Sep 23, 2009 4:53 pm US/Mountain
How The High Cost Of Health Care Came To Be
Written by Alan Gionet
DENVER (CBS4) ―
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Good Question, a regular part of CBS4 News at 10 p.m., is an opportunity for Alan Gionet to drill past the basic facts of a story and give it some depth & perspective. See more Good Question reports.
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The High Cost of Health Care
Good Question: How did we get into this mess?
"Oh man, I blame the insurance companies," says one woman.
"I like to refer to the issue as bean counter issues," says a man with longtime medical problems.
There's the big buildings theory.
"When I see the huge palaces that insurance companies have built," says the woman who blames them for the fact that America has the highest cost in the world, but leaves tens of millions uncovered.
Sure enough the stories of multi-million dollar salaries for insurance and leading health care industry CEOs are enough to create outrage, but are they the only ones to blame? Be careful, you may be sticking that pin in yourself.
"It is a basic American premise to support free enterprise and God knows we've supported a lot of free enterprise in health care," says Dr. Richard Krugman, Dean of the University of Colorado Denver School of Medicine.
But that's not all. Put simply, "We don't have a coordinated, coherent approach to health care in this country," says Krugman.
Certainly insurance holds its frustrations for patients and physicians like Dr. Katherine Fitting; these days the only medical doctor in all of Park County.
"The people who do all of the billing, who do all of the paperwork, outnumber the physicians," says Fitting.
Earlier in her career she was a kidney specialist in a practice of five physicians. There were two office staffers.
"They did everything up front, they checked the patients in, they did all of the billing. When I left seventeen years later, we had increased the number of physicians to about ten physicians, but we had a whole department." Well more than ten handling the paperwork. Fitting says she laughs when she gets a form that says it's part of the paperwork reduction act.
The South Park Medical Group where she works has a staff of nine. There are two nurse practitioners.
In a bad economy people are downscaling coverage says office manager Paul Christian.
"Folks that can't afford any of the normal insurance policies have to select you know different policies which means bigger deductibles."
He finds himself calling people he knows in the small community where he lives, shops and goes to church and asking them to pay bills.
"Sometimes you have to make decisions. Sometimes they're not easy decisions." There's not enough money to pay Dr. Fitting regularly.
She rarely draws a salary from the clinic. When you ask about the American health care system, she points to other doctors as party to the problem of high cost.
"When I was a resident as an internal medicine person, I would be taking care of the person with the heart attack, I would be taking care of the person with kidney problems, the person with gastro-intestinal problems, now, everybody has a specialist, every organ, every organ system has a specialist."
More specialty medicine means more sophisticated testing and procedures. Certainly malpractice has been an issue, although with limitations on settlements the problem in Colorado has not been as bad as in some states. Dr. Fitting says it's another layer of cost and admits there are tests added on to prevent the potential of lawsuits.
"I think any physician who said no to that question would be lying. We all do it, even though we work hard not to. That's in the back of your mind in many cases."
When you reach back looking for a cause Krugman says the tax code has played a big role.
"Businesses historically over the years have been more than willing to pay more premiums because of the tax code that has given them a deduction for what it costs to have employer based health care," says Dr. Krugman. "For years people were driven to get better and better health care coverage, which would be valued as a ten percent raise, but instead of ten percent cash they would take eight percent as health care benefits and a two percent raise and people would come out ahead."
That, Krugman believes, has meant little interest from the patient in what health care really costs.
"When the person buying the care doesn't have any say in what the cost of care is and frankly doesn't care, they want to get better, and when the physicians and the hospitals are being paid by a third party payer who can pass on the cost of this to everyone else there just are no incentives to keep costs down."
All of that adds on to the price of research and development, drug approval and the high profit margins of drug makers. And one more thing Dr. Fitting pointed out. We're living longer.
"People get more disease. The more disease that you have, the more complex your medical regimen."
Years ago, infections were major killers. Much less so these days. The diseases we get can be more chronic and may be treated over a period of years.
"They didn't live long enough to get cancer," says Dr. Fitting.
(© MMIX CBS Television Stations, Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
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