We're spending enough

It seems that both articles had a fairly negative view of the financial part of our health system. The Washington Post article used the example of cardiovascular disease as a case study in medical care to follow how our advances are increasing the costs. Over time, these costs will come down, as the technology for creating stents becomes cheaper and as the various drugs come off patent (Plavix, Zetia, etc).

It seems that these questions always come down to a cost benefit analysis. Unfortunately for planning purposes, the benefits are measured in other units than dollars. Is the cost of a slightly more expensive drug worth the 0.5% decrease in mortality? Who makes those decisions? Right now, the market makes it. And the people will pay. We don't want to let people die, even those in pain with little or no chance of recovery. Some of the most expensive, least likely to work treatments are for those patients with little chance of recovery, and we are trying to eke out a few more months. There needs to be some regulation of those decisions, cost benefit analysis and decision trees. We need to make it easier for patients to decline the more invasive options, and easier for doctors to take the less invasive approach when deciding between two treatment options.

There is an adage in medicine "When you hear hoofbeats, think horses, not zebras" which is to say that common things are common. However, we are all trained to make sure that its not a zebra, because there is always a case of "you should have known, but you missed it". This does come down to defensive medicine, which is related to malpractice, but not only malpractice. Its looking into a patients eyes and knowing that they are just the same as your sister, your father, your daughter or your son, and wanting to make sure that you are doing what is best for them. Public health pushes us to think of the big picture, how trends affect medical care and which treatments are the best for the most people, but we as individuals don't like statistics. We play the lottery because we think "I know that for most people, that is true, but what if this one is different". I don't think that mentality is going to change.

As for the idea that happy health care is good health care, I agree for different reasons than other people have stated. Happy people are less likely to sue. People happy with their health care are less likely to seek care elsewhere and have repeat tests. Multiple studies have shown that in cases of medical errors, the best course of action for the practitioner is to admit the mistake, be forthcoming and express remorse. Saying you're sorry isn't the same as admitting guilt. The idea being to develop that relationship with the patient and keep them happy.

There are always little things we can do to keep costs down: like the ideas of choosing lighter colored rooftops and keeping your tires filled to combat climate change, the idea of increasing handwashing and decreasing nosocomial infections and medical errors is incredibly important. Some of the mechanisms in place to make those things happen may not be the most efficient/cost effective (hmmmm....JCAHO requirements), but are certainly a step in the right direction. Free vaccines and health care maintenance/preventative screenings are also a key step in the right direction, and I was happy to hear Obama talk about it.

The NY Times article listed "Not following doctors orders" as one of the main costs, but didn't address it in the body of the text. I assume this means patients not following recommendations. I have no idea how they came up with that number, but I think it would be more if it included public health initiatives. If only it was easy to quit smoking, lose weight, get more exercise, cut fat intake, use condoms, wash our hands.....