The Trump administration is back this week with a budget plan that addresses rising health care costs by reducing coverage for millions of low- and middle-income Americans. By slashing Medicaid spending and marketplace subsidies, the budget cuts Federal spending on health care to make room for increased military spending, the “wall,” and lower taxes.
But there is one thing the proposed cuts won’t do: reduce our nation’s overall health care bill, which is sapping the strength of our economy.
Health care spending consumes one-fifth of GDP. While health care does create jobs, it also takes jobs away by reducing spending for other public goods: housing, education, and infrastructure. Health care costs bankrupt patients, choke small businesses, contribute to stagnate wages, and force governments at all levels to trim public services.
In short, neither the president’s budget nor Congressional proposals will solve our health care spending crisis. But it is also true that if we enacted a single payer system — universal Medicare coverage for all — tomorrow, costs would still rise and Americans would still suffer from higher rates of chronic illness and lower life expectancy than all other modern democracies.
“Our health care system is no longer about relieving the suffering of patients... It’s about making money.”
Why? Because our increasingly corporatized health care system is driven by an insatiable appetite for profit. Our health care system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money: for pharmaceutical companies, device manufacturers, hospitals, insurance companies, and increasingly, for doctors. And all of these players are gaming the system and hurting patients in the process.
Take Ralph Weiss. An athletic Los Angeles lawyer, Weiss was told he needed spine surgery or he would be risking serious nerve damage. He never thought to question the surgeon’s opinion. Now he is disabled and in chronic pain from surgery he never needed in the first place.
Weiss’ surgery was performed by a UCLA orthopedist who failed to disclose he was taking hundreds of thousands of dollars from the manufacturers of the spine surgery products that would be used in Weiss’ operation.
In any other industry, such behavior might be called a kickback — i.e., a corrupt practice. But in health care, it’s seen as par for the course.
“Corruption” is not a term most Americans would probably apply to what goes on inside American health care. But if corruption is defined as persons or institutions wielding power for their own gain, then our health care system is riddled with it. And it is not only costing us billions of dollars, it is harming untold numbers of patients like Ralph Weiss. Examples abound.
Hospital administrators routinely urge emergency room personnel to meet quotas for admissions, whether or not patients actually need to be admitted to the hospital. Meanwhile, their billing offices have perfected the art of “upcoding,” manipulating patient diagnoses in order to game payment systems and costing Medicare an estimated $10 billion a year.
Physicians refer patients for unnecessary imaging tests such as CT and MRI scans when they own a share in the testing facility or equipment.
Drug and device makers pay tens of millions of dollars each year to physician specialty societies to influence continuing medical education and treatment guidelines. They pay out hundreds of millions to patients who have been harmed by their products, but that’s just the cost of doing business.
With so much money at stake, it’s not surprising that corruption exists within the health care industry. What sparks our outrage is the fact that such behavior has come to be accepted as normal in a system that professes to care about nothing but the welfare of patients.
There is no simple cure for this insidious disease. The 2010 Physician Payment Sunshine Act has brought payments from manufacturers into the open, a first step towards encouraging physicians and their specialty societies to think twice before accepting the money.
But to fully address both our health care cost crisis and the harm it is doing to patients, we must call out the forces of greed and corruption that are undermining the American health care system. It’s time to stop treating health care like it’s a guaranteed profit center in an otherwise slow economy, where another big dose of free market reforms will somehow control costs and keep patients safe.
Vikas Saini, MD, is a clinical cardiologist and president of the Lown Institute, a think tank based in Boston. Shannon Brownlee is senior vice president of the institute. Together, they co-founded the Right Care Alliance.
