Is The Cost Of Medical Care
All That Bad For
Some of the material the
New York Times prints on its Op-Ed page in support of current cant is so tired
that it should be put to bed without risk of further exposure. An example is Robert Claiborne’s article
“Rewarding Thrift in Health Care” (Times, Jan 14, ’78, p 21) rehashing old and
tried methods to create disincentive to costly medical care. The current propaganda, that medical care is
too expensive and that the country would be better off were it cheaper, has
been accepted as fact. But is it?
No one has demonstrated
that the cost of medical care is bad for the country. What other industry is to provide jobs for
those laid off by the heavy industries?
Medical care is a big employer.
Jobs in the industry run the gamut from highly sophisticated to
unskilled, thus it can provide employment for individuals of any level or
education and experience. The service
itself is humane, certainly more gratifying than employment in the war
industries.
The medical care industry
does not use energy extravagantly. Its
technology is for the most part neatly packaged in electronic devices very
sparing of energy. It runs mainly on
manpower, which is fundamentally solar energy.
If one were to devise an industry that would fulfill most of President Carter’s
energy goals, the medical care industry would fit the bill.
The similarity about all
plans to reduce health costs is that they are aimed at the patient; they attack
the privilege of a sick American to stay in the hospital until full
recovery. The cost-containment plans
accentuate efficient utilization of hospital beds, that is, the discharge of
patients at the earliest convenient moment.
The emphasis on utilization
has even enveloped the doctors, who foolishly sit on utilization committees to
scan records and gore their colleagues with letters about overstays, and create
an ambience of guilt to surround doctors who don’t fall in line. No records are kept about the human cost of
pre-mature discharge of the patient from the hospital in order to conform to
government guidelines. But there is a
cost, measured not in money, but in terms of humanity, pain and distress.
Claiborne talks glibly
about health maintenance organizations (HMOs) “show members thrive on 65
percent less hospitalization.” Based on
this, Claiborne feels that the “average” American can thrive on about 50 percent
less hospitalization than at present.
Claiborne has no idea about
illness or reasons for hospitalization, or the demands and ravages of age. The elderly have multi-system diseases and
little reserve. Heart and lung problems
occur simultaneously; therapy for these may embarrass the kidneys; in the
ensuing metabolic turmoil, the cerebral oxygenation is compromised and the
patient becomes confused. There is no
way that the patient can be discharged from the hospital until all systems are
brought into some semblance of metabolic balance. To do otherwise would be a fracture of
conscience and professional obligation which is the price of cost containment.
If Claiborne is serious
about cost containment, he might take a look at other figures. For example, most hospitals have public
relations departments. The minimal cost
for any of these must be about $50,000 annually. Considering there are roughly 7,000 hospitals
in the nation, this ($50,000 x 7,000) equals $350 million annually.
Inspecting authorities
(JCAH) require medical records libraries, apparently as a service to the legal
profession for the one case in 10,000 that comes to litigation. These cost minimally $100 thousand annually
for each of the 7,000 hospitals, a total of $700 million per year.
Since Utilization Review
and Medical Audit will be written into law, doctors will not perform these
services for nothing, because the penalties might be too great. They will be paid, and the hospitals will
have to do the paying. Nurses and
secretaries and clerks will have to be hired to assist and handle the
details. Let’s assume, figuring about
$150 thousand per year for 7,000 hospitals, a modest $1 billion in annual costs
for this.
Thus, with no trouble, I
have been about to show $2 billion in unnecessary costs, which can be eliminate
each year, with no risk to human life.
All of the several billions
of collars in financial fat that is built into hospitals is simply added to the
patient’s per diem charge. Claiborne
says that the patient has little reason to question this because he pays so
little out of pocket, the remainder coming from the third parties. However, the patient contributes to the third
parties. The real problem is that
neither Claiborne nor the patient knows where the money is being wasted.
Hospitals have a peculiar
accounting system. Most are voluntary,
private, non-profit institutions; by allocating all surplus funds to various
projects, they become effectively non-profit, no matter how much in the black
they operate, thus per diem rates are never reduced. The government has been trying to contain
hospital expansion by Certificate of Need (CON) legislation. All this does is to make second rate hospitals
remain second rate, because it prevents them from getting first rate equipment;
to make crowded hospitals become overcrowded because expansion and new
construction are forbidden or unduly delayed; and to make some patients travel
for vitally needed treatment at centers such as dialysis and burn units lest
there be duplication of “costly” facilities.
Suppose the hospital could
get a piece of equipment, such as a