charles-barsotti-and-only-you-can-hear-this-whistle-new-yorker-cartoon2Average Doctor: What we need to do is repeal Obamacare and start over.

Policy Wonk: The Congress can not overturn the aging process, or the rise in chronic disease. Our care is high-cost and low quality care, and politicians are discovering there is no political constituency or market demand for this. Employers and other large purchasers of health care will  no longer write open ended checks. The right strategy, regardless of the future of reform, must be driven by what’s right for the patient. So, then, if not through Obamacare how would you fix the heath care system?

Average doctor: We practice way too much defensive medicine. If medical malpractice reform was enacted we could pay less for insurance and doctors would be able to practice medicine like in the old days and do what is good for the patient.

Policy wonk: OK, that’ll reduce the total cost by about 1%. The medical malpractice “crisis” is here. in large part, because the system fails patients.  Defensive medicine is tough to define and tends to exist only in the eye of the beholder. By most estimates we could reduce health care only by another 2%. Got any other ideas?

Average doctor: The insurance companies are making too much profit.  If we took money away from the insurance fat cats health costs would go down

Policy wonk: Let’s say we take away all insurance “profit.” Let’s even say we take away the cost of administering insurance. That would reduce our bill by $11 billion. Real money, except that the total health care spend is almost $3 trillion. At most, if we went to a single payer, VA type system, we could reduce administrative costs by 7%. Really want to go there?

Average Doctor: It’s big pharma. We need to rein in those drug companies.

Policy wonk:  Partly, but outpatient prescription drug costs have actually gone down in the last couple of years.

Average Doctor: It’s those patients who are reading stuff on the internet, then. They demand all sorts of things and if I don’t give it to them someone else will.

Policy wonk: Partly, but most people, though they may demand it, don’t get much. Half of all Americans spend less than $300 in an average year. 1% spend $90,000 (20% of the spend) annually.

Average Doctor: So how do we fix the problem?

Policy wonk: Look in the mirror. You collectively order too many tests on the top 20% of the spenders and often for the wrong reason. When doctors’ groups warn patients about 100 things that are being done by doctors that cause harm, you folks have a problem. You pick expensive medicine for chronic conditions when cheap medicine will do. Taking Nexium, the number one prescribed anti-acid drug, for GERD is attacking a flea with a sledge hammer for most people. The generic is just as good. Most people should try taking. It is much safer and just as effective. I’ll admit that people are getting older and fatter and there are some regulations that make it difficult for doctors to work together but, for the most part, the problem is you guys and the way you are paid. Our fee-for-service method leads to bad medicine.

Average doctor: What we need to do is repeal Obamacare and start over.

Most of this taken from the Institute of Medicine workshop on Delivering Affordable Cancer Care in the 21st Century.