A View of the Health Care Mess

Once upon a time HMOs (Health Maintenance Organizations) were seen as the saviors of exploding medical costs. A little over twenty years ago the Food and Drug Administration (FDA) allowed direct-to-consumer advertising of prescription drugs on television. Thirty years ago the American Medical Association decided it was not unethical for doctors to advertise, reversing its stance held for decades.

One of the ways HMOs were going to reduce medical costs was to eliminate duplication of services. Instead of two competing medical facilities offering the same high cost service, one would offer one type of service while the other would offer a different type. Thus, keeping the overall costs down yet still providing patients and medical staff with comprehensive options.

Currently, I am in a small city with great medical facilities. All are vying for the dollar offering the same things. In theory, if one offered a specific service and allowed its competitor to offer another, the overhead would be dramatically reduced. Subsequently, there would be less the patient would be forced to pay for but, then the income would be reduced. And everyone knows the bottom line must show a decent or sometimes obscene profit.

According the the Organisation for Economic Co-operation and Development (OECD), it is reasonably well known that for some time the United States has spent more per capita on health care than other countries, including those whose system provides care to all its citizens. What may be less well known if that the United States has had one of the highest growth rates in per capita health care spending since 1980 among higher income countries. HMOs and direct pharmaceutical advertising just coincidentally all kicked in about that time.

In the U.S.A., the growth of the share of Gross Domestic Product (GDP) devoted to health care has risen from 8.8% in 1980 to a rate that is projected to be nearly 20% in 2019 according to the U.S. Department of Health and Human Services.

So much for the saviors of reduced costs.

Since the advent of pharmaceutical companies being permitted direct-to-consumer TV campaigns, that industry has spent well in excess of $3 billion in the mass media. One result, outside of obscene profits, if the patient now tells their doctor what drug they want as opposed to the practitioner telling the patient what is best for them. Consequently, the average number of prescriptions written per patient has risen dramatically in the past few years. Care to investigate what their profits may be?

As for doctors advertising ... that's not a bad thing. It provides a choice for the public, they are better informed and it does help us be more proactive in our own own healthcare.

Healthcare reform??? Reduced costs??? These are only small examples of a broken system. Maybe tomorrow ... or Wednesday after giving my brain a rest ... the insurance industry can be the target of discussion.