TIME magazine recently released an article called “Bitter Pill: Why Medical Bills Are Killing Us“. The article raises several points about the US healthcare industry and why health care costs so much in this country. As a budding health policy wonk, this article is extremely interesting to me – however it’s sheer length and the number of issues raised in article lead me to believe that one blog post is insufficient coverage. So I’m going to drill down section by section into some important points. This isn’t necessarily a positive or negative critique of the article. Rather, I’d like to offer some opinions and some evidence both in support of and to refute the author’s words.
Section 1: Routine Care, Unforgettable Bills
I want to start where author Steven Brill starts – with the case of Sean Recchi. The 42 year old native of Lancaster, Ohio has an unfortunate turn of events when he’s diagnosed with leukemia. His wife does what any loved one or family member would do – she directs her husband to what she believes to be the best possible care for Sean’s condition, and she takes him to MD Anderson Cancer Center in Houston, Texas. Self-employed and unable to afford comprehensive health insurance, the financial woes associated with Sean’s disease therefore begin.
To say that Sean’s condition is an unfortunate event doesn’t even begin to describe the impact of a cancer diagnosis on an individual, let alone someone so young. And although I somewhat question the choice, I’m not trying to belittle Stephanie Recchi’s decision to travel to MD Anderson for care (ranked the #1 cancer hospital by US News and World Report) – after all, she did what she thought was best – although one could argue that similar care could be received closer to home at the Cleveland Clinic (ranked #6). My own parents made much the similar decision when they consulted oncologists both at the University of Pittsburgh’s Hillman Cancer Center as well as the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (ranked #3), but the Recchi’s choice brings about the bigger issue of what I like to call “name brand” medicine.
Americans have the idea that “name brand” medical care – care received at the nation’s well known, well recognized, and top-ranked hospitals – is always better than care received at lesser known community hospitals. This idea that US News and World Report has ingrained into our collective minds is only partially true. Certainly for certain types of specialized care, the well known academic medical centers of our nation’s “medical meccas” are probably the best choice. I could go on a long diatribe about how these rankings (especially from US News and World Report) come about – but reputation and the number of specialists in a particular area often play heavily into those rankings. For routine care, however, the hospitals with the best reputations do not necessarily provide care with the best performance. If you don’t believe me, go to whynotthebest.org, and you can compare your local community hospital to the “top-notch” hospital in your area on a variety of quality measures. Additionally, many of the specialists at top-notch hospitals are being farmed out to increasingly more sophisticated community hospitals, where the cost of care is cheaper.