Dr. Delos “Toby” Cosgrove, a retired cardiothoracic surgeon, and current CEO of Cleveland Clinic in Cleveland, Ohio, was recently interviewed on Bloomberg News. The interview and subsequent story was entitled, “Health Care Must Be More Efficient, Cosgrove Says”. Before I comment on his interview, I first want to say that the title doesn’t adequately describe the quality of his comments. Dr. Cosgrove said more than “healthcare needs to be more efficient”. His interview can be seen in its entirety below.
There are many inefficiencies within the healthcare system. Tests are reordered unnecessarily because electronic medical records are not always available to access prior test results. X-rays (CT scans/MRI’s) may be done to rule out the least common cause of a headache just to cover all bases and avoid a costly lawsuit because a rare malady was missed. Patients are kept in the hospital for an extended period of time because the patient’s insurance won’t cover home IV antibiotics or other services that could be addressed outside of a costly acute care hospital setting.
Some people think insurance companies are to blame. Maybe it’s the lawyers and their lifeblood of filing lawsuits. Others blame the doctors for getting paid too much. As a plastic surgeon, I can’t be very objective about the last accusation. I went to school for 11 years after college and I don’t think there’s anything wrong with getting paid well for “saving life or limb”, although in my case, I save more limbs than lives. Anyway, we’re all to blame for our part in this big mess. However, I think we need to look ourselves in the mirror, not as insurance companies, lawyers or doctors, but as citizens, as human beings and accept blame for our indiscretions.
As Dr. Cosgove said in his interview, smoking and obesity are major, avoidable contributors to our healthcare costs. But I don’t want to lay the blame at only smoking and obesity. It’s an overall lack of accepting personal responsibility. Rather than treating our bodies terribly and with total disregard, assuming that the healthcare system will treat us back to health, we should avoid those vices. The problem with my advice is that it’s hard to do. Eating what we want and just taking a cholesterol lowering pill is much easier than resisting the new American classic Pizza Hut $10 Dinner Box (includes medium 1 topping pizza, 5 breadsticks (& marinara sauce) and 10 cinnamon sticks (and icing)! Check out this recent Facebook post from a friend of mine:
The bottom line is that regardless of how many efficiencies we introduce into the system – electronic medical records, value reimbursement vs fee for service, etc – the only way to lower health care costs will be 1) accepting more responsibility for our healthcare and improving our lifestyle or 2) limiting resources which will lead to rationing of care. This may sound shocking and melodramatic but care will be limited in subtle increments for the unhealthiest of patients. Mark my words.
