MONEY

Are MDs diagnosing us into the poorhouse?

There’s no question about it: When you go to a doctor nowadays, you’re more likely to be diagnosed with something, and sent home with a prescription, than you were a generation ago. A much tougher question to answer is whether or not these new diagnoses, and new tests and treatments that come along with them, are actually worth all the money they cost you and/or your insurance company.

As Darshak Sanghavi points out in an interesting piece in Slate, there are certainly plenty of people who think that they aren’t. Sanghavi cites a New York Times op-ed by a couple of doctors who complain that our country has been overrun by an “epidemic of diagnoses.” Over the last few decades, they argue, we’ve seen a “medicalization” of everyday life, in which “physical or emotional sensations we don’t like [that] in the past [were] considered a part of life … are [now] considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.”

But, Sanghavi asks, is this really such a bad thing? Many of the things now being diagnosed are real medical problems, and treatment can make a world of difference. “As a child, I coughed myself to sleep for years,” he writes. “(T)oday, it’s clear I have allergic asthma.” I can certainly sympathize: A couple years back, I was wheezing and choking all night every night, and awakening in the morning seemingly as tired as when I’d gone to sleep. Then I was diagnosed with sleep apnea; now I sleep with a breathing machine, which has quite literally changed my life. A generation ago, no one had even heard of sleep apnea.

Is it really fair, Sanghavi asks, to “blame people with dyslexia, erectile dysfunction, or restless leg syndrome for the [health care] mess[?]“

Well, no. But in making this case, Sanghavi misses the broader picture: Researchers at Dartmouth, led by Jack Wennberg and Elliot Fisher, have demonstrated clearly and unequivocally that while health care has improved over time, as things stand today, higher health care spending does not in fact correlate with better care.

As Fisher explained in an interview I recently did with him in Money, some regions in the US spend much more per capita on health care than others. “More health care doesn’t necessarily mean better health care,” he told me. What it means, rather, is “unnecessary days in the hospital, unnecessary referrals to specialists, and unnecessary diagnostic tests.” All of which can be hazardous not only to your wealth, but also to your health: Because of the risks of infections and medical errors, “hospitals are dangerous places to be if you don’t need to be there.”

One of the biggest problems, he told me, is that doctors and hospitals who’ve invested in expensive diagnostic equipment — like CAT scanners, for example — have huge financial incentives to use these machines whether they’re necessary or not. Whether or not you get a CAT scan often depends less on your medical condition than on whether or not your doctor owns a scanner. Changing the incentives, and reducing these unnecessary tests, could save the country an enormous amount of money.

If you want to see just how these perverse incentives can affect the care you get, take a look at Atul Gawande’s astonishing New Yorker article about a small Texas town where “Medicare spends three thousand dollars more per person here than the average person earns.” It’s a piece that reveals far more about what is wrong with our current health care system than you’ll ever learn from watching talking heads squabble over health care reform on TV.

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