Obamacare is on the minds of many of my patients. They ask me what will mean [ translation: how it will effect them] or they TELL me what it means, which is worth a blog entry itself.

Once in a while a patient will ask me “Why is everything (about Medicine) so expensive?” Even my most conservative patients who staunchly attest USA Medicine is the best in the world chime in with a gripe about health cost.

I will tell you what I tell them.

Mind! I am going to quote JAMA and articles from my medical journals. This is not a science paper; this is my opinion.

Bottom line: there is no single thing that easily explains why health care in the USA is the most costly in the world. It is not a simple problem; there is not going to be a simple solution. Like many problems, the contributing factors are legion. Here are some I frequently hear but they turn out not as important as you would think:
Doctors ordering too many medical tests.  There is some truth to this; as seen in the number of MRIs and CTs ordered in the USA compared to other countries. This is guessed at 55 billion dollars, but it turns out this is only 2% of our health cost spending. People/patients are all for ordering less tests – in other people. Ever try to explain to a demanding patient ordering a test is not necessary? Nowadays they not only use it against you, they go on line to complain you are an awful doctor.

Malpractice issue/suits: In states which have passed tort reforms there is cause/effect to lowering cost; there is no real cost savings (alas).

Insurance and paperwork is estimated at another 90 billion dollars per year.   This is a sizeable chunk but it still doesn’t ‘explain it all”

We take too many medications.  Turns out we don’t take more than others.**   Our problem: for a complex reason the cost of a pill here is far more than in other countries. (as my patients who order their meds from overseas can attest).

We are obese and/more more sick than others. The stats don’t support we are worse off than those in Europe, and we actually have less smoking/drinking than in European countries, who tend to live longer.

We go to the doctor more. Overall not true; what with the inability to get time off from work to go the doctor, combined with the cost of going, Yanks tend to stay away from doctors more than not. This makes for less prevention medicine.

Bottom line: Everything about Medicine costs more here, whether it’s a prescription, a procedure, or an admission to hospital (a fraction of what it costs in Europe).

A note on “free health care’ elsewhere –

We spend more money per capita on health care than any socialist countries of Europe including Canada and Australia. In exchange we get no health care unless you are old, poor, or a congressman. 18% of our GDP goes to  health care- I read the next country Germany spends 9%. However, all Germans have health care, more vacation time, and live longer than us.

Although we are richer than other countries, we spend a hell of a lot more on health care and we don’t get not much in return by some measures.  For example: we don’t live longer: the US life expectancy (I believe in this year’s JAMA) quotes us as 33% for life expectancy. Health outcomes for chronic illnesses are not superior compared to other countries. We don’t seem to be happier either.

For those among us without health care, they still get health care, usually in ERs which is a bad management of health and funds. This ~ 30% of the nation is resented by the 70% who feel cheated and obliged to provide for them.  So much for Christian Nation values.

I give President Obama credit for trying to fix things but sense he and his proposals will fail. To make real improvements, we would all have to be behind it and be ready to give up their particular sacred cow. And then there is the GOP, determined to disallow The President any advance, let alone any achievement.

I think health care reform the most vital problem of the US economy and our inability to process it cooperatively without seeing it as political theatre thwarts all hope to fix it.

Meanwhile, health care will rise and we won’t get better for for it.

** There is one exception: opiate-based prescriptions. The USA consumes far more pain killers than other countries.  Fascinating.