The Stanton Peele Addiction Website, July 19, 2010. This blog post also appeared on Stanton's blog at The Huffington Post website.
The Case for Managed Health Care - And Why Americans Reject It
The New York Times reports that small businesses are increasingly adopting insurance plans that restrict employees to doctors who are part of panels of providers who contract with the insurers. American employers want to cap their constantly escalating health care costs. It's called "managed care," similar to the way they control costs in the UK and other socialized medicine countries. The British system spends half as much annually per patient as we do.
What! That's anti-American, like death panels. As the Times article notes, such policies violate "repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices." On this issue - offering more expensive health care -- each party out-vies the other.
Let's keep this in mind when we turn to one of Atul Gawande's New Yorker series about health care costs - his 2009 commencement address at the University of Chicago Medical School:
Our country's health care is by far the most expensive in the world. It now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It's also devouring our government at every level -- squeezing out investments in education, our infrastructure, energy development, our future.
Yet studies find that in high-cost places [and countries] -- where doctors order more frequent tests and procedures, more specialist visits, more hospital admissions than the average [and, he might have added, where people insist on their favorite doctors - usually someone they started dealing with accidentally in the first place] -- the patients do no better, whether measured in terms of survival, ability to function, or satisfaction with care. If anything, they seemed to do worse.
[An amazed joint team of English and American researchers found that older English subjects had roughly half the level of every measured disease state - cancer, heart disease, diabetes - as comparable Americans. Despite appearing in the American Medical Association's flagship journal, JAMA, and literally addressing matters of life and death, the study caused nary a ripple.]
But the public doesn't know what to do about it. The government doesn't know. The insurance companies don't know...
The Times article describes something insurers and patients know about that tackles the problem -- but they make Americans' skin crawl -- HMOs!
Yet survey after survey has found that patients in HMOs (like Kaiser) are perfectly satisfied with their health care, and the doctors they have access to. We have a magical tendency to believe, if a doctor has done something good for us, that he or she was the only medical provider in the world who could have done that good. It's not true. (Did I tell you that most pilots -- not only Sully -- could have landed that plane in the Hudson?)
Managed care programs control costs, partly because they negotiate fees with medical providers, partly because they negotiate better prices from equipment and testing providers, partly because they may create treatment protocols, where doctors follow the treatment plans proven most effective -- and cost effective.
What, no doctor freedom?! Sounds like death panels!
Let's just power ahead. This was from this year's commencement address at Stanford Medical School by Gawande:
By the end of the decade, at the present rate of cost growth, the price of a family insurance plan will rise to $27,000. Health care will go from 10 per cent to 17 per cent of labor costs for business, and workers' wages will have to fall. State budgets will have to double to maintain current health programs. And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem -- far and away -- is the soaring and seemingly unstoppable cost of health care.
What do you think -- pretty scary? Most Americans won't be getting such good health care under this scenario, they'll barely be surviving. Something's got to change. Or will it?
Remember the movie, As Good As It Gets, where Jack Nicholson induces his editor's top-of-the-line New York specialist husband to visit Helen Hunt's sick child in her working class Brooklyn home? We are sure he will diagnose and treat the kid correctly, unlike the HMO in which she's enrolled -- why, the doctor guarantees it. He promises to do a great number of tests, at considerable cost -- but the Jack Nicholson character will pay.
We should actually pray for a system where Hunt, a waitress, and her son have guaranteed access to primary health care. Instead, the film suggests giving everyone access to the leading specialists and endless testing comprise the best health care system (unlike Dr. Gawande's assertion above). But Hunt is convinced, exploding with: "Fucking HMO bastards pieces of shit!" "I'm sorry." Doctor: "It's okay." Audiences cheered.
That's right: Damn those HMOs! Damn those death panels! Damn treatment protocols and negotiated fees and provider panels! Give us free choice of doctors, more tests and medications (but no vaccinations), more expensive health care! We're Americans, for God's sake!