Unnecessary treatment and "misaligned" financial incentives are largely responsible for the poor state of the American health care system, according to former Dartmouth Medical School Dean John Baldwin, who recently stepped down as the president of Texas Tech University Health Sciences Center. Baldwin outlined his ideas to improve the nation's health care system, including the addition of a public insurance option, in a discussion at the Thayer School of Engineering, on Monday.
The current health care system is a "bottomless pit," Baldwin said.
It will be difficult, however, for the federal government to pass health care legislation, Baldwin said, pointing to the heated public debate surrounding the current reform effort.
"It's really not that complicated, but there are a lot of people out there that want to keep it complicated," Baldwin said.
A government-sponsored insurance option is an essential part of health care reform, he said, and would help to generate competition within the insurance industry.
"The public option is absolutely essential if you're ever going to hold the health care companies accountable for their expenditures," he said.
Baldwin said that there is a discrepancy between the amount of money spent on health care and the quality of care available in the United States.
"We spend far more than any other country," he said, adding that the United States continues to rank behind other developed countries on metrics such as infant mortality and life expectancy rates.
Reform efforts must do more than expand the current, deficient system to cover more patients, Baldwin said these efforts must also improve the efficiency of the overall system to decrease per capita costs.
"Health care reform is not the exercise of multiplying the number of uninsured people by the amount we spend now," he said.
Reform efforts must also seek to realign doctors' financial incentives, eliminating existing incentives to perform invasive and unnecessary procedures, Baldwin said.
Baldwin, a noted cardiologist, used his own experience and expertise to identify examples of these misaligned incentives and inefficiencies. Angioplasty a cardiac procedure that uses a balloon to widen a patient's arteries is overused and sometimes unnecessary, Baldwin said, though patients collectively spend a "colossal" sum on the procedure each year.
Baldwin also warned against excessive treatment, citing a study that found that visits to the doctor did not necessarily benefit patients.
The study revealed that people often experienced negative health outcomes after doctors prescribed aggressive but potentially unnecessary treatments for previously undiscovered illnesses, he said.
"The presence of disease is not always an indication for treatment," he said.
When doctors request reimbursement from insurance companies, they are not required to justify the procedures they use, allowing them to make decisions based on potential profit rather than medical evidence, Baldwin said.
These decisions inflate health care costs, making treatment unavailable to many Americans, he said.
"I've personally taken care of people who have recently lost their health insurance but still have their BMWs," he said.
