Talk past one another and watch healthcare costs inevitably rise


The United States has long been described as a melting pot. A group of volatile chemicals striving to reach the top of a beaker would be more accurate. That is among the reasons that healthcare in the U.S. is the most expensive on earth.

We have long excelled at not only not listening to one another, but being enraged that the other side actually presents facts. Talking over each other's heads is a constitutionally guaranteed right, but institutionally we prefer a top-down culture insulated from inconvenient truths.

How else to explain the slipshod care at the military's network of hospitals as reported in Sunday's New York Times? Infants are injured more often during delivery than the general population. "Never" events are far more commonplace than in civilian hospitals--that is, when any sort of tracking actually occurs. And, when someone in the middle tries to alert someone higher up of the problems, they are scolded for doing so.

A retraction was demanded from Ronald Wyatt, M.D., head of the Pentagon's patient safety center from the Army's deputy surgeon general when he noted that there was no way to improve safety at military hospitals without data on patient deaths and malpractice claims. A staff member at Womack Army Medical Center reported more than four dozen patient safety incidents to superiors. The single time there was a response it was to dress the staffer down for the "fusillade" of reports that had been presented.

"Reports are submitted, but patient safety offices have no authority. People rarely talk to each other. It's 'I have my territory, and nobody is going to encroach on my territory,'" Mary Lopez, M.D., a former staff officer for health policy and services under the Army's surgeon general, told the Times.

It's little better in the civilian world, where even though there is more back and forth, the ignoring of basic truths continues unabated because doing so would constitute "encroachment." Michael Hiltzik, the longtime business columnist with the Los Angeles Times, recently reported about all the vile emails he receives from readers when he reports on the inconvenient fact that the Affordable Care Act (ACA) is actually insuring more Americans.

Hiltzik gets these disturbing missives in a much larger volume than I do, but I have received them as well. One person loudly suggested my digestive system must have been cross-wired with my mouth. That's when I wrote about a friend who died from leukemia after losing her Medicaid coverage when she got a well-paying job without benefits. This occurred after the passage of the ACA but before it fully took effect. I suspect the reader had an emotional reaction to this story but found it easier to be abusive than actually reconsider his or her position.

Another, an executive using his corporate email address, ended his missive with a straightforward obscenity. I resisted the temptation to ask his CEO if that was an appropriate use of the company's email system, primarily because I would fall into the gotcha and conquer morass myself by doing so.

Healthcare reform in the U.S. has been an emotionally freighted and often ludicrously debated issue for nearly 70 years. It dates back to when Harry Truman made the first failed attempt at universalizing healthcare, but was ramped up geometrically by Ronald Reagan's hollow yet galvanizing 1961 argument that Medicare would lead to Communism. That trope is still in use today, fortified by Sarah Palin's craftily vapid concerns about death panels. In the meantime, all the other industrialized countries of the world created effective healthcare systems that have kept the costs of delivery in check. They scratch their heads at our utter imperviousness toward doing so ourselves.

At last week's HFMA conference, healthcare consultant William O. Cleverley produced an astonishing chart about the per capita spending on healthcare in the U.S. It was $147 in 1960, the year before Reagan's record on the evils of socialized medicine was released. By 1970, it had reached $356, likely driven by the creation of the Medicare and Medicaid programs in the middle half of the previous decade. Still, that's only about $2,100 when adjusted for inflation.

But as the debate over President Bill Clinton's failed reform plan began to heat up, so did per capita spending. It was $2,855 in 1990, but managed to hit $4,878 by 2000, an increase of nearly 80 percent. By 2010, after the rhetoric of the ACA had heated up, it had reached $8,411, another rise of nearly 80 percent. That's during an historic period of low inflation.

No doubt the use of more expensive technologies and drugs have had their fair share in contributing to rising costs. But the military's healthcare system can serve as a microcosm for cost trends in the civilian population.

While everyone in the military bickered and tried to preserve their turf, deaths and injuries continued unabated. And as one side called the other Commies and euthanasia proponents in order to stifle reform in the civilian world, the healthcare sector felt little pressure from either side to keep costs under control.

But with the introduction of the ACA, it appears that costs are rising more slowly. And possibly, the vitriol regarding the law is diminishing.

However, Martin Arrick of Standard & Poor's expressed some surprise that the emotions over the ACA remain as strong as they are. He suggested during the HFMA conference that if the presidency and the Congress swing completely to the GOP in 2016, efforts to repeal the law would arise again.

That's not a surprise. If there's an opening at the top of our great American beaker, someone is always going to take a lunge for it-- regardless of how it affects the volatile atmosphere further below. -Ron (@FierceHealth)