While out to lunch with some co-workers the other day, our talk gradually shifted to health care. Actually, first it was about pregnancy (for some bizarre reason, I seem to find myself in some sort of unitiated baby/maternity/pregnancy conversation about once every day or two these days) which then led to us talking about rising health care costs. One co-worker who gave birth a couple of years ago told us that she needed a C-section and their medical bill totaled almost $40,000. Fortunately, of course, her insurance picked up the tab. A normal pregnancy, I learned, was itself about $15,000 about a year and a half ago. And this from a guy whose wife had a natural childbirth! No drugs or anything, all they did was stand there, yell for her to push, and be there to catch. Thirty years ago, however, my other colleague had been billed $257 for her entire delivery, of which her insurance paid $200. Is it really that much more to bring a baby into the world now? What are doctors doing differently these days anyway? Did some sort of new technology make the whole childbirth process less of a pain in the ass?
Since then, the topic of health has been a bit on my mind. Not surprising, I suppose, seeing as how its a frequent news topic these days. Obama just spoke before the AMA and basically told them that any health care reform bill will result in doctors having to be be paid less money. I hear they took it reasonably well, as in, there wasn't any booing or shoe-throwing. Not a bad start. The Obama administration, of course, is in favor of some sort of affordable public insurance plan like Medicare. And this makes sense. The whole idea of health insurance being tied to employment is completely strange to me. Who suddenly decided that it was the employer's role to pay for health care anyway? And how unfair is it that you can get better or worse (or no) health care just depending on where you work?
So definitely the idea of public insurance is a GREAT idea and long overdue. But I was listening to NPR the other day, and they did a profile on a county in Massachusettes (Howard County) that offered a low cost ($50-70 a month) to its residents. The goal of the plan was to promote prevention, healthier habits, etc. and catch issues sooner rather than in an emergency room (thereby keeping costs down). But while its been super successful with those individuals that participate, one of the biggest problems they have run across is that most people (as in something like 95% of those eligible) don't even enroll.
And anyway, I'm not convinced that changing who pays for the health care (the govt vs. health insurance companies) really changes the problem. What I want to know is why health care is so expensive to begin with. A few weeks ago, I read this fascinating article in the New Yorker that attempts to address this very question. Its a long article but definitely worth reading if you have the time. The author, Atul Gawande (awesome surgeon and writer), is trying to find out why one county in TX spends thousands more in Medicare funds per person than anywhere else in the US. And the answer, he determines, is that the doctors there perform more tests, surgical procedures, etc. Procedures that don't necessarily lead to better health care or provide more satisfying medical experiences for patients. That is, more is better. But in medicine, that's not always the case. Gawande argues that where medicine has proved to be the most successful are places like Mayo and Kaiser, where doctors of different specialities work together to treat patients, where doctors are paid a monthly salary rather than by test performed. Or, as an another example, he cites Grand Junction, CO, where physicians and HMOs have created a medical community that works together to look at each patient and root out problems, resulting in health care that is comprehensive, low-cost, collaborative, and accountable.
A few weeks ago, while we were in Napa, we were chatting with one of the pourers at a winery we were at. He told us it was his first day back at work after his appendix had ruptured. A young guy, he was without health insurance when it happened. While he was recovering at home, he received his bill for the procedure and hospital stay: $91,000! Now if that's not a reason to look at health care prices, I don't know what it is.
Any docs or med students out there that have some insight on the whole issue? I'd be curious to get your take on it.
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