George Lundberg

The current healthcare reform debate underestimates the ethical professionalism of many American physicians and the clout of many American patients. Efforts to control American medical costs date from at least 1932. With few exceptions, they have failed. Healthcare reform, 2009 politics-style, is again in trouble over cost control and it would be a shame if we once again fail to cover the uninsured because of hang-ups over costs.

Physician decisions drive the majority of expenditures in the US healthcare system. American healthcare costs will never be controlled until most physicians are no longer paid fees for specific services. The lure of economic incentives to provide unnecessary or unproven care, or even that known to be ineffective, drives many physicians to make the lucrative choice. Hospitals and academic medical centers are also motivated to profit from expensive procedures. Alternative payment forms used in integrated multispecialty delivery systems such as those at Geisinger, Mayo, and Kaiser Permanente are far more efficient and effective.

Fee-for-service incentives are a key reason why at least 30 percent of the $2.5 trillion expended annually for American healthcare is unnecessary. Eliminating that waste could save $750 billion annually with no harm to patient outcomes.

Currently, several House and Senate bills include various proposals to lower costs. But they are tepid at best, in danger of being bought out by special interests at worst. The Congressional Budget office has reported that none will "bend the curve" in a corrective economic direction. Continuing the status quo growth of costs is certain national economic disaster. As has been true for most of a century, many physicians will fight hard to keep fee-for-service payment systems and delays to affect such a major change will likely be significant. This presentation explores these varying, highly influential factors in the future of medical costs and their role in the structure of our nation’s healthcare reform.

Quick savings can be realized by an alliance of informed patients and physicians widely applying recently learned comparative effectiveness to big ticket items, saving vast sums while improving quality of care. In this presentation Dr. Lundberg takes a look at key areas in which dollars can be saved, such as:

1. Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving billions of dollars annually.

2. The same for invasive angioplasty and stenting (currently around one million procedures per year) saving tens of billions of dollars annually.

3. Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions of dollars would be saved here.

4. Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions of dollars saved.

5. CAT scans and MRIs are marvelous art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by a packaged method that is use-neutral.

6. We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer.

7. Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. Again, billions saved.

Patriotism, new science, stewardship and the survival of the America we love. No legislation is necessary to affect these huge savings. Physicians, patients, and their institutions need only take a good hard look in the mirror and then follow the medical science that most benefits patients and the public health at the lowest cost.

Dr. Lundberg takes a close look at how such changes will positively affect the current healthcare landscape: physicians can reaffirm their professionalism and patients their rights, with sound ethical behavior without undue concern for meeting revenue needs. The interests of the patients and the public must supersede the self interest of the learned professional.