With the dissolution of the Soviet Union in 1991, the phrase \u201carms race\u201d became a less frequently used part of our vocabulary. Before then, both the US and the Russians had been developing, building, and stockpiling larger and more threatening weapons, in the process draining wealth and increasing, rather than decreasing, the odds of armed conflict.<\/p>\n\n\n\n
Money–simple greed, really–was behind much of it. In one of President Eisenhower\u2019s last speeches he warned of a \u201cmilitary-industrial complex\u201d whose interests were financial gain rather than the safety and well-being of the American people.<\/p>\n\n\n\n
Now for a thought experiment. Replace the US and Soviet Union with any of Chicago\u2019s outsized medical centers: Northwestern, Rush, University of Chicago, or Advocate. Competition among these giants for your business is ferocious. Health care now costs 17% of our GNP, or $3.2 trillion. That\u2019s $10,000 for every person living in the US.<\/a><\/p>\n\n\n\n If you moved your lifetime of care–the appendectomy, delivering your babies, the knee replacement, your heart surgery–to a single medical center, that\u2019s potentially millions of dollars in their pocket. Northwestern wants YOU! Rush wants YOU! And to capture your loyalty, there\u2019s a medical arms race going on.<\/p>\n\n\n\n Since you (and your doctor) are the meal tickets for these medical center giants, they\u2019re willing to spend extremely large sums to get you into their system. They want you to equate excellent medical care with size, to be seriously impressed by their skyscrapers designed by internationally famous architects and by their investments in capital equipment: robotic surgery, gamma knife surgery, PET scans, and more.<\/p>\n\n\n\n Behind the scenes, these medical centers write enormous signing bonuses for superstar surgeons who can keep their operating rooms solidly booked months in advance. They\u2019re buying up Chicago\u2019s medical practices, writing generous checks to the physician-owners, and in the process acquiring thousands of warm bodies (yours and others your doctors can send their way) to feed the maw of their medical behemoth.<\/p>\n\n\n\n It really is like an arms race.<\/p>\n\n\n\n But ponder for a moment the concept of competition, let\u2019s say between two grocery stores on Main Street or between Mariano\u2019s and the Whole Foods situated across the street. Whole Foods is painfully expensive, but when Mariano\u2019s sets up shop and starts offering many of the same products at lower prices, Whole Foods begins selectively lowering a few of its prices as well. That sounds sensible. That should be the consequence of competition.<\/p>\n\n\n\n But that\u2019s not what happens in health care.<\/p>\n\n\n\n As giant healthcare systems grow, their prices skyrocket. Worse yet, in order to pay for all the stuff they bought–the scans, the robotics, the surgical teams–they have to use these tools, and use them a lot.<\/p>\n\n\n\n You\u2019ve likely read about some of this. You might have heard that Blue Cross was no longer covering care at Northwestern, Rush, or U of C. That\u2019s because Blue Cross simply got tired of the high prices and the excessive overutilization of services. Funding the medical arms race just got too expensive for Chicago\u2019s granddaddy of health insurers. Until there can be some serious price negotiations (probably occurring as I write), everyone walked away from the table.<\/p>\n\n\n\n \u201cBut,\u201d I can hear you splutter, \u201cI want the best. I want access to those medical giants. I want my hysterectomy done by a robot!\u201d<\/p>\n\n\n\n It came as little surprise to anyone following this medical arms race when a report published last week analyzed one tiny piece of it: robotic surgery.<\/a><\/p>\n\n\n\n To remind you, robotic surgery is performed by a surgeon sitting at a console, fingers in a glove-like device, controlling a robot-surgeon. It sure looks impressive. I tried it once (not on an actual person, of course), pouring a cup of coffee, adding a teaspoon of sugar, and stirring it and I thought, \u201cWow! Neat!\u201d but it seemed a leap of faith to let the robot anywhere near my prostate. Maybe when you saw one of these surgical robots on TV you thought it was the ne plus ultra <\/em>of health care, imagining your friends looking at you admiringly when you told them your hysterectomy had been done robotically.<\/p>\n\n\n\n But several conclusions from the recent report might dampen your enthusiasm:<\/p>\n\n\n\n In order to get yourself scheduled for a surgical procedure, your primary care physician (PCP) must first refer you to a specialist. Further funding the medical arms race is the dramatic increase in the number of such referrals. Hospital administrators track this very carefully. They monitor PCP \u201cphysician alignment,\u201d making sure referrals remain within their system lest they suffer the dreaded \u201creferral leakage.\u201d What they really dread is the proactive patient who uses the internet for physician research and discovers a better doctor at a competitor across town.<\/p>\n\n\n\n Hospital systems hire consultants like AdvisorsMD<\/a> or Healthcare Success Strategies to the tune of $10,000 a month to teach PCPs to refer to specialists they may not have considered and to teach surgeons to build referral networks without resorting to sleazy billboards or huge Harry and David gift boxes around Christmas.<\/p>\n\n\n\n Nagging back pain? Your PCP will be taught to think orthopedist, rheumatologist, physiatrist, or pain management specialist or even to refer you to the hospital\u2019s new laser spine surgery center. For more on this, you might want to read \u201cThe Surprising Secret<\/a> <\/a>Behind Doctor Referrals<\/a>\u201d that appeared in MarketWatch a few years ago.<\/p>\n\n\n\n The long and the short of it is this. At $3.2 trillion, there\u2019s just too much money being spent. More and more these days, I\u2019m envisioning all the so-called providers of US healthcare as pigs at a trough. Although legendary columnist Mike Royko was referring to Chicago politicians when he suggested the motto of the city should be changed from \u201cI Will\u201d to \u201cWhere\u2019s Mine?\u201d it certainly applies to health care today.<\/p>\n\n\n\n Just be cautious, be careful, take care of yourselves, know what you\u2019re up against, and get second and even third opinions before you become a cog in the wheel of this medical arms race.<\/p>\n\n\n\n Be well, With the dissolution of the Soviet Union in 1991, the phrase \u201carms race\u201d became a less frequently used part of our vocabulary. Before then, both the US and the Russians had been developing, building, and stockpiling larger and more threatening weapons, in the process draining wealth and increasing, rather than decreasing, the odds of armed […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,203,3,62],"tags":[1532,1292,1265,467,1834,1614,1771,1773],"class_list":["post-7715","post","type-post","status-publish","format-standard","hentry","category-blog","category-health-insurance-issues","category-knowledge-base","category-t","tag-financial-incentives","tag-health-care-costs","tag-health-care-dollars","tag-health-care-system","tag-hospital","tag-hospital-pricing","tag-procedure-driven-specialty","tag-unnecessary-procedures"],"yoast_head":"\r\nMoney for warm bodies<\/strong><\/h3>\n\n\n\n
Let\u2019s look at the facts<\/strong><\/h3>\n\n\n\n
The process<\/strong><\/h3>\n\n\n\n
David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"