How to control health care costs in the USA

We are finally in the midst of American football season again, after so many dull months. Are you ready for: “We’re Number 1; we’re Number 1″?

School pride; conference pride; regional pride; confirmation of identity; proof of manhood.

Think Summer Olympics in London, 2012. As the Gold Medals add up, the chants will ring out … U.S.A, U.S.A.

Goose bumps; spine tingles; national pride.

Years back, when John McKay coached the USC Trojans, he used to say about the USC-UCLA football game: “It’s not a matter of life and death; it’s more important than that.”

Fast forward to the 21st Century and to our fields — health and medicine.

U.S.A., U.S.A. — we’re Number 1; we’re Number 1.

The U.S.A. is indeed Number 1 of the top 19 Western developed countries in money spent for medical and health care, in absolute dollars and in % of the Gross Domestic Product. And, we are number 1 in worst cost-effectiveness in reducing death rates.

For many years after the threat of global war posed by a hostile U.S.S.R. ended, I believed that the U.S. military-industrial complex (USMil-IC) was the greatest efficiency bumbler and resource consumption organization in the history of our country.

I mean the Pentagon declares that it won’t even be able to launch its first ever comprehensive audit of how its spends its money until maybe 2017. What?

Their supporters do always seem to identify or create new threats and wage new expensive wars.

Although illusory, the control of that growth slope is doable, simply by a new budget approved by the U.S. Congress.

But the sheer size and the unimpeded growth slopes of the U.S. medical-industrial complex (USMed-IC) has replaced the USMil-IC at the top of consumption artistry.

By steadfastly maintaining pluralism and diversity in funding streams, the USMed-IC has perfected the “divide and conquer” strategy to keep the money flowing without regard to its effect on total quality or quantity of American health and life.

Dr. Don Berwick has correctly said “every system is designed perfectly to achieve exactly the results that it achieves.”

Yep. True.

I wish I could live long enough to see the fantastic capabilities of the citizenry of the U.S.A. turn the corner and be able to say that … WE’RE NUMBER ONE … in the cost effectiveness of our health system, measured by death rates, and the length and quality of the lives of our people.

It can be done, but only by a complete redesign to a system intended to actually meet the goals of the people, not primarily those of the medical profession and its supporting industry.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit for more health policy news.

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  • Anonymous

    US is also number one in Tort Costs too. Hmmmmmm

  • Darrell White

    Um…perhaps I missed a page…where is the “how to control” part of the post?

  • Anonymous

    I don’t know why this blabber-mouth gets his articles published.

    He made over $500,000 a year as a medical journal publisher.  When was the last time he picked up a stethoscope?

  • Anonymous

    Yet another know-it-all self-proclaimed “expert” in healthcare policy telling us how to fix it. I think the Obama administration is full of these guys.

  • Anonymous

    I’m sure when physicians become better at editing things, the medical system will turn around. Here is one way of reducing health care costs: stop wasting money educating physicians to write pointless articles like this. And stop thinking that physicians are responsible for the length and quality of peoples lives. 

  • Payne Hertz

    Money, money, money.
    Me, me, me.
    To hell with you.

    That about summarizes the quality of responses you can expect to get from suggesting any reforms that benefit the people who pay for this system.

    • Anonymous

      And what “reform” did the good Dr. Lundberg put forth?
      Do I hear crickets?
      I don’t know what you do for a living, Mr. Hertz, but walk a mile in a primary care doc’s shoes and you’ll understand how insulting Dr. Lundberg’s comments are.

      • Anonymous

        Good doctor:

        You didn’t read carefully. After much cogitation, Dr. L. solemnly recommends “a complete redesign.”

        Problem solved.


        • Anonymous

          Oh my gosh!  I must have totally missed that!  I was looking for something with details.  You know, with at least as many details as a well-written JAMA medical article.
          Well, I guess if the entire health care system can be solved by something as simple as “a complete redesign”, then we have nothing to worry about anymore.

      • Payne Hertz

        Spend a few moments in your patient’s shoes, and you will understand
        that “Insulting” would be an improvement over the way we are often
        treated in this system. The kind of comments we as patients typically
        see on medical blogs are not only deeply insulting, they represent a seemingly hallucinagenic disconnect from reality, if not raw mendacity.

        The US medical system is the number one cause of bankruptcy in this country and one of the leading causes of death. Yet we as patients are told that we have no “skin” in this game as if the $2.3 trillion a year and growing we spend on this kleptocratic disaster of a system grows on trees or is donated by belleaguered doctors who work for free.

        The medical profession is so pathologically entrenched in its own self-interest and propaganda it is incapable of discerning reality any more. The only “solutions” I see coming form the medical side are completely self-serving and invariably involve making patients suffer even more than they do right now out of some distorted belief that this will magically contain costs, when it will not. While Dr Lindburg did not give specifics, he put the emphasis where it needs to be: on designing a system that works for patients. Whenever you do that you can expect to be attacked.

        • Anonymous

          You don’t I and my family are patients?  You don’t think I pay insurance premiums and deductibles as everyone else?  The answer is “yes.”  

          “A system that works for patients.”  That’s what you want.  Please be warned that unless whatever new system comes to be, unless it also benefits PROVIDERS of care, the system could very likely be worse than we have now.  Providers does not mean slaves, and right now, primary care docs being being taken advantage of.


    travesty that we pay so much, risk bankrupting the economy and live no longer nor better. and that is a fact!!!  trouble is the public does not buy it and republican troglidytes scare monger the feckless masses with the bogey men of socialized medicine, death squads and rationing care. until there is political will to reform healthcare delivery from paying to perform stuff to incentivizing to keep people healthy and the public learns how they are abetting their own mismanagement nothing will change. decry all you want, greedy specialists and big pharm and medical device companies are not the problem. although the bard’s suggestion to first kill all the lawyers may be a sensible way to start.

