As we all watch in horror the events unfolding with the murder of Brian Thompson, the CEO of United Healthcare, one cannot help but think about what is wrong with our healthcare system today. Sure, it is easy to blame the insurance industry and our healthcare systems for the billions of dollars in profit that they rack up every year. The truth is that they are a symptom of a larger disease which is that our system is set up to deliver the right care for the wrong reasons.
I do not know the alleged killer Luigi Mangiones medical history. But as primary care providers, I have seen a lot of people experiencing similar back pain. People in their early twenties come in after an accident that caused sudden and severe back pain. First, we send them to physical therapy. When that does not work, they undergo imaging. After which they are seen by a spine specialist who decides whether they should undergo surgery. After $75,000 in medical costs, most of them improve a little. Some get worse.
Why is the cost so high? The clinicians (physical therapist, radiology tech, radiologist, primary doctor, spine surgeon, anesthesiologist) earn around $10,000. After expenses for the hardware, medication, sterile equipment and monitoring, the hospital nets around $10,000 for its quality and safety initiatives. The insurance company recoups $5,000 to keep the cost under $100,000.
In any other country the solution is simple. The spine surgeon is not available to perform these elective procedures. Subsequently, you are placed on a waiting list and hope to get something sooner if you develop worsening symptoms. The simple fact is that these procedures are not available unless judicial thought is used to decide if the procedure will be beneficial. In the United States, we perform many procedures that provide little to no benefit. This is due to primary care providers having no time to counsel their patients, and the surgeon’s compensation package is based on the number of procedures they perform.
As clinicians we all want our patients to feel better. Especially, with young adults who will need to live with pain for many years. However, the value of these procedures is limited and require a more judicial use of resources. Value based healthcare where outcomes that matter most to patients are considered over the total cost of care. Without tipping our system to favor quality over quantity, there will never be real change in our system, and we will continue to overspend for less and less results.