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Health costs, overtreatment, and the myth of consumer driven medicine

The policy journal Health Affairs has a great first-hand account from a physician who visited the emergency room when he came down with shingles. The doc, who teaches at Stony Brook University, got caught in a maze of over testing and ran up an unnecessary $9,000 bill.

You should read the entire story when you get a chance, but he concludes:

One thing’s for sure: I’ve lost the smugness and condescension I often felt when listening to others’ stories about being trapped by the system and manipulated into excessively complex and specialized medical situations. Unlike most of my patients, I actually knew what my diagnosis was and what to do about it, but I learned how difficult it is to remain objective when you’re feeling very sick. Maybe I should have been more assertive. Instead, I wound up as a poster boy for excessive medicine. I understand now how all those people could have been so gullible, so easily manipulated by the system. Now that I’m one of them, that is.

The story is important because the physician was not given more and more tests because the emergency room docs and specialists were afraid of getting sued. And given his fear and vulnerability, requiring the patient to pay more out-of-pocket would not have changed the circumstances. When a specialist recommends testing for a brain tumor paying more out-of-pocket is unlikely to deter anyone.

What we need is better coordination of care. Someone rational thinking about the whole patient. And this story is a good example of how fixing health care is much more complicated than the simple talking points offered by conservative critics who push health savings accounts and tort reform.

7 Comments


  1. Louie

    September 18, 2009 at 7:05 pm

    salaried docs dont have an incentive to overtreat like docs billing under the failing, unsustainable fee-for-service reimbursement approach to comensation.

    waiting patiently for a non-profit health cooperative to open up in the Triangle. Any bets on when we will seesuch an org? 2015 2019?

  2. Louie

    September 18, 2009 at 7:06 pm

    I believe Group Health Cooerative of the Puget Sound has salaried docs

  3. […] Adam Linker writes of a “physician who visited the emergency room when he came down with shingles. The doc, who teaches at Stony Brook University, got caught in a maze of over testing and ran up an unnecessary $9,000 bill.” The physician’s tale of expensive, time and money wasting, medically unproductive woe concludes: […]

  4. Nan Richards

    September 21, 2009 at 9:32 am

    David,
    I heard another radio spot for BCBSNC this morning on WPTF. It also had what I thought was a false claim about forcing people out of their private health insurance into government-run insurance. Has anybody out there got a recording of it, so that we can transcribe the actual copy and de-bunk it?

  5. Nan Richards

    September 21, 2009 at 9:39 am

    Here is the copy:
    “North Carolina employers know we need health care reform, but Senator Kay Hagen and our leaders in Washington shouldn’t create government-run health insurance that will drive people from coverage they already have. Four out of five people with health insurance say what they have works for them, and building on what works is the best path to reform. Learn more at nchealthreform.com.”

  6. IBXer

    September 21, 2009 at 10:40 am

    45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul

    http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199

  7. Jack

    September 21, 2009 at 10:49 am

    45%! Now that’s what I call health care reform.

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