The Problem

Why is American health care so expensive?

1) The majority of Americans do not take enough responsibility for their own health, nor are they incentivized to do so. By subscribing to behaviors known to be pleasurable but harmful [excessive caloric intake, sedentary lifestyles, and substance abuse are common examples), they develop chronic conditions such as obesity, diabetes, and premature vascular disease. These people then turn to the health care system to manage these problems with costly interventions [bypass surgery, kidney dialysis, joint replacements, and chronic pain management programs].

2) People are living longer and reaching an age where they develop a myriad of medical and surgical conditions for which they will seek treatment. They don't just sit at home and pass away quietly in their sleep. They access the care system repeatedly over decades for to fix their sexual function, skin cancer, arthritic hip, failing bone marrow, and heart failure. (More people) X (more years of life per person) X (more dollars spent per person) = growing costs with no end in sight.

3) Our health care culture is plagued with non-evidence based medical practices that rely on expensive unproven interventions that have not been demonstrated to improve outcomes. Yet, numerous health care providers and patients subscribe to such practices because "newer and more expensive must be better." Pharmaceutical companies that practice direct to consumer advertising to promote products they cannot convince physicians to prescribe exacerbate the problem. The result: total body CT scans and expensive "me too" drugs.

4) The practice of medicine has become much more complex, complicated, and costly. Yet, most health care providers who direct health care dollars through their decisions do not have the tools that allow them to leverage data and technology to improve outcomes and control cost. How can a doctor prescribe an equally effective and less expensive therapy if he/she is blind to the evidence and cost behind the various options?

5) The increased demand for services, emphasis on metrics for purposes of regulation and outcomes analysis, and rising costs across the board eliminate room for inefficiency and financial profit. Yet, human and systems inefficiencies and greed are constants. Thus, total health care costs continue to rise.

6) We have a problem with setting limits and saying no. The day of allowing people to do whatever they want and then access the health care system for any and all services regardless of cost is over. It's admirable but unsustainable. It's time to start linking behavior to cost and benefits. For many people, that's the only sustainable path to fundamental lifestyle changes. If you smoke cigarettes, your premiums are higher and you are at the end of the line for kidney dialysis. Draconian in a world of abundance; essential in the world we live in today.

Don't believe we have reached a health care crisis? Read on.

1) Nearly 50 million Americans, or 20% of the population under 50 years of age are not covered by health insurance. Double digit premium increases have become the norm and this is unsustainable for purchasers.

2) Over $2 trillion, or 20% of our gross domestic product, is spent on health care. Yet, we do not compare well with many other nations in health care outcomes.

3) Young physicians are shunning careers in primary care and opting for more lucrative and sustainable careers in the specialties. A health system without an adequate supply of bright, motivated, satisfied primary care physicians is doomed to failure. A primary care physician has the most intimate knowledge of the patient's total being and acts simultaneously as coach and quarterback to maximize the health care team's service to that patient.

4) In some cases, labor unions stress the system by negotiating extraordinary pay and benefits and protecting workers and practices that are not in the best interest of patients. The auto industry has demonstrated that such practices are unsustainable.

5) The menu of patient care options is growing in breath and cost: tailored interventions based on one's genetics; lighter, stronger, more durable replacement parts for your body; stem cell products for tissue regeneration. These all come with a hefty price tag. In this new world, is newer and more necessarily better and who will be the arbiter of who gets what?