CONSUMER-CONTROL
OF HEALTH-CARE COSTS:
ELIMINATING
UNNECESSARY MEDICAL PROCEDURES
SYNOPSIS:
Can we live healthy lives
without agreeing to all of the medical care we are offered?
We consumers of heath-care do
have the power to say "No thank you"
when there are less expensive ways of keeping us alive and healthy.
OUTLINE:
1. TWICE AS MUCH HEALTH-CARE
AS I
NEEDED?
2. WHY ARE DOCTORS SO WILLING TO PERFORM SURGERY?
3. MEDICAL PROCEDURES
BENEFIT BOTH
THE PROVIDERS AND THE PATIENTS.
4.
COULD CAREFUL USE OF MEDICAL CARE
ELIMINATE AS
MUCH AS HALF OF THE COST?
5.
SHORTENING MY DYING PROCESS BY ONE MONTH
MIGHT SAVE
$100,000.
CONSUMER-CONTROL
OF HEALTH-CARE COSTS:
ELIMINATING
UNNECESSARY MEDICAL PROCEDURES
by
James Leonard Park
For the first 50 years of my life, I have no medical
care.
This saved a lot of money, but it was a mistake,
because at the end of that period I had colon cancer.
I had no health-care for 5 decades because I was
basically healthy.
And I had a very low income and no employer-provided health-care.
I did not qualify for any tax-supported medical care
because I had too much in liquid assets.
I would have had to spend almost all of my assets
before I qualified for publicly-funded health-care.
In those years, I was supporting myself
by investing a small nest-egg in mutual funds.
Thus, my liquid assets were my main source of income.
And spending my few thousand dollars on health-care
or spending all of my liquid assets to qualify for medicaid
would also have eliminated my income.
And since I did not think that I was sick,
I was unwilling to impoverish myself.
Also, during all of these years,
I was waiting for
some system of health-care reform,
which would have provided heath-care for me
and all others with similar
levels of income.
1. TWICE AS MUCH HEALTH-CARE AS I NEEDED?
Once there was eventually a health-care system
that provided health-care for me
without requiring me to bankrupt myself first,
I did begin to receive health-care.
And ever since I connected with the health-care system,
I have been offered about
twice as much care as I needed.
Before it was discovered exactly what genetic defect
was causing my colon problems,
I met with several surgeons who were only too happy
to remove most (or
all) of my remaining colon.
I declined each of these offers for changing my body
—and
radically reducing my quality of life.
I did not believe removing my colon was the best choice.
And subsequent history has proven this to be correct.
With annual colonoscopy, I have kept my large intestine
and I have remained cancer-free since 1993.
2. WHY ARE DOCTORS SO WILLING TO PERFORM SURGERY?
Removing my colon would have prevented
further colon cancer.
That would have been an almost certain method of cure.
Without a colon, that part of my body could never redevelop
cancer.
But, in retrospect, it seems to me that the surgery
would have benefited the
surgeon than for me—the
patient.
The surgeon would have earned several thousand
dollars
for removing the problematic part of my body.
The providers would have received a large economic benefit.
But only a very small
health-benefit would have come to me.
And in retrospect, the loss of the rest of my colon
would have made my
life much worse
even tho it would have resulted in no further colon
cancer.
However, I have kept my colon and saved thousands of dollars.
When doctors are paid for each procedure
they
perform,
it is understandable that they will recommend procedures
that will put more money into their own bank accounts.
If I can ever choose doctors who are paid a regular salary
no matter what medical procedures they
perform,
I will select these doctors.
I will know that they have only
my benefit in mind,
not how much they will earn
from questionable treatments they might
recommend.
3. MEDICAL PROCEDURES
BENEFIT BOTH
THE PROVIDERS AND THE PATIENTS.
When patterns of medical costs are tracked by
geographical area,
it always appears that patients
get more care where the providers
exist.
Wherever there are high-tech machines for diagnosis, they are used.
Wherever they do not exist, doctors and patients can get along without
them.
When a doctor knows of several possible courses of
treatment,
and when he is paid different amounts of money for each,
what prevents him from recommending
the most expensive treatment,
even if the results for the patient would be the same?
