Saving Money By Providing Care

I don't understand. Simple as that. I don't understand how anybody could be opposed to a law that will provide insurance coverage to over 32 million people who don't have it today.

I understand that we have huge debt in this country, but I'm not convinced that covering people is more expensive than sending them to emergency rooms. There are so many studies that show that when people with chronic illnesses can't afford the care they need, they skip care, and that allows their illness to spin out of control, getting much more expensive by the time they end up in the hospital on the taxpayers' tab. Indeed, although it's true that higher copays (meaning cheaper insurance) lead to people using less care, I haven't read anything that substantiates the view that that's a good thing. It's a whole lot easier and cheaper to treat a cold than it is to treat pneumonia.

How, then, do we bring down the cost of health care? A lot of smart people seem to think wellness programs and prevention are part of it, and I'm sure that's true. Smoking is bad. Obesity is bad. Lack of exercise is bad. And I'm a failure at most of those things, although I did quit smoking about 15 years ago or so. I mean to swim every morning, but I got an infection, and then there was ice and snow, and then another infection -- there's been an excuse for months now. I have to get myself back into the water, for sure. But the truth is that I am unable to swim hard enough and fast enough for it to be a real cardio work-out, and my joints hurt way too much for me to do anything other than swimming.

My weight? Well, we've been down this road before on this blog. It's a constant struggle just to stay at my current weight and not let it keep creeping up. My diet is so restricted -- no roughage, nuts, whole grains, fresh fruit or veggies -- it's very hard just to keep from gaining. And I have to say that so many of the people we help are overweight, as well, I discover when I read their medical charts. Interesting that most insurance doesn't cover bariatric surgery or nutrition counseling or diet programs. If it would really make us healthier, why not help us lose the weight by giving us the tools to do so?

But okay, let's assume we should all stop smoking and drinking, exercise, eat better. Is that going to cure Crohn's disease or multiple sclerosis or the whole host of chronic illnesses with which we struggle mightily? No, we need medical care, too.

And so we are back to what to do about the rising cost of health care. We know that our current system is badly broken. We know that we spend more on health care in America than most countries, but our health outcomes are lousy compared with the rest of the world. Clearly, we are doing something wrong. But it withholding care by making the prices prohibitive the right answer?

One thing that always interests me is that insurers don't actually respond to economic analysis. I can't tell you how often a patient will say to me "but if they let me have this surgery for $50,000 I can get off the feeding tube that is costing $50,000 a month." That assumes a level of rationality that is not there, does not exist.

I had a cancer patient who was so sickened from one chemo drug that she couldn't work, couldn't function. She found another drug. It worked to keep her illness in check. It had essentially no side-effects. It wasn't more expensive than the alternative the insurance company wanted her to take. How is it better for us as a society to have a disabled patient whom we now have to support entirely -- disability benefits, Medicare, free care at hospitals -- than it is to have a functioning patient whose disease is in remission?

You're going to think I'm nuts, but it's the truth. Pointing out to an insurance company that the treatment you seek is less expensive than the alternative doesn't change their minds. Maybe it ought to. Rather than worrying about the size of the clinical trials that support the use of the treatment the doctor prescribes regardless of cost, why not allow people less expensive options that are prescribed by treating physicians even if the treatment hasn't been as studied in as many people over as many years? If it's a wash on cost, why drive up the price of insurance by doing all of these reviews of treatments completely regardless of cost? Eliminate the need for insurance companies to staff with doctors and nurses whose job it is to second-guess treating physicians and you save money, no?

Look for more of these kinds of essays on this blog from now on. Because it's time for me to make sure that everybody else sees the piece of the world I see. Maybe then, people wouldn't be so quick to judge, to blame it on the patients. Maybe then, we would get that chronic illness affects all of us, if not directly, than through the costs on society. Maybe then, we would better understand the incentives that drive costs through the roof.

I promise you -- nobody wants more medical care than they need. If you think this is fun, think again. Patients aren't the ones who order health care or, most of the time, even request it. What we need is a society that supports us enough to get us the care we need -- nothing more, but also nothing less. I bet we'd save money just by doing that. Jennifer