Debate Over Obamacare Misses the Big Issue, Brownlee Tells SMC Audience

Author Says Overtreatment Is Costing U.S. $700 Billion a Year

Brownlee at podiumFor Shannon Brownlee, the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer,” the battle to reform U.S. healthcare is more than a cause, it’s a crusade.

That’s because the stakes are so high for our nation’s economic well-being. As she pointed out in an address at Saint Mary’s College on February 13, Americans will spend an estimated $2.7 trillion on health care this year -- more than the entire world market for oil. In fact, our country will spend more on health care than on defense. Clearly, reforming the nation’s health care system is essential if we’re ever going to get the federal deficit under control.

In a speech entitled “Obamacare or Romneycare: Why the Debate Over Healthcare Reform is Missing the Point,” Brownlee argued that the partisan squabbling over the Affordable Care Act, which was passed by Congress and enacted last March, is missing the bigger issue.

Although the Woodrow Wilson Fellow lauded that legislation for providing coverage to millions of Americans, she noted that the law is really health insurance reform, not health care reform. 

“Now it’s time to turn around and tackle the really hard task,” she said, “the task of transforming our dysfunctional, behemoth, disorganized and spectacularly expensive health care delivery system.”

During her week at Saint Mary’s, Brownlee also engaged in a panel discussion with pre-med students Karen Trang, Brian Shaw and Vincent O’Brien on the findings and recommendations in her book, “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer,” and a roundtable discussion on “Five Myths About Healthcare That You Need to Know.”

An Industry on the Verge of Collapse

Brownlee at student roundtableAs everyone who has ever paid for health insurance premiums or doctor’s visits or a hospital stay can tell you, health care costs in the United States are not just high, they’re astronomical. The United States currently spends $8,000 per citizen to pay for health care -- two and a half times the median for the rest of the industrialized world, Brownlee said.

That’s $32,000 a year for a family of four or, as she joked, enough to buy a Lexus, or pay for a year at a private school. She compared the health care delivery system -- doctors, nurses, hospitals, drug companies and such -- to “a giant vacuum Hoovering up all the productivity in the economy.”

All joking aside, though, she’s serious about the threat to the nation. “I’m concerned that like the housing bubble, the healthcare system is going to get too big and will collapse,” she said. “Already, private industry is having a hard time paying for insurance and is cutting back. It’s an industry waiting for collapse.”

What’s to blame for making American health care so expensive? Brownlee listed a few of the common targets: fraud, administrative overhead, the outrageous cost of drugs passed along by pharmaceutical companies. But the one that often escapes attention, she said, is the high cost of unnecessary treatment.  

A “Terrible Paradox” in U.S. Health Care

“This is the terrible paradox of our health care system,” Brownlee said. “It is failing to deliver needed care to millions of people. And at the same time, about a third of the care that people do get is unnecessary,” according to the Institute of Medicine, which investigates medical evidence.

As an example, she cited the case of a friend who went to her doctor with heart palpitations. She explained that she was feeling anxious, which can cause palpitations, yet the doctor ordered an angiogram, in which a catheter was threaded into the coronary artery. The test showed no heart damage, but when the physician removed the catheter, he ruptured a vessel, permanently damaging her heart. Brownlee has also experienced the consequences of overtreatment in her own family. Her father suffered severe kidney damage as a result of a diagnostic treatment gone awry.  

One study has estimated that 30,000 Medicare recipients die prematurely from overtreatment. “That’s the equivalent of a jumbo jet crashing every week of the year. Imagine the outcry about the airline industry if that happened,” Brownlee said.

In her book, “Overtreated,” Brownlee cites evidence from the Dartmouth Atlas Project. Among Medicare patients, it found that there is 2½-fold variation in the amount spent, depending on where you live. In places like Sacramento, Minneapolis and Portland, we spend about $6,000 per beneficiary per year. But in Los Angeles and Miami, it’s more like $16,000 a year. The extra money goes to expensive tests, like MRIs and CT scans, and extra days in the hospital, more specialists and more drugs, she said.  

Multiplied all over the nation, that amounts to about $700 billion a year -- 20 percent to 30 percent of every health care dollar -- on treatments and diagnostic tests which patients don’t actually need and, far from buying better outcomes, even expose them to needless risk, Brownlee said.

How to Cure Our Ailing Medical System

Brownlee with students at panel discussionWhat’s the cause of this epidemic of overtreatment, and how can it be cured?

Well, individuals can help turn the tide by taking back control of their health. Brownlee praised a new technique called a “patient decision aid,” which can help assure that patients truly understand the consequences of medical procedures.

She also suggested that patients ask three questions before entering any test or treatment:

     What if I don’t get treated?

     What are the alternatives?

     What are the risks and benefits?

Beyond this, she said, we have to remove the incentives for health care providers  to request expensive tests, prescribe expensive drugs and require long, expensive hospital stays.

“The providers have to change the way they do business,” she argued. Instead of private practice, she suggested that more of the nation adopt the “organized care” model, similar to group practices like Kaiser Permanente or the Mayo Clinic.  

“These groups have figured out that 20th century medicine should be practiced as a team sport,” she said. At organized care groups, “doctors truly work as teams. They earn salaries. They aren’t paid fee for service.” And just as important, she said, they put a premium on primary care. “These systems know that the primary care physician is the lynchpin to good health care.”

Brownlee recognizes that it won’t be easy to change the U.S. health care system. “Hospitals are in the business of filling beds,” she acknowledged, and “medical organizations have huge political power.” But she’s on a crusade, and she’s determined to see it through.

But first, she said, Americans have to change the way they think about medicine. For too long, we’ve been told that every new discovery represents a medical breakthrough and that more care is better care. This is especially true in end-of-life care. Instead of going to extreme lengths and using every available technology to extend the lives of our loved ones, even when they are in terrible pain, we need to treat the frail and elderly with respect and compassion, she argued.

“People have to recognize that you can’t live forever,” she said. “And we can’t pay for every problem. We have to begin to understand that when it comes to medicine, sometimes less is more.” 

Teresa Castle
Office of College Communications

Photos by Thomas Vo ’12 and Teresa Castle