Fatal Flaws in American Health Care

ByOpinion By Nortin Hadler, M.d.

Oct.18, 2006 — -- The widely touted solution to the dire state of American health care is "National Health Insurance."

It's a promising idea: National Health Insurance promises to drastically reduce the administrative costs of insurance companies.

It promises to save money on health care. And it promises to work more effectively than our current system, which is currently so strongly defended by the bureaucrats who run it.

They promise to save money and give those with less money better care.

But lost amid the debate over a new system of health care, and whether it would or would not save money and would or would not serve everyone more equally, are the two fatal flaws in the U.S. health-care system.

These flaws are often overlooked when health-policy experts talk about changing our current system.

The first is that much of the billions of dollars we spend goes to the doctors, the insurance companies, administrators, the pharmaceutical industry and other purveyors. And you -- the patient -- are the last to be served.

The second flaw relates to why we have health insurance. The abiding principal of health insurance is to share the risk of untoward, unexpected events that would be catastrophic without insurance.

In other words, we contribute so that if one of us gets seriously ill beneficial recourse will be readily available.

But in truth, American medicine does so much today that does not work and does so little that actually makes the sick get healthier.

In fact, most of the insurance dollars that are not swallowed by administrative and other costs pay for medical interventions that simply do not work.

As I discuss in my recent book, "The Last Well Person: How to Stay Well Despite the Health-Care System," American medicine leads the world in doing the unnecessary very well.

The blame is not with doctors, nurses and health-care providers; most would serve their patients ethically and compassionately were it not for the financial, organizational and policy constraints placed on them by the entrenched and powerful American "institution" of medicine.

This leaves you, the patient, on your own.

And you are the only hope for graceful and rational reform. What are you supposed to do? No one should assume that the "standard of care" is good for us.

The critical question is not whether something can be done, or is done, or is affordable? We must each learn to question whether the "standard of care" will afford a meaningful outcome with a meaningful likelihood.

If it's not effective, it's not worth it at any price.

There is a wealth of science that informs our decision to accept treatment. All we need to do is ask the critical question.

When there's evidence for benefit, is the amount and likelihood of benefit sufficient for me?

We all need to think like this. We need to demand that health plans and regulatory agencies demand effectiveness from medical treatments. If we were to demand effectiveness, many commonly accepted treatments would not be covered.

We would no longer pay premiums to share the cost of expensive treatments and tests with questionable effectiveness. What would that encompass?

Cardiac bypasses, stents and angioplasties, all elective orthopedics, all spine surgery for back or leg pain, screening for bone mineral density, mammography, all pills for treating diabetes and moderate hypertension, "me too" drugs and many a biotechnological marvel, screening for prostate cancer, screening for high cholesterol, and much, much more.

And we'd be better off because they are all ineffective. Furthermore, American medicine would be effective and transparent.

This is the way to transform the American patient from cash cow to sacred cow. There need be no misdistribution were this to come to pass.

Dr. Nortin Hadler is a professor of medicine at the University of North Carolina at Chapel Hill and author of "Last Well Person: How to Stay Well Despite the Health-Care System" published in 2004 by McGill University Press.

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