THE BLOG

Why Are People Shocked?

03/09/2011 05:57 pm ET | Updated May 25, 2011
  • Andrew Rubin Vice President for Medical Center Clinical Affairs for NYU Langone Medical Center

There has been a strange lull in the healthcare discussion in this country. Certainly the events in the Middle East and the recent good jobs report have taken the news spotlight off of healthcare reform. While the debate over repealing healthcare reform is far from over, the news has definitely moved on to other topics.

Then on Saturday, the New York Times published an article on rising healthcare premiums across the country and the shock that many Americans are experiencing when they see their monthly premiums go up 20% or more. Once again, republicans and democrats are seizing the opportunity to use this bad news to reinforce their positions on what this means for the future of healthcare in the country. And once again, they are completely missing the point and misrepresenting the truth. It would be easy to blame healthcare reform or the health insurance industry for these rising costs but that would be completely misplaced. The real issue is our nation's insatiable desire for the best and latest healthcare treatments, regardless of costs, and an aging population in need of ever more expensive healthcare.

As I have said all along, the Patient Protection and Affordable Care Act, signed into law last March, moved this country forward in addressing the plight of millions of Americans in creating access to affordable healthcare insurance starting in 2014. It also fixes some of the many injustices that consumers face when they get sick, like finding out their insurance plan may place a lifetime limit on benefits or not cover basic healthcare services. I want to be very clear, what the law does not sufficiently do is address the skyrocketing costs of healthcare in this country. Before healthcare reform became law, projected healthcare expenditures in this country were expected to rise to close to 20% of the U.S. gross domestic product (GDP). After the law was implemented, most projections say healthcare will reach the same level. What does this mean? It means healthcare will consume 1/5 of every dollar spent in this country. A number that has been growing at shockingly high rate over the past two decades and a level of spending that will be increasingly be hard to afford.

It would be unfair to say the law is absent of cost controls. There are many pilot programs starting around the country, funded using federal dollars, to reduce the cost of providing healthcare. But these programs are cumbersome and will merely be a drop in the bucket of what we need to do to stop the rising costs. The only real way to tackle the issue is to recognize there are limits to the amount of care we can afford to provide. Some would call that rationing, others would say do the most you can with the resources available. Since implementing these new payment methodologies is going to be very difficult, if not impossible, the government is simply going to just pay less. It is a dangerous path for hospitals that are barely surviving.

Society has shown we are unwilling to be told we cannot have access to latest treatments or tests when we are sick. One needs to look no further than a recent study on Avastin in the use of late-stage breast cancer. Avastin, a very expensive and life prolonging drug is very effective in certain cancers but was scientifically proven to be ineffective in treating certain late-stage breast cancer. As a result, it was recommended the drug stop being used. At a cost of about $100,000 per year for treatment, that would save the healthcare system quite a bit of money. Yet even with all the data showing it did not prolong life, groups around the country became outraged and protested. As a result, coverage for the drug remains in place. And there are many other examples.

We then wonder why our insurance premiums continue to rise 20% a year. It's not rocket science. There are going to be new treatments for diseases and conditions every day. As our science improves, we are able to create new drugs and technology to do ever more wonderful things for smaller numbers of people. The more we discover, the more tailored our treatments become for specific diseases. Some will work, many will not. And all of this comes at a great price to society. We must be willing to ask some very difficult questions. When is it enough? Are there limits to what we can afford to do? I have written about this before yet we rarely hear this discussed in the mainstream media because we are all afraid to talk about it. It is politically untenable to discuss this without creating a firestorm and quite frankly, many politicians do not seem to understand the issue. The healthcare system and the choices we have to make are rarely discussed in our classrooms and religious institutions. We are hiding behind the truth because the truth is scary.

For now, we are going to keep hearing that our health insurance premiums are going up and up, every year. We are going to be paying more for our healthcare out of pocket as employers and the government shift more costs onto us. And 30 to 50 million more Americans are going to enter the healthcare system over the next few years creating immediate and unprecedented demand for the limited healthcare resources we already have today. I hope we are all ready. The idea that people are surprised that this is going to happen needs to change. We need to keep the dialogue going so we can find new and better ways to tackle the problem. There are an unlimited number of ideas, some good and some bad. Let's try and stop the politicians from making it worse. In the interim, get used to higher premiums.

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