'First, make a profit' seems to be the mantra for shrewd
health-care executives and certain physicians. All the while, patients suffer.
Here's what drives this travesty.
The pursuit of excessive
profits in health care isn't healthy. Care is increasingly unaffordable, and
many people don't have insurance coverage at all. Employers are dropping
coverage or shifting health care costs to employees in the form of high
deductibles and coinsurance. Simultaneously, shrewd health care executives and
certain physicians are getting rich at the patients' expense. It seems that
success in health care has been defined by money and by Wall Street, not by the
overall improved health of patients. This is disturbing to me as a physician.
How can it be considered acceptable or reasonable? There are three trends in
particular that demonstrate how money and profits have become too influential in
the health care system.
A $1.6 billion check?
How was this acceptable? Why did it
take alleged options shenanigans to get people upset? There is something
fundamentally wrong with a physician or CEO having pay that essentially could
provide a small country with basic health care for a year.
And there should be further outrage
that the escalation in McGuire's salary wasn't tied to a fundamental improvement
in health or affordability for people with UnitedHealth coverage. It was all
about mergers and acquisitions.
When a physician becomes a health
care CEO, shouldn't that result in better alignment of insurance and care
delivery?
Money from drug companies
A second troublesome trend is the
number of physicians who are succumbing to the influence of pharmaceutical and
medical-device companies, more darlings of Wall Street. Under the guise of
providing "information to guide the care of patients," marketing campaigns spend
millions to promote drugs without regard to whether they truly deliver a better
health outcome or cure. It isn't about improved health or affordability; it's
all about market share.
Physicians increasingly are paid to
act as consultants to a drug company, and essentially allow their good name and
reputation to be tied to articles written by drug company employees. They are
paid to influence the development of practice guidelines to support the use of
specific drugs in treatment and thereby increase the profits for a drug company.
In addition, the physicians give
talks (prepared by the drug companies) to fellow physicians, and in return are
paid handsomely. The doctors attending the session are also paid, so everyone's
pocket is getting lined in the process -- except for the patient seeking
affordable care.
Perhaps this shouldn't be a
surprise, since health care is being measured on money and profit, not health
improvement and quality. But how is this acceptable? Drug companies spend
millions on this "doctor to doctor" marketing, and individual physicians are
being paid tens to hundreds of thousands of dollars a year for this so-called
consulting.
Have MRI, will scan
A third indication of money's role
in driving health care is the emerging trend that allows specialists to double
their income by owning high-end imaging devices (MRI and PET scanners) or
treatment devices (like those used in radiation therapy).
Now remember, these oncologists and
orthopedic surgeons already make a handsome salary -- just a bit north of
amazing to this geriatrician. But by simply owning a machine and ordering an
increased number of tests or performing an increased number of treatments,
whether necessary or borderline, a doctor now can directly and massively
increase his or her income.
Is health improving in the process?
No. Is it more affordable? Definitely not.
Studies indicate that when a
physician owns a piece of equipment such as an MRI or PET scanner, there is a
tendency to use it more often. Studies also show that patients do not benefit
from -- and may be harmed by -- the excessive use of this machinery. So who
benefits? The physicians who own the machines.
Doctors aren't immune to the
pressure of profits, and in fact some feel deserving of the dollars. After all,
aren't we saving lives? Aren't we curing illness and disease? Who can put a
price on that?
We doctors take pride in our
training. We made it through medical school and residency. We studied hard and
worked hard. We feel smart and believe ourselves immune to marketing influences
or conflicts of interest. I have heard physicians say over and over again that
they always put patients first and that they can remain objective.
Baloney.
I think it is absurd. It doesn't
matter who you are or how smart you are; the seduction of money and profits
works. Simply put, money matters. It influences our decisions in caring for
patients. It may be subtle, or it may be blatant. But it is there. We are only
human.
You can't imagine how demoralizing
it is for my colleagues and me when we hear these examples of excessive
financial profit. It is shameful and disrespectful to our patients. Physicians
always believe they are "just doing what is best for the patients," but as money
continues to influence behavior and as we continue to define success in health
care by business standards, the patient loses.
These three examples put money right
in front of good medical care, and that's not a good thing. Our increasing
comfort with the transformation of the art and science of medicine into the
"business" of medicine comes at a cost. It allows the invisible hand of the
marketplace to take a greater role, and in many instances that hand is stuffed
with cash. It also shortchanges the patient in the process.
I have been practicing geriatric
medicine in a large group for 23 years. I have personally worked hard to avoid
situations and relationships where it seems that money could end up being the
driver of my decisions.
I challenge all of us as physicians
to look very hard at the decisions we make when profit is involved. And I ask
patients to demand that we keep putting them first.
Tom von Sternberg,
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