UCLA expert blames American values for health care crisis
Reforming the system will require strong medicine, tough choices
By Elaine Schmidt December 03, 2008
(Note to editors: PDFs of journal articles are available upon request.)
(Correction: An earlier version of this release mistakenly stated, "only one-sixth of Americans are insured." One-sixth of Americans are not insured.)
To heal our ailing health care system, we need to stop thinking like Americans. That's the message of two articles by UCLA's Dr. Marc Nuwer, a leading expert on national health care reform, published this week in Neurology, the journal of the American Academy of Neurology.
"Americans prize individual choice and resist limiting care," says Nuwer, a professor of clinical neurology at the David Geffen School of Medicine at UCLA. "We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, then they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada."
Consider these statistics:
- The United States boasts the world's most expensive health care system, yet one-sixth of Americans are uninsured. Medical expenditures exceed $2 trillion annually, making health care the economy's largest sector, four times bigger than national defense.
- By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation's gross domestic product.
- An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.
- 31 percent of U.S. health care funds go toward administration. "We push a lot of paper," Nuwer says. "We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork."
10 percent of U.S. expenses are spent on "defensive medicine" — pricey tests ordered by doctors afraid of missing anything, however unlikely. "Doctors don't want to be accused in court of a delayed diagnosis, so they bend over backwards to find something — even if it's a rare possibility — in order to cover themselves," Nuwer says.
Reforming the U.S. health care system with the goal of providing universal, affordable, high-quality care will require rethinking our overall values and paying greater attention to care-related expenditures, according to Nuwer.
Part of the current problem, he says, is that doctors are oblivious to the price tags of options they're prescribing for patients. He recommends educating physicians about the costs of care, including imaging, blood tests and specific drugs.
"Does a fancy electric wheelchair cost $500 or $50,000?" Nuwer asks. "Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders."
Nuwer's co-authors on both articles include Dr. G.L. Barkley (Henry Ford Hospital, Detroit); Dr. G.J. Esper (Emory University School of Medicine, Atlanta); Dr. P.D. Donofrio (Vanderbilt University School of Medicine, Nashville); Dr. J.P. Szaflarski (University of Cincinnati Academic Health Center); and Dr. T.R. Swift (Medical College of Georgia, Augusta).
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