  • Terence Ivfmd Lee

    Every additional layer of middleman that comes between the physician and the patient is one more person that gets a cut and thus adds to the cost. Insurance company, management service, IRS collector, miscellaneous bureaucrat, lawyer, politician. If those middlemen add value to the process, then they deserve a cut. But if they don’t add value and still want to hold their hands out for a piece, well, then that’s another story all together.

  • Anonymous

    Medicine is a financial disaster for the same reason as all of our other financial disasters: Some or all of the players have no skin in the game. In medicine, the players without skin are the patients. When patients have no predictable co-payments for the medical products and services they consume, the demand for low yield, no yield and harmful medical procedures is nearly infinite and grows far faster than inflation. A progressive means-tested co-payment system is one way to restrain the growth of medical costs from the bottom up rather than from the top down.

    • Anonymous

      The very first question my primary doc asks me when I suggest lowering costs by switching to a perfectly good generic medicine is, “What are you worried about? You have good health insurance, don’t you?”  What incentive does my primary doc have of switching me to a generic medicine when he has a much better incentive coming from the Pharma Sales Rep that visits him several times a month? Higher co-payments? That’s an absurd suggestion. Maybe a thorough investigation of corruption would provide an incentive? Maybe some prison time?

      • Anonymous

        That’s too bad.  Maybe your PCP was sued once from complications from a generic med.  I don’t know what benefits your PCP gets from sales reps– it’s only supposed to be a lunch or dinner presentation at the most.  Sorry, that doesn’t influence too many doctors I know.  Now, junkets and political donations for congressmen, that would carry a lot of weight with those politicians, I’m sure.

        I prefer trying generics because I know the decreased cost actually helps to improve patient compliance.  I also discuss treatment options and advantages and disadvantages of tests and try to get patient involvement.  It doesn’t always work, sometimes the patient just says “You’re the doc–you decide,” but at least I can feel better that I tried to educate the patient a little more.

  • Anonymous

    Control Health Care Costs? 

    Let’s start with speeding up the implementation of the health care exchanges the are in the Affordable Care Act.QUESTION: What value do health insurance brokers bring to America’s health care market?Besides skimming a profit for selling something that could more easily and more honestly be sold in the state exchanges on the Internet. what value do health insurance brokers bring to our health care market?The sooner we see these health care exchanges on our computer screens, the sooner our health care system will begin the slow migration to honesty and integrity. For far too long, consumers and been held hostage by health care insurers. I want more choices! I want robust competition! I want the anti-trust laws to be obeyed by “all” businesses! I want to see a day when health care insurers are forced to be honest and fair. Every business deserves a “fair” chance to earn profits. Today, with the private health insurers in complete control, there’s nothing fair about it! These insurance sharks control the entire market with an iron fist and they have Congress on their payroll to keep it that way! For certain, the consumer has absolutely no say whatsoever! It is outrageous! I say, bring on these Internet Exchanges as fast as possible! Show me someone who is against these exchanges and I’ll show you someone who loves a status quo system where the consumers continues to be at the bottom and constantly gouged.

    • Terence Ivfmd Lee

      It’s not for any outsider to judge what value a certain entity has. It should be up to the participants themselves to judge. If all different entities were free to compete, then the patient himself/herself will judge what is better for himself/herself: 1. Pay another individiual or entitity for medical care directly out of his/her own pocket 2. Go with the current standard insurace model (but with free choice from any of several companies, all competing to provide the best prodcut) 3. Optionally paying government workers (via VOLUNTARY taxation) to let government do the administrative work of allocating medical care. In an ideal world where all options were available, then the one that is the best overall would win out over time.

    • Anonymous

      Really, Dave? Have you READ your health insurance policy?  Brokers have, and they get training every year on every product they sell, and those products are changing frequently these days. These are the people best positioned to expertly counsel people on what is a significant financial decision that protects their assets as well as their health.

      Don’t want insurance? Fine, you can navigate the health care system all on your lonesome, negotiate your own rates, pay your own way, cash or credit equally acceptable. Pick any doctor or medication you want – you are perfectly free to do so — with your OWN money. But if you want a $50K back surgery with questionable results and you want your insurance pool to pay for it, then we get to say (through our representatives, the health insurer) how you spend our pooled money.

      You can already buy health insurance online and compare coverage and prices, it’s called “” – go ahead, take your best shot. If you want to know how hard it is, ask somebody who has to pick from dozens of Medicare plans.

      Bring on the exchanges – it’s time people see for themselves what those in the business already know. there’s no such thing as a free lunch, and there’s no such thing as cheap, high quality health insurance  OR health care.

  • Anonymous

    I was thrilled to hear that Walmart will be getting into the primary health care business very soon. If anyone can force cost down and force competition, it’s Walmart. If my guess is correct, Walmart will not play games! If my guess is correct, Walmart will dictate the price they will pay Big Pharma for prescription medicines, or else! If my guess is correct, Walmart will insist that, given a choice, their patients always choose cost effective generic drugs. If my guess is correct, Walmart will force corrupt prima donna health care providers to compete or go out of business. It will spell the end of designer healthcare and will make basic healthcare affordable for most Americans. If my guess is correct, Walmart will force the vast majority of mostly corrupt health insurance companies to go bankrupt. I am looking forward to the bloodbath!

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