If I had to name the one single biggest problem in US healthcare, it would be this:
"Twenty years ago, when I was in training, nobody really dealt with
economics," says Stephen Hufford, an oncologist in San Francisco. The
prevailing thinking, he says, was: "Cost should never be an issue in
In a survey of 167 cancer doctors reported last year in the Journal of
Clinical Oncology, 42% said they regularly raised the issue of costs
when discussing treatment options with patients.
Which means that even today, 58% of oncologists did not raise cost or price issues with various treatment options, despite practicing in perhaps the most costly of medical fields. What planet are we living on, here? Can you imagine a survey in which 58% of car dealers refused to raise the issue of cost in a new car sale? Or 58% of real estate brokers saying they never mentioned the prices of houses when discussing them with clients?
This represents a process failure in the health care system on two levels. First, not having any single person in the decision-making process making cost-benefit trade-offs is a recipe for disaster. Insured customers will consume as much as they can when price is off the table. Many folks in the health care debate recognize this.
But there is a second problem. Even when there is a single entity making these trade-offs, it is almost never the patient. Most "reformers" on both the left and the right want to place this decision-making authority in government bureaucrats, in insurance companies, in Congress, in doctors -- any place but in the individual patient herself. This particular article discusses the role of doctors in this process:
Many health-policy experts say it's high time for American doctors to
start considering costs when assessing treatment options. In 2007, the
cost of cancer care alone reached an estimated $89 billion in the U.S.,
up from $72 billion in 2004, according to the American Cancer Society
using data from the National Institutes of Health....
The study, conducted
by Deborah Schrag, an oncologist at the Dana Farber Cancer Institute in
Boston, found that 23% of oncologists said costs influence their
treatment decisions, and 16% said they omit discussion of very
expensive treatments when they know the cost will place great strain on
This misses the mark. Doctors should be ready to inform patients of their options, but at the end of the day we need a system where the patient is making these tradeoffs. Note the absolute, nearly criminal arrogance of doctors who don't suggest the best treatment regime because the cost might stress out the patients. How does the doctor know what financial resources the person might be able to bring to bear?
Postscript: In an adjoining article, the WSJ has an article on the wacky way the French government makes these cost-benefit trade offs in health care:
Since 1860, when Napoleon III appropriated this
ancient Roman spa at the foot of the Alps for his empire, the National
Baths of Aix-les-Bains have been a symbol of France's cushy health-care
On a recent morning, Jacqueline Surmont and her
husband, Guy, a 77-year-old retired construction worker, headed for
their daily mud wrap. The spa's rheumatism cures, thermal baths and
13-minute deep-tissue massage all are covered by France's national
health-insurance system. Transportation and lodging are, too....
"For many people, it's like a free holiday," says Ms. Surmont, who says
all her mud wraps and massages were properly prescribed by a doctor to
soothe her ailing back. "Some patients go shopping in the afternoon.
They're hardly in pain."
Wonderful. This kind of BS is virtually inevitable in state-run systems. I think one can already imagine a US health care system where taxpayers foot the fill for groovy treatments loved by the dippy left, from acupuncture to aromatherapy to homeopathy, while cancer patients are denied drugs and people have to wait months or years for elective surgery.
By the way, we get this in the "goes without saying" file from a state-run spa employee facing cutbacks:
"Of course we went on strike," said Martine Claret, a 52-year-old
physiotherapist who has worked at the spa since 1979 and doubles as a