The High Cost of Care: A Presidential Tale

Dr. Cindy Haines Health Guide
  • Back in the spring of 2010, we learned about President Obama's health checkup. The good news: the President was fit and trim, with a body mass index below 24, a low resting pulse, and blood pressure at a healthy level. The not-so-good news: his cholesterol was too high and he still smoked.

     

    But the really bad news for many involved in health care policy and reform was that the President received unnecessary tests during his checkup: an electron beam CT scan of his heart's arteries to look for coronary calcium, and a "virtual colonoscopy." Bad news in that this strategy was bad for the President, but also bad as an example to set for a nation struggling with escalating health costs - in no small part, due to rampant misuse of the health care system.

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    The strategy was bad for the President because both tests involve radiation exposure, which carries a cancer risk (albeit small). And testing in and of itself carries the risk of false positives, oftentimes leading to even more unnecessary health care involvement in the form of testing and procedures. Plus, they don't provide great data in terms of definitive diagnosis.

     

    The strategy was bad as an example because it sets expectations that more is better. If the President did it, it must be better…? It also indicates by action over words that following guidelines and recommendations based on evidence is optional. National guidelines do not support the use of either test in the President's case: the President wouldn't fall within a risk category that warranted the coronary calcium scan, according to the US Preventive Services Task Force (USPSTF). And the USPSTF doesn't recommend using the virtual colonoscopy for screening due to insufficient evidence supporting it.

     

    A more effective and cost-efficient strategy, better for both President Obama as well as national example? Quitting smoking: this does far more for heart health optimization than knowing whether calcium -found in plaques- was building up in his heart's arteries. And following national guidelines for other screenings, as well, as a teaching opportunity on appropriate use of the health care system at a time we can ill-afford the opposite messaging.

     

    Some may argue that if anyone should be getting "state of the art" care and "just in case" testing, it's the President of the United States. That's missing the point. That assumes that more is better, when it comes to health care. And we know that is simply not so.

     

    What is the health care we want and need? We want and need better care - and should only want the health care we actually need. And it's simpler to get there than we, the consumers of health care, are making it.

     

    Let me repeat myself: More care is not necessarily better care. The pricier option isn't necessarily the better one. The newest medication, device, or technique isn't necessarily the better one. Taking fast action isn't necessarily better than taking a wait-and-see approach. In fact, these can all lead to worse outcomes. And sometimes even screening tests can be harmful. As it turns out, sometimes looking for problems (without having a clear rationale on why and how) isn't the best idea. What is certain: unnecessary medical care costs us. And the cost is too much for America to continue to bear.

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    We can save millions, perhaps even billions, by working harder to prevent and better manage expensive, chronic diseases including diabetes, heart disease, cancer, and dementia. And when these medical issues arise, the choices you make can still have a big effect on how much your health care will cost. And that's worth looking into.

     

    For even more tips on how to get better health and need the health care system less, check out: The New Prescription: How to Get the Best Health Care in a Broken System by Dr. Cynthia D. Haines, M.D. (Dr. Cindy Haines) and Eric Metcalf, M.P.H. This is a book about getting what you really want: better health on your own terms. 

Published On: October 16, 2012