American healthcare: a malignant tumor that can’t stop killing its host

As I said recently, I’ve been writing less here for a number of reasons. One is that I’ve been asked to write on other sites. Another, a sobering factor, as that after years of study, I’ve concluded that the American healthcare system has tied itself in a fatal knot. The post shown here, on the Patient Power blog, is an example of both.

It’s about my conclusion that while all the many, many great doctors and nurses and administrators do their best to save people like me, the system has become lethal. I don’t say that lightly, but I truly believe that you and I need to understand this, because it is killing people despite the best efforts of good medical professionals. While good people work hard at the local level, at the system level the incentives are perverse. When your turn comes to get good care, you need to understand these pressures, because all hope is not lost, but you need to know what you’re dealing with.

[UPDATE: 3 hours later this 4 minute comedy video appeared on Facebook,
very accurately portraying one big part – but only part – of the problem.]

That guest post, American healthcare: a malignant tumor that can’t stop killing its host, links to several others I’ve written this year and in the past. Here’s the first paragraph, and the headings in the post, and the conclusion.

As someone whose life was saved 10 years ago by the best of healthcare, I find it bizarre that we have arrived in an era where—only in America—there’s a new medical concept called “financial toxicity.”  Google it. Or read this ASCO interview on CancerNetwork.com. (Or for a deep, deep dive, far beyond oncology, try the sobering 2017 book An American Sickness.)

Headings, each linked to another post:

1. The system wants to grow, and is good at it.
   (“Remind you of anything? Reminds me of a tumor. I’m not kidding.” It links to the inexorable growth curve I’ve blogged about here (which has continued unabated for three years since first posting.))
2. It’s not necessarily getting the job done
   (Links to my post on the e-patient blog about “amenable mortality”)
   
3. Bottom line, price and value are out of whack. Result: toxicity.
   (Links to my post on the severe disconnect between health costs and outcomes, with the graphic shown here.)

Conclusion:

My single biggest tip, combining all of this, derives from the now-well-accepted discipline of SDM (shared decision making), in which providers have accepted that the right choice of treatment cannot be made without knowing the patient’s priorities.  So express yourself:

“I know there are a range of options, and the right choice depends on what’s important to us as a patient and family. We are really concerned about financial toxicity. How can we learn about that issue for each option, and make it part of our decision process?”

This positions you as an informed, thinking person, savvy about an important issue. And perhaps most importantly, it opens the door for providers to help you get what you want: “My patient asked for this information—what can we tell them?”

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See what I mean? All the things I’ve been learning and observing have come together in what is frankly a pretty nasty picture. It’s not at all that doctors are gouging us; it’s the US for-profit health system. Every health system in the world has challenges of various sorts, but none has the problems we face here.

Don’t believe me?  Go look at this Facebook post and see what an American living in Australia recently paid for three days in the hospital: $27. For the meds.

We can do better, folks.

But what to do? Others are working at restructuring incentives, but if you need help now, that’s no use. Until things change, see the conclusion of the Patient Power post for my recommendation: learn how to express your belief that while you love good healthcare, costs are important too.

See, I’ve also learned that if we don’t speak up, they say “My patients aren’t worried about this, so leave us alone.”