For example: back pain.
Lots of people have pain somewhere along their spines.
And before spinal fusion
was possible,
the problems were treated with simpler (and less expensive)
methods.
But where specialists emerged who can cure back pain
by fusing the offending joints in the spine,
they recommend this procedure even when less invasive treatments
have almost the same results at a much lower cost.
Another example: cancer in dying patients.
Under standard medical care, if it can be done, it will be done.
Because standard medical procedure removes all cancerous
tissues,
this will be recommended for all patients who have cancer.
But from the patient's point of view,
it might make little sense:
It will perhaps add a few months to a life
that is already on a
downward pathway towards death.
If the surgery cannot cure
the patient
because so many vital organs are engulfed by cancerous cells,
the burdens of the
proposed surgery
should be weighed against the possible benefits to the patient.
In terminal care, the possible benefits are very small.
But the providers will be paid
for the surgical
procedures
no matter how short the
patient's life after surgery.
More examples can be provided by each reader:
When you consider the health-care you have experienced or observed,
which tests and procedures provided little or no benefit to the
patient,
even tho everything was paid for by some health-care system?
Especially when both the providers and the patients
do not know the costs
of any particular medical test or procedure,
they proceed with the confidence that the system will pay the bill.
If the patients had to pay for x-rays or scans out of their own
pockets,
they would want to know the
costs and possible benefits
before buying any medical service.
Compare shopping for auto repairs:
Instead of accepting the most expensive repair recommended,
we seek other solutions for the likely life-span of the car.
We do not install a new air-conditioning system
when we know the car has only one year left in it useful life.
We do not buy a new engine when the rest of the car is falling
apart.
4. COULD CAREFUL USE OF
MEDICAL
CARE
ELIMINATE AS
MUCH AS HALF OF THE COST?
Based only on my own experience with health-care
providers,
I have been offered about
twice as much health-care as
I really needed.
I have turned down unnecessary surgeries and chemotherapy.
And even some of the procedures that I did accept
turned
out to be
unnecessary, even tho at the time that was not clear.
For example, I had a second surgery for colon cancer.
But no cancer cells were
discovered.
They had all been killed by the radiation I received between surgeries.
My doctors recommend colonoscopy 2-4 times a year.
That would provide a slightly higher margin of safety,
but once a year
removes all polyps before they become cancerous.
These doctors are not motivated by income from
each procedure.
It is primarily concern for my health and well-being.
But I have decided once a
year is enough to save me from cancer.
And near the end of my life, I will discontinue
colonoscopies entirely
because they will not add meaningfully to my life.
5. SHORTENING MY DYING
PROCESS BY
ONE MONTH
MIGHT SAVE
$100,000.
I am the founder of the One-Month-Less
Club.
Anyone can become a member by saying in an Advance
Directive
that he or she does not want to be 'treated-to-death'.
If we make no such provisions,
we will probably receive standard
medical care:
We will be kept alive as long as medical science
can postpone death for
one more day.
If hospital care costs $3,000 per day or more,
that last month of life could cost more than $100,000
—since
doctors must be paid separately from the hospital.
Medicare will pay all the expenses of my terminal care.
However, if I am permitted to exit one month
earlier,
all of this additional cost to the taxpayers will be saved.
That last month might have low quality and little meaning.
I plan to live so well now
that no one will lament omitting the
last month.
Would you also like to join the One-Month-Less
Club?
Created
April 18, 2010; Revised 4-23-2010; 5-29-2010; 11-19-2010; 2-24-2011;
9-22-2011;
5-26-2012; 11-9-2012; 6-7-2013; 10-11-2013;10-12-2013;
8-5-2014; 1-24-2015; 1-20-2016;
12-22-2016; 1-26-2019; 10-28-2020
AUTHOR:
James Park has written extensively about medical
ethics.
As mentioned above, his financial limits are publicly stated
in his Advance Directive for Medical Care,
which is available free of charge on the Internet:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/JP-LW.html
Scroll down to Question 10, page 222.
This essay "Consumer Control of Health-Care Costs:
Eliminating Unnecessary Medical Procedures"
has become Chapter 4 of
CONTROLLING
HEALTH-CARE COSTS.