Health care debate pits patients, bottom line

There's no GPS for the health care reform debate, but one set of numbers might help triangulate the patients' positions: In 1960, patients paid 70 percent out of their own pockets for medical care. In 2009, insurance companies are paying 70 percent.

The total amount Americans spent on medical care 50 years ago was about $500 billion. Today, it's approaching $2.4 trillion a year. There are a lot more Americans, there are a lot more diseases, a lot more people living with conditions that used to kill them. Along with there being a lot more people, a lot more of them are living a heck of a lot longer.

"And there's a lot more waste," claims Salt Lake primary care physician Dr. Joseph Jarvis. "And the fact is, health care providers as a rule used to put patients first. Now, for a majority of doctors and hospitals, the bottom line comes first."

And the fact that puts a fine point on the problem is that under the current so-called system, health care has become the one thing it is isn't — a commodity.

"It just isn't," Jarvis, whose been doing his best to reform health care for well over 20 years, told the Deseret News recently. Peer reviewed studies dating to the 1990s and since have documented that for-profit hospitals, kidney dialysis centers, health maintenance organizations and nursing homes have ever higher costs and higher mortality.

"In this move to keep the free market aspects of health care intact, the underlying fact of a free market system is being avoided," Jarvis said. "You pay more to get better quality in a free market, whereas in health care, high cost is associated with poor quality."

Jarvis and other health care reformers in Utah and nationwide who have been examining the way health works and doesn't, offer a mask of sorts to filter out the reform blather virus:

If you put patients first, always do the right thing for them at the first opportunity, and keep complications low, you will have fewer sick patients. But in the United States, you will also be reimbursed less, because your patients will not need to be rescued from extreme illness as often.

When you are managing a for-profit entity, whatever maximizes the return on investment for the provider or the stockholders comes first and remains foremost.

"The bullseye of health care bickering no one's even hitting close to is reducing cost," said Regina Herzlinger, a Harvard Business School professor who has spent 30 years studying and writing about health care. Her most recent book is "Who Killed Health Care," and she has consulted with the state legislature's special health care reform task force.