Reform Health Care Now: Special interest groups shouldn't call the shots

Of all the problems with the current health care system, perhaps the most insidious is that the system is fueled by special interest groups, whose chief concern is their own bottom line.

There are a lot of hands in the pot: insurance companies, drug makers, hospitals, device and equipment manufacturers, and yes, doctors. They all pay lobbyists huge sums of money to convince legislators to maintain the status quo, or to draft legislation in their favor. But unless these groups agree on a solution that will overhaul our system, costs will continue to rise and the quality of care will fall.

We have already seen signs that special interest groups are willing to play nice because they all want to be included in health care reform discussions. But keep in mind that special interests ended up killing Hillary Clinton's efforts at health care reform in the 1990s. More importantly, the companies and groups profiting from the current system have a lot at stake.

Let's start with the insurance companies. It's no surprise that profits at ten of the country's largest health insurance companies increased 428 percent from 2000 to 2007, according to Health Care for America Now (HCAN), a grassroots lobbying group. HCAN also reports that the CEOs of these companies earned on average, $11.9 million each -- a combined total compensation of $118.6 million.

They've done this by using practices that are both well-documented and despicable -- refusing insurance to people with pre-existing conditions, denying care based on technicalities, and raising premiums for employer-based health insurance 120 percent since 1999, according to the National Coalition on Healthcare. From a doctor's perspective, the insurers also create arbitrary coding and credentialing guidelines contrary to those proposed as fair by large physician organizations, which serves to reduce compensation.

I could go on and on, but let's move on to other players whose practices drive up health care costs. A big problem is that the medical industrial complex is creating demand for expensive new drugs, procedures, medicines and technologies, but we don't know whether many of these new technologies are cost-effective. As I've pointed out in an earlier column, research comparing the effectiveness of various treatments and drugs is sorely needed so physicians will have a clearer idea if a more costly treatment is actually more effective than cheaper alternatives.

For example, in my field, gynecology, preliminary research has shown robotic surgery to be promising in terms of treating women's health problems less invasively than traditional surgery. Its advantages over other minimally invasive techniques using laparoscopy have not been clearly demonstrated, however.

Despite the lack of data from well-designed prospective studies looking at long-term clinical outcomes regarding pain, cost and how quickly patients can return to normal activities, this technology has become the new marketing gem of many hospitals. I saw a billboard last week on I-95 for robotic surgery emblazoned with the words, "It's a Miracle!" The costs, however, are astronomical, with the equipment involved in setting up a program at a hospital running into millions of dollars.

Up to this point, some insurers have balked at covering the expenses of robotic surgery, which could be ten times other minimally invasive techniques. Likewise, backlash from physicians who feel pressure to join the robotics bandwagon was evident on a recent physician blog on the American Association of Gynecologic Laparoscopists (AAGL) web site. Many doctors were not impressed with robotic surgery, and are angry about how it's being forced into their practices by patient demand.

You know something is amiss when physicians actually applaud insurance companies for denying payment for an expensive technology without clear benefit -- you don't see that often.

Advertising directly to consumers is a tactic that has worked well for pharmaceutical companies, and they have been allowed to use it since 1997. As a result, patients often demand more expensive, newer drugs, even though sometimes the old ones work just as well and cost much less. Unfortunately, many doctors give in to these requests because they don't want to lose patients. We just witnessed a worst-case scenario when Michael Jackson apparently got his hands on lethal drugs that killed him.

You have to wonder, who's looking out for your health and well being? Obviously it should be your doctor, but people have lost faith in us, too, questioning whether we're ordering a test or even performing a surgery because it's really necessary or because we want to avoid a lawsuit and/or make more money. Nobody likes to hear a doctor cry poverty, but physician's pay has actually gone down and reimbursements have decreased, another reason some doctors resort to unnecessary and expensive tests and procedures to offset the drop in income.

That's why I strongly recommend that any health care reform bill include a way to stop reimbursing doctors based on the number of high-tech procedures they do. Let us get paid based on how well we care for our patients. We also need to be able to call the shots again -- instead of leaving this to the insurance companies or manufacturers who are pedaling high-tech gadgets and medicines.

I know it's easier to pop a pill than to eat right or exercise, but we also need to encourage Americans to adopt healthier lifestyles and incentivize efforts at preventive care. As I've pointed out before, there's no lobbyist for exercise and other lifestyle modifications -- which may turn out to be just as effective as costly new treatments. And nobody will profit from these efforts but you.

Russell Turk, M.D., is an obstetrician and gynecologist in Fairfield County, Connecticut.

This is the ninth article in a 10-part series, 10 Reasons to Reform Health Care Now:

Part 1: Syrocketing costs are choking American businesses

Part 2: 87 million uninsured, and growing

Part 3: The economy is making the crisis worse

Part 4: The current system emphasizes quantity over quality

Part 5: Insurance reimbursements make no sense

Part 6: The malpractice liability crisis persists

Part 7: We need to practice preventive medicine

Part 8: End-of-life costs are too high

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