Why are Medical Costs Increasing?

by Edward R. Annis, M.D.

Media headline reflect the shortcomings of that small percentage of avaricious or incompetents who properly earn disrespect and who are primarily responsible for public opinion polls which report a public increasingly distrustful of physicians in general. Though not gaining headline prominence, those same polls indicate that most respondents admit a high percentage of satisfaction with their own physicians, their treatments and their fees.

Despite that small percentage of medical practitioners whose primary motivation is to make money, the vast majority of medical professionals are still practicing in keeping with the Hippocratic oath and their major concern is for the best interest of each individual patient who comes to them for help.

Today there is a prevailing sentiment in hospital halls and doctors' dressing rooms which echo a rather unanimous frustration and at times genuine anger because of the steadily increasing interference in their efforts to provide the best medical care for patients. Prudence dictates a sharing of these frustrations with patients, most of whom are unaware of those external forces which increasingly come between doctors and patients and threaten to deny or to delay care in order to save money.

Recent months have witnessed a steady campaign to persuade the public that our system of medical care should be replaced by something else which theoretically operates more efficiently and at much less cost. Repeatedly via the media doctors and patients read and hear that "The United States is the only major country without a system of national health insurance." Doctors would be wise to stimulate thought by using a turnabout of that statement with a question: Why is it that no other nation has ever been able to provide the number of technological tools, the extent of research and development and the widespread availability of quality medical care experienced by the vast majority of the quarter of a billion people here in the United States? As our patients and thought leaders contemplate that question, they will be confronted with the fact that limiting money and not health dictates the manner in which these other systems operate.

The proponents of change in our system repeatedly emphasize cost and suggest that strict budgetary limits on the dollars available for care, coupled with cut-backs in payments to doctors and hospitals, will bring our system in line with other countries where less money is expended for medical care. This arises from the assumption that doctors and hospitals are primarily responsible for the steady rise in costs, but such an approach demands further thought and investigation.

No one is more aware of costs than doctors who desire the best care for their patients. They know, however, that over one half of all escalating costs are beyond their control and are caused by others. A number of economic records indicate that it has been the past decade of government deficit spending, with its attendant inflation which affects everyone and accounts for more than one quarter of current doctor and hospital bills.

It is the excessive rules, regulations and paper work which every day demand more costly personnel and time better spent with patients that remind doctors of the reasons behind the July 1991 Daily News Digest report that by the end of this year $166.5 billion will have been spent on paperwork alone. That amount constitutes another one quarter of today's hospital and medical costs. Few people understand that both of these external pressures continue to be the major cause of the costs which are beyond the control of doctors or hospitals.

It is time for realism and common sense. Our regular population increases by more than a million people every year and is augmented by immigrants in the hundreds of thousands who seek a better life here in the United States. The medical care for these individuals will naturally add to the total health costs.

Government records indicate the though they comprise only 12% to 13% of the population, those over the age of sixty-five consume one third of all money spent on health and medical care. This continues to be the fastest growing segment of our population, and their needs must be met. More elderly, living longer will cost more, not less, if we continue to provide the care they need and ask for.

Truly marvelous and effective new drugs continue to flow from continuing research. They sustain and control many medical problems such as diabetes and high blood pressure, but they also are making great advances against many kinds of cancer, AIDS and other serious medical problems. Their costs are considerable, but those who benefit from them admit their worth. Today's research and development in the pharmaceutical industry averages $150 million for every major new and successful drug which ultimately reaches government approval by the Food & Drug Administration. Total costs for drugs will continue to rise as new and better products provide doctors with ever more and better tools against infection and disease.

Ours is the world's most litigious society and the abuses in our legal system add many unnecessary cost to our medical care. Doctors provide liability insurance to compensate those injured because of negligence or human failures, but the vast majority of lawsuits have proven to be unrelated to fault or negligence. These unjustified cost add billions to our nation's health care bills.

There are many other factors involved in the total price paid for medical care in our country. Prudent cost controls are both wise and necessary, but they should not be at the expense of good patient care nor should they be dictated by non-medical appraisals which concentrate on costs to the exclusion of what is best for those for whom we care.

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