Dr. John Roberts discussed rising health care costs andthe Affordable Health Care Law before a large crowd in the Whitlock Room at St. John's Episcopal Church at the Monday "Lunch with the League." This is the first of two columns reporting on his presentation and deals with the seriousness and challenges of financing our health care system.

Medical expenditures in the United States are now 16 percent of the GNP. Medical inflation is far greater than other costs. By comparison,if the rate of inflation since 1945 in health care costs was same for a dozen eggs, the eggs would now cost $55/dozen. A gallon of milk would cost $48, and a dozen oranges would cost $134! To better understand the rapid rise in health care in America, Dr. Roberts recommended reading the March 4, 2013 TIME Magazine article "Why Medical Bills are Killing Us" by Steven Brill.

We spend more/person for health care than any other nation in the world. With this great cost, are we getting good value? Dr. Roberts addressed three major issues: (1) overuse of medical therapies, (2) end of life care and (3) are we using "Science Based medicine?"

In overuse of medicaltherapies, Dr.Robertsnoted medicine does not adhere tonormal supply and demand economics. When you have a health condition or emergency, you rarely have time or knowledge to comparison shop. Doctors are compensated for services provided and patients are insulated from the true costs of care. Americans demand the latest and the "best" and usually receive it at high cost.

Secondly, end of life care is very expensive. In looking at Medicare expenditures in the last year of life, 25 percent of medical expenditures ($125 Billion) is spent on 5 percent of beneficiaries. Out of pocket costs average $39,000 for individuals and $51,000 for couples. Bills exceed assets in 40 percent of households.

Informed consent? Dr. Roberts asked are patients truly aware of the cost/benefits of treatment? A New England Journal of Medicine study revealed that 70 percent of individuals with advanced lung cancer and 81 percent with late stage colon cancer did not realize that chemotherapy was not likely to cure them.

How do we know if a treatment will work? Our brains have evolved to react quickly to stimuli in our environment. Humans are not wired to make logical, valid conclusions about our observations of nature. We are intrinsically vulnerable to bias. Dr. Roberts noted that this can be minimized by use of the scientific method.

We tend to believe anecdotes and testimonials from others. We accept narratives of one-time events that are not balanced by averaging effects from multiple observations. "Confirmation bias" reveals a tendency to notice and attach significance to observations that reinforce one's beliefs/perceptions while dismissing or ignoring contrary information. We use rationalization instead of reasoning.

The media, such as MSNBC or Fox News, presents bias information, and the internet promotes"news aggregators."Dr. Roberts stated it is important to use well designed clinical studies and statistical analytics to minimize bias to improve the VALUE of medicine.

Dr. Roberts stressed we need to reduce the bureaucracy and apply reason to the problem. USPSTF (United States Preventative Services Task Force) was started in 1984 as independent panel of 16 primary care professionals and epidemiologists who are not federal employees. Their task is to "systematically review the evidence of effectiveness and develop recommendations for clinical preventive services" without regard to cost or politics.

The column next week will report on Dr. Roberts' comments on The Patient Protection and Accountable Care Act "Obamacare" approved March 23, 2010.



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