The Stuff

By now you must be wondering what is the cause of this massive healthcare inflation we have seen over the last 30 + years. After all it was so easy and convenient to point fingers at the doctors. But doctors care about patients, and what they want most, is simply to get their patients what they need. That's what doctors do.

To fully understand this health care cost crisis, it important that you know about the "Stuff". The Stuff, is my shorthand for all of the collective new and expensive drugs and medical technologies. This includes drugs, tests, implants, surgeries and surgical equipment, testing equipment, and medical treatment equipment necessary for various therapies. For the most part, these are tangible things that are made and sold by various companies domestic and foreign. They almost universally require FDA approval in the US.

The best studies done to date, regarding heath care cost inflation, show that it is the cost of the Stuff, that drives this inflation. (kff.org/insurance/7670.cfm ) Think about it. Thirty years ago we didn't have all of the Stuff, that we have now. That's why health care costs made up half as much of the economy then, as it does now. So what we all really need to be asking ourselves is: "Why does the Stuff have to cost so much"?

That is a very good question indeed, particularly when that same Stuff, and sometimes even better Stuff, can be gotten in other countries for significantly less. Hey, we all know it is true. Millions of Americans get drugs and treatments outside of the US every year, at a fraction of the cost. And technically speaking, it is generally illegal to do so. So why can't we just get that Stuff right here, for less, and not have to break the law? It really is that simple, despite what you hear. Well almost anyway.

It turns out that the Stuff is more than just things. It also refers to the manipulation of all of these things by politicians, and other interested parties, even including companies from other countries. Yes it goes that far. It's the reason that the Stuff costs so much more in America than everywhere else in the world.

Companies around the world are inventing new medical treatments of all sorts too. These new treatments then get American patents, and FDA approval, even though they may be only marginal improvements, or not even as effective as what is already available off-patent. This is particularly true for drugs. Because congress forbids Medicare and Medicaid from negotiating lower prices on FDA approved treatments, they can advertise and sell in the US market at far higher prices than they can in all other markets or their own market. Americans pay much higher prices than anywhere else in the world. In effect, Americans are subsidizing new treatments for people all over the world, and we are also the cash cow for foreign companies who make the Stuff too. Is it any wonder we're going broke over health care?

Now politicians and makers of the Stuff, really don't want you to know about this, so they try hard to convince the public that the problem is all of those greedy doctors. And they would be right about a very, very, tiny number of doctors who actually do make millions of dollars helping companies sell their expensive Stuff. But the vast majority of doctors do not engage in helping these companies sell their Stuff. In reality, your doctor really wants the stuff to cost much less too. If for no other reason, it's so they don't have to constantly hear their patients complain about the high cost of the Stuff!

You know in all of my years in medicine, no salesman selling Stuff for his company, ever ever asked me how much I thought that Stuff should cost. Further, I have asked hundreds of doctors personally, whether they were ever asked to weigh in on the cost of any of the Stuff, that these salesmen wanted us to recommend for our patients. Not a one said they ever had any input about the cost, nor were they ever even asked.

So there you have my very unscientific take on physician participation, in deciding about the cost of the Stuff. But just ask your doctor if he has ever heard a complaint about the high cost of the Stuff? Undoubtedly he will tell you that he hears about it every day......