On the Cutting Edge
Last week, I was a visiting faculty member as a Spine Symposium. I gave three talks related to a systems approach to healthcare delivery. The context of spine surgery was purely serendipitous, as the folks inviting me did not know in advance that I have spent several years doing my best to avoid spine surgery. I used my case history, and that of a colleague, to make the case that poor care coordination is a major issue, as the many specialties involved seem to have difficulty adopting a perspective that is broader than their specialty.
Why does this happen? How does a group of highly motivated, well-educated physicians end up taking such a myopic view of back problems? The answer is rather simple. We, collectively, incentivize them to do this. We only pay them for exercising their specialties, not for understanding the relationships across the various aspects of back problems and treatments. If the orthopedic surgeon or neurosurgeon helps you to avoid spine surgery, he or she loses significant income. If they help you to achieve a better outcome with much less pain and suffering, they are penalized.
Why do we do this? I think it is our preoccupation with minimizing healthcare costs rather than maximizing health. We have lost track of what really matters. The goal should be a healthy, educated, productive population that is competitive in the global marketplace. Everyone seems to agree that this should be the goal, but we somehow cannot collectively commit to making it happen. We want to minimize healthcare expenditures. Now, that is really simple. Why don’t we eliminate Medicare and Medicaid, zero out NIH research budgets, and start closing down hospitals and nursing homes. After this, politicians can run for office on platforms that extol the merits of zero healthcare costs – at least, for the voters that are still with us.
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