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Doctors Must Monitor Health Costs: One Physician’s Plea To His Peers

George D. Lundberg, M.D.

Physicians have both the duty and unique power to improve end of life care in the U.S., said George D. Lundberg, M.D., speaker at the James E. and Bonnie L. Eckenhoff Lecture at Northwestern University’s Buehler Center on Aging, Health and Society.

The U.S. spent around $2.7 trillion on health care costs last year, yet the quality life for Americans has not improved or translated into better care, said Lundberg, the editor-in-chief of CollabRx, a genomic-based health care analytics company. Lundberg acknowledged that many see health care spending as exorbitant for what consumers get in return. But actually, he said, consumers receive a lot- testing, technology, medication, surgery and hospitalization- whether or not all such things are really necessary. “Often a lot of what we need we only get a little. That, in a nutshell, is the problem.”

Health care reform is needed 

Lundberg asked the audience of medical students, doctors and nurses who controls American health care. “No one and everyone,” he answered. “Anarchy and chaos stand side by side. There’s nothing remotely akin to a U.S. health care czar. The marketplace determines how much money is spent on what, and how many people of what types work in health care. It is by no means a free market.”

He also asserted that lobbyists for hospitals, physicians, insurance companies and pharmaceutical companies exert tremendous power over U.S. health care, and as a result, they also control the U.S. economy. Health care spending amounts to 18 percent of the nation’s entire expenditures.

I want you to know and I want you to care about what you prescribe is going to cost. Insist, rise up as one, demand to know.

Lundberg said the U.S. health care system is the best in the world, for those who match the following ten-part description: 1)  having full health insurance that can’t be taken away 2) living in  a major metropolitan area 3) having a long term relationship with a physician 4) having knowledge of English and lacking a hearing or visual impairment  5) having education 6) having financial resources and access to transportation 7) being white 8) being naturally skeptical 9) having internet access 10) being male. Lundberg said most politicians who champion U.S. health care fit the prior description. “How about all the rest?”

Some simple solutions to health care

Monitoring spending is the simplest way to cut health care costs, Lindberg argued, and he made a personal plea to physicians to help with the task: “I want you to know and I want you to care about what you prescribe is going to cost. Insist, rise up as one, demand to know.” He noted that greater transparency of costs would also help lower spending.

Lindberg said that physicians have a duty to change individual care as a group or individually, because they are in charge of treatments and interact with patients. “They make the real things happen.”

End of life care

Lundberg concluded with a focus on end of life care. “Death is not the enemy. We all die,” he said. “The enemies of patients aren’t physicians. Disease, disability and pain, those are the enemies. I believe that all people deserve a death with dignity and without pain.”

Palliative care is the right option, he said, for some 80 percent of patients who die of chronic progressive disease. Unfortunately, most of these patients die in intensive care units, and often against their will.

Hospice care is also right for many, Lundberg said, but the process of the patient and family choosing the option often takes too long to receive its full benefit. “The main key to getting it right for patients with incurable chronic progressive disease is counseling. Medicare could pay for it.”

Lundberg is an academic pathologist and has 30 years of editorial experience writing and editing for major peer-reviewed medical journals, including: the Journal of the American Medical Association, 10 AMA specialty journals, the Medscape Journal and e-Medicine from Web MD.