Letters to Business
By Richard T. Landres, M.D., Stockton
San Francisco Chronicle
September 11, 2005
SB840, the (single payer) bill proposed by state Sen. Sheila Kuehl, D-Santa Monica, would increase the cost of health care rather than reduce it. This is because a large portion of our health care expenditures are driven by consumer demand for services.
As a practicing physician in California for more than 30 years, it’s been my experience that patients and families usually want the very best health care (i.e, every conceivable test, whether medically necessary or not, and sometimes more than once).
Even when the diagnosis is understood and not serious, medically unnecessary tests are frequently obtained in order to reassure the patient and/or because of physicians’ malpractice liability concerns.
Ethical physicians who attempt to curtail unnecessary testing and treatment often have dissatisfied patients, who need only go to another doctor to get whatever test or treatment they desire.
Whether or not one favors a single-payer system politically, make no mistake that Sen. Kuehl’s proposed legislation — lacking as it does any provision for patient copayments or premiums or any external utilization controls — would dramatically increase health care costs.
And…
Many Adults Do Not Follow Doctors’ Recommendations for Care, Survey Shows
Kaiser Daily Health Policy Report
Sep 13, 2005
More than half of U.S. adults have previously decided not to follow treatment recommendations from their physician because they considered them “unnecessary or too aggressive,” according to a Wall Street Journal Online/Harris Interactive poll, the Wall Street Journal reports.
Poll respondents cited as the main reasons for unnecessary treatment recommendations physicians’ concerns about malpractice lawsuits (53%), physicians’ desire to earn more (45%) and physicians’ desire to meet the demands of patients (45%).
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=32531
Comment: Supporters of the consumer-directed health care (CDHC) contend that health care costs are out of control because patients are demanding too much care. CDHC advocates contend that we will not control costs until we require patients to pay more out-of-pocket for all of this “unnecessary”
care.
Judging from this Harris poll, it appears that, in sharp contrast, patients believe that it is the physicians who are responsible for all of this “unnecessary” care. Would anyone suggest that physicians be required to share in the costs for all of this “unnecessary” testing and treatment that they are ordering for their patients?
Both theories are fundamentally flawed. Most health care spending is for beneficial services (though qualifications to this comment will not be addressed here). The excess spending that would be due to meeting unreasonable demands of patients would constitute only a minute fraction of overall spending. Likewise, most recommendations made by physicians are sincerely intended to benefit patients. Instituting financial penalties on either the patient demand side or the physician supply side would have only a very modest impact on overall health care spending. More importantly, the reduction in spending would reduce the amount of beneficial services provided. The savings would be very small, but the negative impact on health could be significant.
There are better methods of managing costs such as improving the primary care infrastructure, using capital budgets to ensure appropriate levels of capacity, and negotiating fair pricing of services and products.
Lets’ quit blaming the patients who demand too much care and doctors who are getting rich by providing too many services. Compared to the real problems with our health care system, these are almost phantom issues. Instead, let’s get on with fixing our system using sound theory and proven principles. We really can achieve health care justice for all, if we just get serious.