effort to modernize the Social Security Administration computers and to computerize the FBI paper records have all failed or required so much amount of money over estimates that no cost savings are achievable. There are reasons for these failures, such as the complicated nature of the historical paperwork that has to be computerized; but we don't need to go into them here. When government regulations govern private enterprise, here too computerization costs are vast and never provide historical savings.
According to the New York Times' article, "A consensus has emerged among health economists that at least a third of the country's spending on health care is unnecessary." Eliminating "unnecessary health care" is seen as another source of cost savings. But there is absolutely no documentation or support for this "consensus". Frankly, I think it is not credible talk by economists. I challenge any of them to provide evidence that one-third of health care is unnecessary. What health care that is given is unnecessary? Name the illnesses, injuries, diseases, or doctor's visits, or lab tests, etc., that were unnecessary and provide documentation of the non-necessity, not simply a counter-factual guess-estimate. I'll look at the documentation for myself.
All such discussion, as above, is a smoke-screen. The largest and only real source of significant cost savings in the nation's health system would be improved health of Americans. Only sustained, better health, leading to fewer health care visits and less expensive procedures and therapies when medical needs arise, would cut the costs of health care. The real question is, how could the nation improve the health of its citizenry?
The answer lies outside the dominant medical care paradigm. The dominant medical care paradigm is industrial medicine. The smoke screen of political discussion is intended to hide the idea that there are alternatives to industrial medicine.*
Here are some changes that must be made:
(1) Industrial medicine needs to be replaced by integrated primary care medicine. "Integrated medicine" refers to the addition of alternative medicine (homeopathy, for instance) to the conventional medical therapies available to physicians treat patients. Alternative medicines are not substitutes for many conventional therapies; but they are important supplements for many of them. Further, alternative medicine attacks the causes of disease, rather than the symptoms, on the theory that removing the cause of the disease will ease the symptoms. Reliance upon pharmaceutical therapies prevents conventional physicians from treating the causes of disease, especially when the causes involve lifestyle and dietary issues (see next item).
(2) Integrated medicine is also tied, in a way that industrial medicine is not, to lifestyle and dietary health management. The wisdom, "Three-fifths of health is exercise and diet", points to the great importance of optimizing these two factors of health. Exercise is an effective, if not necessarily complete in itself, therapy for Alzheimer's, breast cancer, depression and anxiety, and heart disease, among many diseases. No one doubts that radical change of diet, guided by tests for food sensitivities, and vigorous exercise are crucial for reducing obesity and controlling weight. Industrial medicine is inadequately equipped to use lifestyle and diet changes as therapies. The inadequacy does not spring from lack of knowledge or inability to print up numerous informative pamphlets, but rather from the kind of doctor-patient interaction, lack of continuity of patient care, coupled with refusal to use alternative medicine, that the industrial medicine paradigm prescribes.
(3) We need to have a significant upgrading of mental and psychological medical care. A significant percentage of alcohol and drug abuse springs out of the patient's self-medication of disorders, such as depression, through drink and drugs. Cure the underlying health problem and the abuse problems will be solved for many patients.
Many private and government insurance programs do not cover alternative therapies and fund mental care insufficiently. If private and governmental insurances would cover alternative medical therapies, as well as conventional medical therapies, then the nation would be in a position to deliver significantly improvements of medical care and medical health. Further, if insurance programs covered alternative therapies, medical schools would incorporate them into medical training and physicians would avail themselves of those therapies. Some of the training that is provided for licensed naturopathic doctors should be incorporated into conventional medical education, whereby conventional physicians would be more likely to refer patients to naturopathic doctors, just as they do for other specialists.
When such changes in conventional medical care are made, and the health of the nation improves, true cost savings in health care will be obtained.
----------
* Please see my series, Issues of Medicine and Insurance. In which I discuss industrial medicine and the changes needed to make universal medical care affordable and effective. Useful is Milt Freudenheim, "Trying To Save By Increasing Doctors' Fees," New York Times, July 21, 2008, which discusses federal experiments to shift to a primary care model by paying physicians and medical support personnel sufficiently for them to pay more attention to patients to diagnose problems that would otherwise go undetected and be worse, and more expensive to treat later.)
Revised.
