Alice in health-care land

Americans pay more than anyone else for medical procedures—but without significant improvements in health outcomes

Read The New York Times June 1 article, “The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures,” at
Jeff vonKaenel is the president, CEO and majority owner of the News & Review newspapers in Sacramento, Chico and Reno. His column, Greenlight, appears weekly in this space.

In the Alice in Wonderland world of health care, crazy things can appear normal. “American health care” normal. The United States spends two-and-a-half times more than most developed countries on health care. But 40,000 Americans still die each year due to lack of health insurance. Relatively simple medical procedures in this country can cost more than having a baby in Europe. Health-care specialists can make more than half-a-million dollars a year. And our elected officials in the Alice in Wonderland House of Representatives have voted repeatedly to maintain this crazy status quo.

I remember a conversation with my dad 45 years ago, when I was a sophomore in high school. This was a couple of years after he had sold his small-town medical practice and moved our family to San Jose. We were discussing friends and family back home, when Dad told me that some other doctors were doubling their incomes.

I assumed that doubling one’s income was a good thing. But my dad seemed upset. I asked him how this happened. My dad paused. Then he took my hand, looked me in the eye, and said, “I think you have the flu, but I want to run a couple of tests to make sure.”

Furthermore, my dad told me that if people knew how much the tests would cost, and the likelihood that the tests would actually matter, they would never agree to them. My dad’s patients were working people who needed money to put food on the table and to buy clothing for their kids. They couldn’t afford to pay for frivolous tests. Many of these tests, like so many other things in our crazy health-care system, have more to do with greed than medical necessity.

There is no reason why health care costs so much more here than in other countries. The New York Times recently did a story on the escalating costs and used colonoscopies as an example. Colonoscopies cost almost twice as much in the United States as they do in Europe. Colonoscopies used to be done in doctors’ offices, but now doctors are investing in surgical centers and referring patients to them instead.

According to The New York Times, “The high price paid for colonoscopies mostly results not from top-notch patient care … but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.”

So, instead of having a typical European medical bill for a few hundred dollars, Americans are paying thousands of dollars without any significant improvement in health outcomes.

Forty-five years ago, my dad was ashamed that some doctors weren’t looking out for the good of the patients. Things haven’t gotten any better. If my dad was alive today, he’d be advocating for health-care reform.