Wednesday, April 4, 2012

SENSIBLE USE VERSUS "RATIONING"

In a comment on my last posting, Anne asked me to respond to an article in today's NY Times (http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html?ref=todayspaper), in which a slew of doctor panels recommended fewer routine tests.

Thanks for asking, Anne. Another friend forwarded the same article to me, and I've been anxious to comment on it.

I've bellyached for years that Americans overuse expensive healthcare technology. We take too many tests, too many drugs, and undergo too many surgical procedures where less intervention might actually lead to better outcomes. In other words, we're in thrall to the presumed wonders of medical science. Some of us behind the scenes, though, are aware that many costly, invasive, and often hazardous interventions do not at all lead to better health…yet some do, and that's our dilemma. The point isn't to do everything for everyone versus nothing for everyone, but to weigh each decision thoughtfully.

We need to get a handle on healthcare costs, after all. While I favor a national single-payer healthcare plan, it will bankrupt us no less than our current non-system will UNLESS we buy it more reasonably.

I suspect at first we'll resist today's pronouncement, for a couple of reasons. First, people in general believe that high-tech diagnostic tests are somehow therapeutic in themselves. This is a common, worldwide misperception. Take radiation, for example. If you travel in Mexico, you'll find signs on medical offices advertising "rayos equis," x-rays. Ask the patients about them, and many say they get them because they feel better afterward. In Hungary, I spent an afternoon swimming in a lake reputed to be radioactive from radon beneath its floor. Fellow bathers uniformly emerged from it refreshed, swearing to radiation's restorative qualities. In the same way, glamorous medical technology exerts a placebo effect on us Americans--not a bad reason to continue its use, but not good enough to spend on it what we do.

Second, today's suggestions will inevitably be met by objections of "Rationing!" from the hard-of-thinking. Look: healthcare, like all services, has always been rationed and always will be. If there were no such thing as insurance, we'd have to weigh the value of anything we buy against its cost; that same principle resides in any financing mechanism. Intent on offering everyone everything, we're spending twice as much on healthcare per capita as any other country, and receiving tangibly less for it. This is an abysmal strategy. It's about time we smartened up.

The article quotes Dr. Christine K. Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation, who puts it more kindly than I do: “In fact, rationing is not necessary if you just don’t do the things that don’t help.”

I salute the medical associations that are stepping in and recommending less intervention. This needs to go hand-in-hand with taking more responsibility for our own health instead of asking docs to clean up behind our careless lifestyles.

2 comments:

  1. I first noticed this with the treatment of minor "head trauma." Back in the day (lol) we examined them, did simple cranial x-rays if warranted, educated them as to what to expect and when they needed to be seen again, and sent them home. Never had any problems.

    Now, well, you know what we do now!!

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  2. Love your blog! You live in a breathtakingly beautiful part of the country.

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