My college psychology professor Abraham Maslow noted, "If you only have a hammer, you tend to see every problem as a nail." His quote captures the essence of the current, pejorative approach to health reform. That is unfortunate.
Media outlets recently have featured stories outlining copious, newly released CMS data on the price of health-care services. According to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, such release, in conjunction with the Obama administration's fourth annual "Datapalooza" conference, is intended to increase transparency and produce smarter consumers.
The Kaiser Health News notes, "The value of hospital charge data is hotly disputed, because few people actually end up paying the amounts listed. Insurers negotiate their own rates and the uninsured often get steep discounts. However, others believe the extremely high amounts that hospitals bill, and the lack of any logical connection to procedures' actual costs, is an illustration of the dysfunctional health-care market." Recently, Kaiser Health News also reported that 85 percent of "geographic" Medicare procedural care cost variation is not because of waste, inappropriate care or other questionable conduct but local factors that are poorly understood.
The New York Times has published a series of articles clearly inferring that the irresponsible and inappropriate behavior and conduct of physicians and health institutions results in greatly inflated health-care costs while delivering no better care or outcomes than foreign industrialized nations. Its June 2, 2013, story on colonoscopy and other procedural costs is an example.
Other than a fleeting mention that certain government restrictions on use of anesthetic agents might contribute, clearly the inference is that money-hungry physicians and institutions deliberately provide more costly, inappropriate and unnecessary care than that provided in foreign countries. Absent is any discussion of the vastly different legal liability climate or the increasing, government-imposed, regulations and other disincentives for physicians to maintain an "office" practice. Rather than $6,000 and up, I have little doubt that if these factors were controlled, a colonoscopy could be provided for about $1,000 in a physician's office.
And, as usual, the Times fails to note that differences in behavioral influences and genetics (not the quality and access to clinical care) account for 80 percent of health status outcomes. Physicians and hospitals do not control the increased frequency of suicide in Baby Boomer males, texting and driving in young adults, obesity, violence, exercise, substance abuse and so forth. They fail to mention that in one of the few legitimate comparisons tied to the quality and access of clinical care, survival time after cancer diagnosis, the United States leads the world by several years of survival.
Few would claim they can make sense of health-care pricing or that the health-care market is not dysfunctional. Why then not constructively examine and attempt to correct what has created the dysfunction, possibly including many policies and programs created by those publishing the data? Why the media splash? Will this really help health consumers figure out what has eluded all the experts, stimulate coherent and fair pricing and result in prudent purchasing? Or, is this but a defensive, political ploy to have health consumers take up their hammers and join the administration in pounding those health practitioner and institutional nails?
Felsen, of Great Cacapon, is a retired public health physician.