Mark Harvey — The state of health care, and where we’re headed


Good Morning! Have we all more or less settled into 2014? Good.

And we realize that we have a little while yet before we need to freak out about taxes? Excellent! So, now what?

Well, this is going to be one of those just-a-little-something-to-think-about columns. I’m not trying to make some huge point, or espouse this-or-that, and we certainly don’t have to jump right up and mobilize in order to accomplish this or prevent that — just play with some ideas.

Last week I said, among other things:

“Here are a few little tidbits, pulled out of a study made available through the Journal of the American Medical Association.”

The studiers looked at a whole bunch of publicly available data on health care between 1980 and 2011, and came up with some mildly distracting observations, like:

• In 2011, U.S. health care employed 15.7 percent of the workforce, with expenditures of $2.7 trillion, which was a doubling from 1980 as a percentage of the GDP (gross domestic product), to 17.9 percent! Interestingly, that growth has actually decreased since 1970 — and especially since 2002 — but at 3 percent per year, still exceeds any other industry, and the GDP, overall.

• Given all of that, a number of health care measurements (like, life expectancy at birth, survival with many diseases, etc.) say that we’re trailing “peer nations.”

• They also found out that a lot of things that a lot of people like to think, are wrong — specifically, price (especially of hospital charges), professional services, drugs and devices and “administrative costs” accounted for 91 percent of cost increases, NOT the demand for services or the AGING OF THE POPULATION!

OK? Well, apparently, in the latter part of last year there was a conference, sponsored by the British Medical Journal, Consumer Reports, and Dartmouth and Bond universities, on “Preventing Over Diagnosis.” And, apparently, the goal of said conference was to identify excesses in medical care and figure out what to do about them — a worthy goal, given the three bullets above.

Just for grins, here’s my dumbed-down-so-I-can-understand-it and severely-abbreviated list of some of the things these folks came up with:

• Early screening and intervention, enthusiastically endorsed by preventive medicine, has turned out to be an oversold, dangerous and expensive flop.

• Lowering the thresholds of disease definitions has, they say, identified diseases that don’t exist, meaning that “getting there too early” misidentifies too many people who aren’t really at risk, and then subjects them to needless (and, potentially, harmful) tests and treatments.

• Health care is going nuts with the technology. An example, these folks say, is that if we do enough CT scans, we can find “structural abnormalities” in just about anyone, and can cause dangerous side-effects.

• Too many docs have gotten into the habit of ordering huge batteries of tests, then treating the results, rather than doing what’s best for a particular patient.

- Except for hospice care, they say, it is almost impossible to die in a “… dignified, humane and cost-effective way …”, so hospitals have become, for some, “torture chambers” — prolonging the inevitable, at whatever cost. Strong words.

• “Tame and shame Big Pharma,” stop direct-to-consumer advertising (which makes us think that “we know best”) and force the publication of all clinical research trial data.

• Realize that all guidelines that define disease thresholds have been developed by “experts” who are already married to their particular area of interest, so guess what? More will, likely, be “better.”

• Consumers should be smarter consumers and not automatically assume that “more IS better.”

• Medical journals need to be more skeptical, the media needs to be more skeptical, we need to “follow the money” and more and more and more.

So, what are we patient-types to take from this? Should we all come down with a terminal case of cynicism and start second-guessing our primary care docs? I, for one, have NO INTENTION of doing THAT!

And do I think that everything called out above is universally true for all of us, all the time? No! Do you?

What I, for one, do intend to do is remind myself (again!) that I am a player in my health care “game;” in fact, I am the most important and most POWERFUL player! I can’t just sit back and allow whatever to be done “to me,” because … “What the heck? I’m not paying for it …”

Yes, you are — and, maybe, in more ways than one. So, here comes my opinion:

Many of us patient-types (which is most of us) get so lost in the debates and technologies and acronyms and big words and big money and grandiose expectations of health care (and health insurance) that the phrase “quality of life” becomes a parenthetical afterthought, if it comes up at all. But isn’t that what most of us really care about?

Aren’t most of us mostly concerned about having a life? Being able to live and love and experience this amazing ride with as much participation as possible? To be IN the game, as much as possible?

I almost never hear anybody say, “You know what? I really want to survive as long as possible, no matter how miserable I, and everybody around me, become, or even whether I know what’s going on, because the most important thing in my life is the clock!”

Nope, I almost never hear that.

We need to listen carefully to our medical providers, then, we need to talk TO them — and they need to listen carefully to us.

Mark Harvey is the director of Information and Assistance for Olympic Area Agency on Aging. He can be reached at harvemb@dshs.wa.gov or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information &Assistance.

 

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