The Mayo Clinic released its latest perspective (pdf) on the health care bill, including the following anecdote:
An older gentleman went to an emergency room because he fainted. A CT scan of the heart was done and showed calcification. Urgent heart catheterization was recommended and then bypass surgery was performed. Later, when a stress test was done, an abnormality was found and a second heart catheterization showed a complication—one bypass was blocked. Stents were placed in the heart artery where the bypass was blocked. However, the fainting spells continued. With his issue unresolved, the patient came to Mayo Clinic, where we conducted a lengthy assessment by a team of physicians. It was determined that all he needed was an adjustment of his medications. In the end, the tests, stents, and surgery performed at the other facility were not needed, did nothing to help the patient, but were paid for by Medicare. On the other side, the additional office time spent at Mayo to fully assess patient's situation and ensure proper diagnosis and treatment was not covered by Medicare.
One wonders whether the same thing would have the same likelihood of happening to a patient who was covered not by Medicare but by a private insurance company, or by one who wasn't insured at all but who was paying for all of the treatment-out-of-pocket. Hard to say. There are strong incentives for an insurance company to resist approving unneccessary surgery, and for individuals to resist undergoing it. In some ways the biggest cost of unnecessary treatment, though, isn't the government's money or the insurance company's money, but the patient's time, time that costs the same no matter who is paying for the unneccessary operation. Someone who has fainted and is in the emergency room isn't necessarily in the best position to resist unnecessary surgery. One answer is for government to adjust the Medicare reimbursement policies. Another answer, which Mayo is participating in, in its own limited way, is to share information. Imagine, for example, a Web site where patients or doctors could share names and stories of doctors who performed surgery that was found later to be unneccessary. Call it unnecessarysurgeons.com (a domain name that turned out to be available and that I bought as I was writing this post.) AOL founder Steve Case is in the doctor-rating business with his Revolution Health, and it's easier said than done, because you don't want to libel the doctors or even unfairly disparage them in a way that doesn't rise to the legal level of libel. The doctor who performed the unnecessary surgery may not have known it was unneccessary before he or she performed it. But anyone who has lost a week or more to recovering from unnecessary surgery knows how infuriating and frustrating it is, and, in my limited experience and circle of acquaintances, it's maddeningly common. One of the reasons for market failures is imperfect information, and the fact remains that you can easily access better and more detailed information if you are considering spending $100 or $200 eating out at a Manhattan restaurant (Zagat's, Michelin, the New York Times restaurant reviews, New York magazine online restaurant listings) than if you are spending $15,000 on surgery at a Manhattan hospital.