One of my recent themes around here has been that modern healthcare is in a state of crisis. This recent LA Times article entitled “Medical spending likely to remain high despite healthcare law” states (as is obvious from the headline) that healthcare costs are not going down anytime soon. One interesting reason…

Technology has helped other industries lower costs by eliminating waste and increasing efficiencies, but it’s done the opposite in healthcare, said Michael Thompson, a principal in Price Waterhouse Coopers’ health and welfare practice in New York.

Although engineers keep building more powerful CT and MRI scanners, for example, there’s no evidence that more scans are helping to prevent disease.

Still, we’re using an awful lot of them. A study published in June in the Journal of the American Medical Association found that from 1996 to 2010, the number of ultrasounds conducted in the U.S. doubled, CT scans tripled and MRI scans nearly quadrupled.

This caught my attention. As I’ve mentioned in the past, at the onset of my unbalance issues several years ago, I had an MRI (which did uncover a brain lesion that doctors fundamentally decided wasn’t worth worrying about.) About a year later, I felt that I had uncovered the source of the problems: damage to my vestibular system. I went to an ear nose and throat doctor and… well, what I don’t let myself tell it (quoting from this blog post.)

[The doctor] was interested in the [first] brain MRI, but, during the course of the appointment, was willing to accept the findings of the previous doctors [that it could be ignored]. But at the very end of our meeting, he said something like, “Why don’t we go ahead and do another MRI just to be safe?”

So, I went ahead and did the MRI (at about $1500 cost to me, and much more to my insurance.) Several days later I called up the MRI lab. To help them find my record, I gave them the name of the doctor. They said something like, “Oh yes, we know him. He’s a frequent flyer.” (Meaning he orders a lot of MRIs.)

That comment stayed with me. Was this doctor ordering an excessive amount of MRIs? Why would a doctor order MRIs that weren’t necessary? Again, the LA Times…

The way we pay providers is another major contributor to the high cost of American healthcare, both now and in the future. The more procedures doctors and hospitals provide, the more they get paid. It’s a recipe for runaway costs, Thompson said.

When you think about it, that’s just insane. In the same way that car salesmen are paid more if they sell you not just the car but the installed security system, antilock brakes, GPS system and solar powered self warming coffee holder (I’m not sure those actually exist, but it’s a great idea) Doctors are incentivized to pile on more services and procedures to the initial bill. Of course, car salesmen don’t enjoy the level of trust that doctors do in our society (I respect most piles of dog feces more than I respect car salesmen.) Additionally most people pay for cars out of their own pocket — we’re not sharing the costs for our car purchases through an insurance pool. So what we have is a system in which trusted authority figures are given a financial incentive to prescribe excess procedures and services. Is that going to result in unnecessary prescriptions (and thus higher shared costs)? Duh!

I’m reminded of a few other anecdotal* cases that might be relevant here. An acquaintance of mine recently had some kind of shoulder surgery. Once the doctors got in there, they determined that it would not be possible to complete the goal of the surgery (which, I think, was shaving down some bone or something.) Someone else I know recently had cataracts removed, but, post-operation, it was determined that his vision had not improved.

Were these surgeries failures? Maybe… if the goal was to actually increase health. But if the goal was to increase wealth (of the doctors), then these surgeries were pretty successful.

By the way, here’s another fact from the LA Times article worth considering while ruminating on the high cost of health care: 35.9% of Americans are obese. Suddenly my “death camps for fat people” idea doesn’t seem quite so controversial, does it?

* Yes, I agree that anecdotes are not evidence. But I do think, especially if they are easily summoned, they contain a certain wisdom.