Recently our office received a brochure for a new piece of surgical equipment that nicely encapsulated the dilemma we face in health care. At the top of the brochure, in big letters, the manufacturer unabashedly promoted this new device as a "revenue generator." To understand why this is so significant, it is important to realize that the health reform debate revolves around two issues, access and cost.
The access problem is that many Americans have no insurance, and those who do have insurance plans could find themselves dropped from coverage or forced into a much worse policy if they lose their jobs or simply at the whim of their insurer.
Many of us are less secure in our medical insurance than we may think. Twenty thousand Americans die each year as a result of these insurance shortcomings and many others are forced into bankruptcy. This problem could be solved with a stroke of a pen, but adding 50 million Americans to our health care system as it now exists would be very expensive.
The cost issue is the heart of the problem and it has not been receiving the attention it requires. It also returns us to the "revenue generator" that an eager manufacturer wants our practice to buy.
For the past several decades, the nation's entire health care industry has evolved into a structure in which revenue generation has become a dominant goal. Many physicians are reimbursed on a fee-for-service basis that rewards us for doing more procedures and ordering more tests (especially if we own the testing equipment). Although no ethical doctor would say she lets reimbursement influence her medical decisions, no honest doctor would deny that it has some effect on how she manages her practice.
For the rest of the medical industry, the sky's the limit as far as revenues are concerned. Hospitals, trial lawyers, pharmaceutical companies, insurance companies and equipment manufacturers all strive for ever-increasing income. New, expensive medications and procedures are introduced and promoted without definitive proof that they are any better than what we did before. In this environment, the incentives to keep costs down are weak.
The lack of cost control has had an enormous effect on U.S. health care expenditures and makes it much more difficult to provide coverage for the uninsured. Despite all the hysteria and misleading statements coming from certain sides, virtually every other developed country has a health system that provides universal coverage with better outcomes and better access than ours, and at a much lower cost. If we could deliver health care as efficiently as Germany, for example, the nation would save more than $800 billion per year.
But that would also mean $800 billion less in revenue generation to all the special interests that benefit from the status quo. Needless to say, these powerful groups are not going to stand by and watch their revenue streams dry up. They have blocked change in the past and they are offering major resistance, directly or indirectly through their agents, to change at this time as well. The chaos we are seeing at town hall meetings from demonstrators protesting against reform plays right into the hands of these corporate interests.
This country must get health care costs under control, and it will take tough decisions by patients, providers and everybody else in the system to do so. It will inevitably require decreases in revenue expectations from those of us on the providing side and increases in responsibilities from those on the patient side.
But it is important to realize that it can be done while actually improving health care. We have plenty of models from other countries to help out in these decisions, and we need to closely examine them without the fear-mongering, deceit and demagoguery that has characterized the discussion so far.
Dr. Randall L. Plant is a physician in Anchorage.
By DR. RANDALL L. PLANT