Malcom Gladwell, the author of the best-seller “Blink,” also wrote a book called “The Tipping Point.” In it, the prominent economist talks about the phenomenon where events snowball and accumulate to such an extent that a major shift takes place. I think we are entering such a tipping point in medicine, and there are multiple factors contributing to this.
First, the array of available technology and treatments is vastly increased over what it was in past decades. Transplantation of organs, neonatal therapy such as ECMO, and new cancer treatments are just three examples of expensive new technological and therapeutic advances that have driven up the cost of medicine. Along with technology, the variety and price of pharmaceuticals has gone up. Fifty years ago we had only a fraction of the medications that are available today. These costs have risen to the point where people are regularly being asked to pay higher premiums, co-pays and deductibles for policies with reduced benefits.
Second, the way health care is delivered is wasteful and inefficient. We have an army of employees doing work that could simply be eliminated. Some people work full time to sell insurance policies, while others work full time to find ways to “cherry pick” healthier members or to cancel policies that are no longer profitable. Physicians hire numerous support staff to get patients and insurance companies to pay the bills, and the insurance companies hire staff to deny claims and treatment-authorization requests. We have hoards of people working against each other in order to protect their respective turf and/or profits. Insurance companies take 20 percent of the health care dollar for administrative costs and profit when most of that money could be put toward patient care. In fact, the only two sectors of health care that still seem to be doing well are the insurance companies and the pharmaceutical companies.
Medi-Cal pays so poorly that a physician cannot even cover overhead much less earn an income from it. Patients are denied access to care by its unavailability, leading them to allow medical conditions to deteriorate until emergency care is required.
Emergency care is much more expensive to provide than preventive care, and thus, in the long run, this ends up being more expensive. Legislation mandates that emergency care be provided, but does not fund the cost of giving such care. Thus hospitals scramble to squeeze money from any profitable area of business to cover operating costs, and those areas of profit are shrinking rapidly.
Our system is on the brink of collapse, and the Legislature seems paralyzed to do anything about it. California started out the year with big plans to provide health care for every Californian, and several bills were put forth. Nothing could be agreed upon except that money was tight. Now the same Legislature is proposing 10 percent cuts to the already inadequate MediCal/MediCare system. The cuts, if they pass, will probably be the proverbial straw that will break the camel’s back.
We are about to hit that tipping point where the combination of increasing cost, systematic inefficiency and waste, insufficient and topsy-turvy funding, predatory insurance company practices and legislative paralysis come together to create the perfect storm, and we are all stuck on the boat while “big pharma” and the insurance industry have just made off with the lifeboats.
Emily Dalton is a physician in Eureka.
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Well, it's good to see someone finally bring up the fact that one reason health care is so expensive is that we have technology, treatments and drugs available today that weren't available even thirty years ago.
This letter only points out the fact that, we have the technology, drugs and treatments for everything, but it is only available to those that can afford.
Our Government works as if, "Wait until it breaks and then spend more to fix it mentallity." I reference Medical and Medicare in how they allow for services covered.
Instead of allowing for preventive care at a higher reimbursement rate, it provides lower and discourages physicians the opportunity to prevent higher costs in medical services.
It is not only in our medical system though, our government is so busy worrying about other countries, they have forgot our infrastructure and education.
We need single payer nationalized health care like virtually every other first world country has. Dr. Dalton's 20% to insurance companies for administration and profit is low according to my research which showed various estimates of 31 to 52% of our health care dollars are going to insurance company administration and profit. While we spend over twice as much for health care per capita than countries with nationalized health care, we don't have better outcomes. The millions of people without insurance delay seeing a doctor until they are critically ill and their treatment costs much more with poor results. Switching to nationalized health care before our health care delivery system collapses will forestall the looming catastrophe on our horizon.