This is one person's perspective on increasingly higher health-care costs.
Let me begin by noting that I haven't seen what I'm about to say articulated anywhere in the press during the increasingly ugly debates over health-care reform proposals. Maybe there is good reason for this not being discussed and debated, but can't figure out why it has not been a big part of the national debate. Maybe I missed something, but I doubt it. If so, please someone enlighten me.
There are many types of "doctors" out there in various professions serving the needs of people and animals. My hat is off to all doctors of all stripes who serve with dedication and expertise for the benefit of their patients.
Instead of "doctors", perhaps the title of this diary might more accurately have read..."doctors and those who educate them". Please follow me below for an explanation.
I happen to be a retired dentist. I was in both private practice and also did a career in the Air Force. I got to observe and compare the practices of many, many physicians, dentists and other doctors from not only the United States but from other countries as well.
One common thread I found was that each and every one of them wanted to maintain the highest technical standard of care possible, regardless of the cost and regardless of the ability of their patients to pay. Why?
Based upon my experience, having graduated from two of the top dental schools in the country (DDS and MS degrees), from the very first day of dental school it was drilled (no pun intended) into our heads to keep up with the latest and most technologically advanced materials, methods and procedures possible. Whatever you do, don't fall behind the latest and greatest advances available to mankind. Well guess what?
No mention was made of the fact that the "latest and greatest" so-called advances might not have materially advanced patient care. Many of the technological advances in dentistry, for example, are more of a convenience for the dentist as opposed to improved care to patients. Much of the technology is designed to impress not only the doctors, but the patients. The same is happening with physicians. Many seem to think high-tech equates to high-quality care.
I'm here to say it doesn't necessarily work out that way. Much of what happens is that doctors want to cover their asses so that none of their colleagues accuse them of practicing "substandard" care, lawsuits notwithstanding. Well, "cost-effective" quality care doesn't mean it is substandard. In other words...
Not everyone needs or wants 2009 state-of-the-art care. Many, many people could greatly benefit (health-wise and money-wise) by a 1960's (for example) style of care. But schools don't advocate practicing anything but the latest thing, partly because it is seen to advance the interest of their professions over the interests of patients who have to opt out of care due to sky-high costs associated with what might very well be a source of pride and satisfaction to the health-care professionals, but because such care simply isn't practical for many patients.
If the educational system would teach potential doctors to provide, or at least consider, cost-effective care as opposed to treating patients with the latest and most expensive treatments then health-care costs could be largely contained. But doctors aren't trained to think that way. And doctors educate and train potential doctors, so the system perpetuates itself to insure that their professional practices have a higher priority than patient affordability.
I can't count the times, for example, that I've been a waiting room and seen drug salesmen come in and get to see the doctor while I wait an hour or so for them to finish their discussions of the "latest and greatest" non-generic drug. They both "win" in the sense that the drug salesman makes a sale, and the doctor takes satisfaction the he/she is keeping up with the latest, though not necessarily the most cost-effective drug to use. But the doctor is "keeping up" with the latest fad and that's what they were trained to do. Screw the patients...let them sit out there for hours suffering while backroom drug deals are made.
That's just one tiny example. High-tech expensive machinery for sale by salesmen takes even longer. To what effect? Maybe it's cost effective, maybe its not. How are typical patients supposed to know?
Do politicians know or care? I haven't seen any evidence of it if they do.