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Wednesday, April 23, 2008

Myths of the Modern Medical Miracle

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Ask any employer what’s keeping him or her up at night, and you’ll likely hear, “The rising cost of health care.” In 2007, total national health expenditures rose nearly 7%—twice the rate of inflation, according to The National Coalition on Health Care. From 2000 to 2007, employment-based health insurance premiums doubled, far outpacing both inflation and cumulative wage growth.

Raj Nijhawan, M.D., a Milwaukee anesthesiologist, is fed up with the inefficiencies, lack of oversight and waste of our current health care system. In his forthcoming book, The Myths of the Modern Medical Miracle, he says the cure is competition and market forces. Nijhawan also argues that “life ecology factors”—or lifestyle choices such as relationships, diet and one’s personal belief system—is just as important as any medical intervention.

But others are skeptical of Nijhawan’s emphasis on the free market. Robert Kraig, director of programming for Citizen Action Wisconsin, says pure market forces are inadequate for delivering quality health care at affordable prices. “The question still remains as to how you build and integrate a system that influences lifestyle issues? How do we make sure people have access to appropriate technology?” he says.

We recently spoke with Nijhawan about technology, market forces and “life ecology factors.”

Shepherd: Most people see modern medicine as a blessing. What is the myth that you write about?

Raj Nijhawan: We are significantly overestimating the impact of medical technology and its impact on health outcomes. We’ve increased life expectancy by 40 years over the last 150 years [from 40 to 80 years], but only three of those years can be linked to modern [technology]. So we need a higher threshold for using technology, and we need to be much more intelligent about using it. Currently, the public doesn’t understand how these technologies add costs and complexity, and too often result in death and injury.

Shepherd: What is the solution?

Nijhawan: More competition. I try to lay out a plan for how individuals and consumer advocacy groups can push our health care institutions to become more transparent and accountable, and then watch as their performance improves. We have the worst health care system in the world on a value basis, which is outcomes relative to cost. The U.S. has the highest health care costs by far, yet we have the worst health care outcomes of any developed nation.

Shepherd: You also talk about “life ecology factors.” What are those?

Nijhawan: Life ecology factors—which include state of mind, strengths of relationships, religiosity, diet, sleep and exercise— can predict 20 years in variance in how long you will live. That is within your control. Any plan for controlling health care costs will have to include life ecology thinking, and hold technology to a much higher standard. That is what I think future health systems will provide once competition is encouraged.

Shepherd: What has prevented these kinds of reforms?

Nijhawan: To me it’s about leadership. It’s about, “Do you want the best system?,” and the key is accountability. If you have transparency and accountability, then you will be forced to provide a better product, and if you don’t, then someone else will. But that only works in a truly free marketplace, which we haven’t had in over 50 years.

Shepherd: What do your colleagues in the medical profession think of your recommendations?

Nijhawan: Doctors are uncomfortable with these kinds of changes. They’ve had carte blanche to do what they want. One of the fundamental causes of our health care crisis has been variability in practice. Without accountability or transparency, doctors can do whatever they want. But the data are indisputable: the higher the spending on health care, the worse the outcome.