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Wednesday, June 24, 2009

Health Care Reform Requires Change

By Dr. Torre Near
Albuquerque physician
      We waste billions of dollars on unnecessary and useless health care.
       People with insurance demand an MRI of their sprained knee that costs $1,000, when their knee will be better in two weeks. They demand Valtrex for shingles that costs $255 when Acyclovir costs $29 and works just as well. We treat high cholesterol with Lipitor or Crestor that cost $125 a month when we can use lovastatin for $4.
       We save extremely premature babies at a cost of millions just because we can, even though that child's chance at a productive life is almost nil.
       We dialyze our terminally demented patients who have no connection with the world and never move from their bed and continue to give them medications to “prevent” dementia and heart attack because the family demands that “everything be done.”
       We spend 90 percent of our life's medical dollars in the last year of our life.
       Seventy-five percent of our country's health care costs are for chronic illnesses, and many of them — obesity, hypertension, heart disease, diabetes, complications of alcoholism, emphysema and lung cancer — can be prevented, but people with unhealthy lifestyles don't want to put out the effort to make the change. Even when they have access to a doctor, are given the correct advice and medications, they don't follow it or take it — but then expect their $50,000 bypass surgery to be paid for by someone else when they have their inevitable heart attack, or worse, want a liver transplant when their liver fails from their alcoholism.
       We say that our life is priceless, invaluable, even divine, until it's our money. We all want the Mercedes of health care, but we only want to pay for a bicycle.
       We can't afford to provide a national, single-payer health plan that covers the cost of our current health care system. We are currently spending $7,000 a year for every man, woman and child in our country — which is $583 a month per person. A family of four would pay $2,333 a month — too much for anyone to afford.
       Medicine does not have the impact on our lives that we think. Our life expectancy has only increased by 10 years in the last 50 years despite the trillions of dollars spent on fancy procedures and drugs, when life expectancy increased 10 years in just 10 years when penicillin and sulfa were discovered.
       We, as individuals, can do more to improve our lives, but the way the current system is set-up, we have no incentive. The person who exercises every day, is in the normal weight range, doesn't smoke, has less than two drinks a day and sees a doctor once every two years pays the same as the person who is fat, smokes, drinks, (who's) exercise is working the remote and (who) sees the doctor every two weeks and is in the ER four times a year.
       It doesn't make sense. We have to change the system, and a national health care plan won't do that. There have to be incentives to be healthy, just like there are incentives in car insurance to buy a lower cost car, avoid tickets and stay out of accidents.
       Until health insurance mimics car insurance, we will continue to drown in health care costs. We also have to make hard decisions as a society as to where we spend our money on health to get the most benefit.
       We can't afford to save the severely premature just because we can, or keep the severely old or ill alive because we have the technology, or give $10,000 a dose chemo that extends someone's life by three months. The best use for our health care dollar is in prevention and incentives to stay healthy.
       We have to change.
       

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