When my kids became teenagers their doctor suggested they see a dermatologist.
All went well until the dermatologist moved uptown. Then his prescribing habits changed.
Suddenly acne was no longer simple. Several times he prescribed medicines that our insurance wouldn’t cover, at hundreds of dollars per prescription, and no explanation forthcoming.
Patients who are passive in the face of such abuse drive up costs for everyone. In describing what he calls the top five reasons healthcare is broken, Alex Rivlin of Insuremonkey (above) offers special contempt for what might be called the doctor-detailer complex.
Detailers, in this case, are drug company representatives who are supposed to educate doctors on the latest treatments, but instead ply them with samples and small gifts to encourage prescription of brand-name drugs.
Three of the five causes Rivlin cites involve drugs. Payment systems reward sickness instead of health. Suppliers spend big on lobbying to keep things as they are. And doctors are tied too closely to the drug companies.
Many of our cost problems are tied to market incentives. Doctors who own clinics, or consult with drug companies, practice defensive medicine and then blame the plaintiffs’ bar. Hospitals have an incentive to stay full, because empty beds bring no income.
In tracking the debate now taking place in Washington, many positions are set by views on what drives cost inflation. The plans now before the House and Senate blame a lack of preventive care, and good information to drive cost-effective care. Republican plans blame the lawyers, and consumer desires to live forever regardless of cost.
The hope is that the final bill will create market incentives that break the doctor-detailer complex, that pay for wellness instead of just sickness, and that bend the cost curve down toward what our economic competitors pay.
Smart policies will slow the inflation businesses now see in their health costs, making them more competitive, and put some costs on everyone’s shoulders because even healthy people need care.
Just remember that our competitors’ costs are continuing to rise, too. To the inevitability of death and taxes, add health care inflation.
