The healthcare system harm may outweight its benefits
Coralee Thompson, MD
Premum non nocere. Every health care professional knows this phrase well – first do no harm. Unfortunately, most health care professionals and even consumers don’t realize or consider that the current health care system can cause enough harm to outweigh the overall benefit that health care provides. In this morass of skyrocketing health care costs, big business health insurance companies dictating the direction of health care, and government officials endlessly grappling with its role in health care delivery, there is no better time to evaluate the real cost of health care.
Most health care professionals work hard, deserve respect, and have no mal intent. And many health care services are effective in treating disease. But nearly a third of all medical expenditures are for services that don’t improve health and may indeed make it worse. Writing in the July 1, 2009 issue of the Journal of the American Medical Association (JAMA), physicians Kilo and Larson state: “Unlike health, health care is not an unalloyed good. Fisher states that perhaps one-third of medical spending is for ‘services that don’t appear to improve health or the quality of care – and may make things worse.’ Although health care contributes to health through disease prevention and treatment, the aggregate effect on health may be smaller than generally assumed.”
Subtract the harm of current health care from the benefits, and just possibly the net may be harm. This includes both direct and indirect harm.
Direct harm from health care includes both bodily injury (side effects of medication, excessive radiation from X-rays, medical and procedural errors, device failure, etc.) and emotional injury (anxiety from testing or treatment, unnecessary screening that leads to over treatment or further testing, false positive results, etc.). In 2006, roughly 1.1 million hospitalizations in the US were a result of medical complications, with an overall cost of $42 billion dollars. Medical over treatment causes greatest harm to those who are in the end stages of their lives, including their families and loved ones. Some studies site that at least 30% of elderly patients receive unwanted procedures that prolong their lives, but don’t improve quality of life. And the expense of end-of-life care can be enormous. Medicare expenses are as high as $90,000 in the last 2 years of life, and up to $53,000 in the last 6 months of life, per person.
Indirect harm may have far-reaching consequences compared to direct harm, but is less obvious to those who cause it and those who are hurt by it. One fact is that resources (money) are limited, and someone must decide how to distribute the funds – who gets what services. This often leads to a harmful trade off of buying one service at a higher cost over another lower cost service that may be more beneficial. For example, providing an expensive surgery of marginal effectiveness in one patient may prevent many other patients from receiving less expensive more conservative treatments that are more effective. Another example is when health care expenses shift funds away from services that have a much stronger influence on health in many more people; healthy food, education, environmental safety, housing, and jobs. The complex interplay of nutrition, exercise, genetics, social settings, job satisfaction, and education determine health far above health care. Statistically, health care contributes only about 10% toward reducing premature death. So even a perfect health care system would offer only a small contribution compared to other social and individual factors.
Another common indirect problem taking health care resources away from people who need it include the cost of administration. The average cost – per doctor – for billing is up to $85,000 per year.
What are the costs of the current health care system, one that is broken, ineffective and doesn’t even focus on health but on disease? US health care costs hit $2.5 trillion dollars in 2008, 17% of the gross domestic product. In 2007, 28% of the federal government’s total revenue was spent on health care. On the state levels, spending on Medicaid represented 22% versus 21% for K-12 education, 10% for higher education, and 8% for transportation. As medical expenses continue to inflate, less money is available for education and infrastructure. Even though a large portion of state and federal expenses go to medical care, 50 million individuals do not have health insurance. And as health insurance becomes more expensive, more people are unable to afford it. Even a small increase of 1% for insurance premiums translates into 300,000 people losing health insurance. Health care debt was responsible for more than 60% of personal bankruptcies that were filed in 2007. These numbers are staggering and pouring more money into an inefficient system is not going to help. Simply put, we don’t need more health insurance or even more health care, we need more health.
The government would have a more powerful role in promoting health by sponsoring the infrastructure to create healthier lifestyles. Consider the possible impact of the following:
- Intensive marketing and education for healthy food while restricting unhealthy marketing much the way cigarette and alcohol advertisements have been regulated.
- Heavy taxation on fast food and junk food.
- Help farmers and companies produce healthy, unprocessed food such as fruits, vegetables, eggs, lentils, etc.
- Bike lanes and parking lots for bicycles.
- Walking trails and safe sidewalks.
- Real environmental clean ups.
The bottom line is that health begins with each individual; taking responsibility for our own health through good food, exercise, reducing stress, a clean environment, healthy sun exposure, and staying away from potentially harmful and unnecessary “health care.”
Kilo CM and Larson EB (2009). Exploring the Harmful Effects of Health Care. JAMA; 302(1): 89-91.
Fisher ES. More medicine is not better medicine. New York Times. December 1, 2003. Opinion.
An Open Letter to President Obama
Dr. Phil Maffetone
I don’t usually discuss politics, but America’s health care system continues to fail – we rank 37th (just above Slovenia and Cuba). And, many other countries are following our healthcare path. In my “open letter to President Obama,” below, I address one key aspect of a successful healthcare program that is almost never discussed. After reading it, feel free to email it to Mr. Obama with your name in place of mine. Also, please forward it to your list of email addresses, especially those healthcare professionals you know who are truly health oriented. Send your email to President Obama here. I've already sent my letter.
To: President Obama
From: Dr. Philip Maffetone
Date: January 5, 2009
There is a primary issue missing from the health care discussions that would help assure success and significantly reduce costs. If we are to truly improve our health care system for the long term, each one of us must take more responsibility for our own health. As such, health care must have a primary proactive component, where individuals focus on avoiding ill health and disease. This has been shown to dramatically reduce health care costs. Instead, the current system is a reactive one, where we wait for disease to occur then treat it with very expensive remedies. This approach is not only more costly but can significantly reduce our quality of life.
Experts generally agree that most health problems, including the majority of diseases, are preventable. In its truest definition, prevention refers to “outlasting disease” by being healthier at an earlier age. While “screening for disease” is important, it’s a separate issue, and does not take the place of true prevention. As individuals, we are the only ones who can truly prevent disease.
Taking responsibility for our own health is a significant step toward improving the overall health of the country. In doing so, health care costs can begin to drop significantly after year one, and continue to be reduced over time. The process is not unlike getting people to wear seat belts or quit smoking – both examples of true prevention that have already succeeded. But the process must be expanded to include the types of food people consume, their levels of physical activity, and the influence of stress.
How can we change a population’s eating and activity habits? Much the same way that most people now wear seat belts and smoking has been significantly reduced – with education. But that process cannot include lobbyists from the food and drug industry, and others with conflicts of interest. There is a consensus of scientific and medical information that could serve as the foundation for education and healthy recommendations.
Yours in health,
Dr. Philip Maffetone