We who lead in the American health care system — primarily physicians and hospitals — are slowly having our credibility with the public eroded. The main reason for this is our collective failure to credibly lead this country in its journey to a health care system that safely and affordably cares for all Americans.
The latest such blow to our credibility is “Bitter Pill: Why Medical Bills Are Killing Us,” published four weeks ago as the cover story in Time magazine http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/. In a 26,000-word article, Steven Brill challenges the idea that hospitals have any justification for their high prices, and details a litany of hospital pricing markups of routine medical supplies such as alcohol wipes by more than a hundredfold. He tells story after story of patients charged extraordinary prices for care they could not do without by hospitals with strong profit margins and CEOs making multimillion-dollar salaries.
The Time article was just the latest of at least four articles or reports in the past 15 years that have shaken the faith many Americans have had in the people and places that take care of them. The first of these was “Crossing the Quality Chasm” ( iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx ), the Institute of Medicine’s 2001 report on the quality and safety of patient care in American hospitals. It exposed the frequency and pervasiveness of errors in medical care, the likelihood such errors and inadequacies were causing thousands of deaths each year, and laid the responsibility for fixing our deeply flawed safety systems squarely at the feet of its caregivers. In doing so, the report said the high prices we pay for our care do not systematically buy us greater safety.
The second of these was a 2006 report from the Commonwealth Foundation comparing the outcomes and quality of care provided by the world’s most expensive health system (ours) with the care provided in 60 other countries. It shredded the idea that we had the best health care system in the world; in fact, we ranked 35th, and had not improved much when the analysis was done again in 2008 ( http://www.commonwealthfund.org/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best—Results-from-the-National-Scorecard-on-U-S—Health-System-Performance—2008.aspx). So the idea we were getting better care than other countries paying a lot less per person for health care has been laid to rest.
The third of these articles was Atul Gawande’s “The Cost Conundrum: What a Texas Town Can Teach Us About Health Care.” ( http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all). In it, he tells the story of two Texas cities that are worlds apart in how patients are cared for, so far apart that Medicare patients in one city cost taxpayers almost twice as much to care for as Medicare patients in the other city, without demonstrably better health as a result. It laid bare the lack of a credible reason for physicians to care for patients so differently.
None of these seminal articles is without flaws, and none tells a complete story. Brill’s article in Time magazine, for example, fails to explain that the bizarre way we price care in hospitals is a direct result of the bizarre way hospitals are paid for that care. It portrays all hospitals as self-serving, failing to describe those hospitals and health systems trying desperately to do right by patients in a payment system that often punishes them for doing that, and working hard to rapidly change their part of this chaotic mess.
But hospitals and physicians cannot hope anymore to refute articles such as Brill’s by complaining shrilly that these articles are not fair. Rather, those hospitals and physician leaders trying to break the mold and fix their parts of the madness — by becoming accountable, supporting transparency in prices and errors, by supporting global budgets for the care of populations, and much more — need to stand up and say the current system is broken, that it must be replaced by one that insures all Americans at an affordable price, and then explain the bold steps they are taking to lead that journey.
Simply caring for Americans is no longer enough for hospitals to keep their trust.
Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.