Dr. Lawrence Gelman

EDINBURG, Aug. 22 - In my previous article, reference was made to mankind’s continuing susceptibility to fabrication and myth; which despite our conceit is as prevalent in modern society as in ancient society.

That politicians and trial lawyers have such lucrative careers is ample testament. The prior topic discussed the mythology of jobs and now we delve into healthcare. The public discourse in healthcare is an issue immersed in myth; as most of what is disseminated in the media, through the system of education and expounded from up high is incorrect, misleading or entirely false.

The so called crisis of rising healthcare costs is always in the news expounded upon by journalists, politicians, academics none of whom have any inkling on the subject. The actual costs of specific therapies have, over the years, been declining. Physicians, for example, are reimbursed less now than 30 or 40 years ago for diagnosing and treating the same illnesses.

It’s the total cost of healthcare which is increasing and not the cost of individual treatments and justifiably so, as the spectrum of available products has increased enormously over the last 50 years.

Prior to 1964, when the government health insurances of Medicare and Medicaid were legislated into being, cardiac care was essentially non-existent. Heart surgery, coronary angioplasty, medications to control serum lipids and cholesterol had yet to be devised. That was the case in almost all components of healthcare. What the average American takes for granted now was non-existent then. CT scanners and MRI devices, hip and knee implants, fiber optics and lasers, endoscopic and laparoscopic procedures, most forms of cancer therapy, medications to control hypertension, diabetes, asthma, most anti-biotics and much, much more  were all unavailable at that time. It was not so long ago that training programs for healthcare specialists first opened.

In 1965 only seven percent of the American population of approximately, two hundred million souls lived beyond the age of 65 or about fourteen million individuals. Medical and surgical management for that age group was extremely limited, so the cost to Medicare was very small. Nowadays, as a result of the advances in healthcare, 15 percent of the American population lives to age 65 and over which totals nearly 50 million individuals. Those 50 million have access to all the modern innovations of which their ancestors had never even heard of. Therefore, the cost of healthcare increased enormously but justifiably for now a sophisticated health care product was available to 50 million which did not even exist for the 15 million Americans aged 65 or over that lived when Medicare was first instituted. Complaining about the cost of healthcare today compared to earlier times is akin to complaining of the costs of computers today compared to their cost in 1900, prior to the development of computers.

Of course, since those populating government tend to be the most myopic of human beings such an occurrence was completely unanticipated. Rather than accepting their un-preparedness as a consequence of the torpid political minds which typically gravitate to government service, politicians and bureaucrats, as is their custom, seek to place blame on others. To do so requires the fabrication of myths to conceal truths and promote falsehoods to defend the indefensible.

Those myths include that healthcare costs are unduly elevated as a consequence of over-utilization. Over-utilization is something the other person does. I’ve never yet met an individual who felt they were over utilizing the healthcare system. Then there is the myth; the costs of procedures are going up because of the greed of hospitals and doctors. The truth is that reimbursements for healthcare providers have been steadily declining for three decades. There is the oft repeated myth that healthcare is less expensive and more effective in countries other than the United States. The truth is that the average American has far greater access to effective healthcare than the citizens of any other country. Even the supposedly high cost of private insurance when compared to government insurance is a myth. Medicare and Medicaid cost more per capita than any private insurance, even despite private insurances’ costs being unnecessarily elevated by government inspired  mandates and regulations obligating  private insurers to pay for non-essential health care services greatly increasing the costs which they pass on to the consumer.

Why the need to fabricate myths on the part of the government? Two reasons; the government created programs which offered benefits, that due to lack of foresight, were under-funded. And, as a consequence of the lack of knowledge of the average politician and bureaucrat, hundreds of billions of dollars allocated for healthcare have been diverted over the years to non-essential expenditures; primarily to enrich a select group of politically connected constituents. These include pharmaceutical corporations, large corporate hospital chains, home health care agencies, ambulance companies, HMOs, durable medical equipment companies, long term acute care facilities, nursing homes and others. As these constituencies consume most health care dollars, especially government insurance healthcare dollars, and because they are protected by their political and bureaucrat followers, the only cuts that are implemented are in that component of healthcare which functions according to legitimate needs.

These include the essential services provided by physicians, hospitals, clinics and the necessary costs of medications and equipment associated with those services. The necessary costs of medications and equipment accounts for a relatively small fraction of the total expenditure for medical equipment and medications. That is why, despite all the rhetoric, the only funding cuts actually implemented impinge on physicians and independent hospitals. The cost of providing essential healthcare is less than one half the total expenditure in healthcare. Proper apportionment of healthcare expenditures, in a system free of government intervention, would result in improved access at greatly reduced cost without any loss in quality. Since this would end the graft to the unnecessary “healthcare providers” and take authority away from the government and give it to the people the odds of this happening are nil.  

The biggest myth is that the recently passed health care "reform" bill has anything to do with improving health care delivery. Its true intent is to reduce access, increase monies going to government and concealing the government generated inefficiencies and waste by eliminating a first rate private sector which would make obvious the gross inadequacy of a government managed healthcare system.

Dr. Lawrence Gelman is a Board Certified Anesthesiologist and critical care specialist practicing in McAllen for 25 years. He writes a weekly column for the Guardian.

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