Years ago while hurriedly shopping at my local Safeway, I turned my cart into the bread aisle and nearly ran over one of my patients. Relieved that I had not injured him, I immediately pulled back and tried to escape his notice. While I generally enjoyed running into patients (without injurious instruments) in public, I had an appointment to make within the hour and could not afford a lengthy conversation.
Still, I had noticed that my patient held within his hands the same coupon circular I held in mine. Like me, he was selecting food purchases by price and special discount.
Weeks earlier, that same man had been in my medical office, strong-arming me for an expensive antibiotic -- all the while I explained that it would provide no benefit for his mild cold. But he had read about the drug in a magazine ad, and, by all accounts, the antibiotic possessed amazing supra-human powers. It was a sniffle-buster, a mucus-vaporizer, a death-avenger; ostensibly, it could bring about world peace and ... well, cure the common cold.
At no point during our office encounter was the subject of cost brought up. My patient's insurance company would pay the bill, so perhaps it did not concern him. To me, it was important to base my refusal to prescribe the drug on "cold" medical facts -- not on a price tag. On clinically sound, scientifically-based reasoning that acknowledged both the uselessness and the potential harms of using bacterial antibiotics
But should I have raised the topic of wasteful spending with my fellow coupon-clipper? Should I have asked him to consider the consequences of resource utilization on a useless treatment that would only profit the drugmaker? That would help abet the escalating costs of health care and insurance premiums?
A new movement is afoot in health care to drag the "C word" (cost) out of hiding. For years, it's been shrinking behind bullying words like "death panels" and "rationing" all the while it's been claiming a greater presence in conversations at the kitchen table and in the Oval Office.
Families intimately experience the onerous burdens of health care costs, the country suffers the price tag, and 99 percent of us could probably talk about it more rationally and freely if the overriding narrative about cost was not owned by politicians and corporations.
A new analysis by the esteemed Institute of Medicine reveals that fully 30 cents of every dollar spent on health care is squandered. That our medical system wastes more than $750 billion each year for services and products that don't promote our personal or national health. (Excuse me for a moment while I scream. ... OK, thanks; I'm back now.)
The big-ticket items in the cost breakdown, based upon 2009 data, include money misspent for services that were unnecessary ($210 billion) or inefficiently delivered ($130 billion); excessive administrative costs ($190 billion) and prices ($105 billion); outright fraud ($75 billion); and missed prevention opportunities ($55 billion).
To put this monumental $750 billion of wasted health care expenditures into a richer perspective, the institute notes that in 2009 it surpassed the entire budget for the Department of Defense -- and by a whopping $100 billion. That it could have funded health insurance coverage for more than 150 million workers, or the salaries of our country's first-response personnel -- firefighters, police officers, emergency medical technicians -- for more than a dozen years.
Surely the "C word" in health care is of grave and daily importance to our 50 million uninsured citizens, and to any American who has ever negotiated trade-offs in food or rent to pay for medical care for themselves and their families. Surely it's important they know that 30 of every 100 pennies they've counted will be wasted, wasted, wasted in the health care sector.
I'm hoping that we doctors and patients will learn to speak explicitly about health care costs so that we can obtain better value for our money. So that we make better health care decisions in the clinic, better choices in the voting booth. So that at the end of the day, at the kitchen table, we can reallocate more of our budget toward food and rent, our kids' education, gas for our cars, an occasional bouquet of roses.
But a lot of people -- human and "corporate" -- don't want that to happen. Right now, all the crazy, politicized, unhealthy, heated rhetoric about health care costs serves to keep the conversation irrational and unwelcome, any solutions unfathomable. And that's good strategy for corporate and political benefactors who profit from our skewed health care spending. It's not considered "waste" when $750 billion is funneled to your company or political campaign.
Fortunately, several public initiatives are launching to encourage and enable us to talk more sensibly and calmly about trimming the waste from our health care bills. Foremost among them is "Choosing Wisely," a campaign spearheaded by the American Board of Internal Medicine that focuses on reducing overuse of specific medical tests or procedures.
But clearly, it is not enough that doctors and patients learn how to make wiser choices in the clinic or at the bedside, conversing about one antibiotic or lab test at a time. Clearly, it is absurd to suggest that coupon-clipping and Medicare-voucher shopping will do anything about the price of bread. We desperately need public leaders who can speak wisely about health care costs -- in voices that register as powerfully in the public square as they do in the kitchen-table checkbook.
Kate Scannell is a Bay Area physician and syndicated columnist. She is the author of "Flood Stage" and "Death of the Good Doctor."