If you were around for a good part of the last century, you probably have noticed what I have, the exorbitant costs of medical care, not to mention other unwelcome changes, here in the USA. Call a physician’s office these days and you’re likely to get a recording, not an answer by a live human. Want an appointment with your doctor? Don’t expect to get it soon. And when you finally arrive in the office, are you happy as a nurse or the doctor stares at a computer screen while talking with you? The human interaction between physician and patient had degraded as the cost of medical care has skyrocketed.
Here are some numbers from a a table I copied from a book (sorry, I’ve lost the reference; it may have been titled Dark Medicine). The table compared numbers from 1975 and 2017. I had trouble reproducing the table, so I’ll provide the data in narrative form. In 1975, health care spending was $550 per person compared with >$11,000 per person in 2017. Quite a jump, don’t you think? Time allotted for doctor’s office visits in 1975 were 60 minutes for new patients and 30 minutes for return visits. In 2017, the times had been reduced to 12 minutes for new patients and 7 minutes for return visits. How is that for cutting you short of time? In 1975, the average hospital daily room charge was about $100. In 2017, the charge for a daily hospital room had increased to $4,600. Not an increase designed to draw applause.
According to a more recent article (in the February 24, 2022, New England Journal of Medicine), U.S. national health care expenditures increased from 4% of the gross domestic product in 1950 to nearly 18% of GDP in 2019. In short, now nearly one dollar out of every five spent in the USA now goes to “healthcare.”
The “healthcare industry” has become the biggest business in the United States. How did this massive growth occur? Here is my simple two word answer. Government intervention. One can quibble over the details, but certain facts are undeniable. In my younger years, free care for indigent patients was common at all levels of medicine. Practicing physicians often received little or nothing from patients unable to pay, yet they made a very good living despite that concession.
Hospitals did much the same. When I was a medical student at the University of Wisconsin and later at the University of Kansas, patients without financial resources were known as teaching patients and hospitalized and treated at no cost to them. The patients usually were attended to first by medical students, then residents, and finally by staff physicians, but they received free standard care. That system was still common practice when I interned in 1969 at St. Luke’s Hospital of Kansas City, with the hospital and physicians writing off the care of teaching patients.
The system wasn’t perfect, but it worked well. All of this changed, of course, when the government got into the business and launched programs that overrode the old system. With government money available, doctors and hospitals were eligible to be paid for services they once had provided free, and they not surprisingly chose to collect the cash. Free care went out the window. With government money, of course, came governmental control, illustrated by the emerging web of proliferating laws and requirements along with the burgeoning army of bureaucrats hired to ensure compliance with the new laws. This new army now naturally has its fingers in the “healthcare industry” pie, pulling cash from it.
An equally impressive growth of private medical insurance has occurred simultaneously, it too with its heavy dose of administrators and its own regulations and requirements, thus inflating the cost of medical care without adding one drop of health to anybody. No wonder “healthcare” has become the largest industry in the country.
As the growing mass of governmental and insurance company dictates landed on physicians, doctors were forced to hire new employees simply to fill out forms and comply. In turn, this necessitated the government and insurance agencies to hire teams of employees to read those newly required forms to ensure compliance with their regulations, thus bloating the overgrown monster even more.
All of this meant that physicians in private practice, distracted by the increasing regulations and needing to oversee compliance, found less time to spend with their patients, even as they increased their staffs, and their overhead. It soon became difficult for many doctors to survive independently. Hospitals and other organizations began buying physician’s practices and folding the doctors into large groups. According to recent articles in the press, physicians these days are burning out as rapidly as Fourth of July fireworks.
So has all of this improved our satisfaction with our medical care? Not for me! According to a 2019 article in Forbes (see here), American families in that year were paying nearly $20,000 per year for insurance premiums, deductibles, and out-of-pocket costs for healthcare. The exorbitant costs of medical care.
This flood of money is going somewhere, and we know a few places. According to the above article in Forbes, so-called non-profit hospitals are adding billions of dollars annually to their bottom lines, lavishly compensating their CEOs, and spending millions of dollars (generated by patient fees), to lobby government and defend the status quo. Uh huh. That makes sense. Who wouldn’t go all out to make sure that a rich stream of greenbacks would keep flowing in their direction? After all, what are lobbyists for?
There is, of course, plenty of fraud as well. Few government programs avoid that. A recent article in the Washington Post (see here) reveals that a California health system employed a woman to scan health histories of thousands of elderly Medicare patients and then pressure doctors to add false diagnoses found in current medical records. (The woman became a whistleblower.) The point of adding outdated and irrelevant diagnoses such as stroke and cancer to the medical records — often without the knowledge of the patients themselves — was to make the patients appear sicker than they were, and thus send bills to the federal Medicare Advance insurance program inflated by millions of dollars, according to federal allegations.
Finally, we mustn’t forget our health insurance companies. It was reported last week (See here), that the CEOs of American’s seven largest publicly traded health insurance and services companies cumulatively earned more that $283 million in 2021 – by far the most in any year of the last decade. These inflated earnings naturally add to the exorbitant costs of medical care.
There you have it. We’ve barely scratched the surface, but I think an image of this particular governmental-induced sludge is emerging. I chose sludge specifically after reading a recent article in The Wall Street Journal discussing pleas for our government to “do something”(see here). Here is a quote from the above mentioned article. “The American political system has accreted so many solutions and sub-solutions to so many problems that what we have created is a system mired in sludge.” Absolutely true! I can think of no better word than sludge to describe our current ungainly, over-regulated, under-performing, crazy system leading to exorbitant costs of our medical care. What do you think?
HOUSEKEEPING NOTE:
After having written nearly 90 essays and posting them here over the past 18 months, I am going to take a necessary break. I have a growing list of unfinished tasks I’ve avoided while considering topics to be reported here and doing the necessary background work. I need to catch up on other parts of my life, but I plan to return, maybe within a month, assuming my aging brain continues to function with a modicum of efficiency. While I’m gone, please feel free to browse through my earlier posts. I think some of my best writing appears in those early pieces (a few of my favorites are here, here, here, and here), and all still are available here on this blog. In the meantime, enjoy life, and stay tuned.
