At this point, it is worth saying, once more, that the purpose of this magazine is to reduce the cost of medical care while maintaining or improving its quality. Initial groundwork for this goal has been made in previous articles. The full quote heading this section which is attributed to Sen. Dirksen is reportedly “A billion here, a billion there, and pretty soon you’re talking real money” (the author could not find the date of this quote or confirm its attribution). The importance of this statement is significant. If one were to ask the man on the street how many zeros follow a number in the billions, on average the response would either be incorrect or not offered at all. This is not hard to understand since few of us deal with figures of this magnitude on any sort of a basis. When we discussed our yearly cost of $4.5 trillion per year as citizens of the United States, this is even more abstract and nebulous. However, the cruel reality of it claws its way back into our awareness when we find out that our co-pays have doubled, our withholds have increased, our deductibles have also increased, our pharmacy coverage no longer uses this medication but requires one to have it switched to that, etc.
However, it is within our means as Americans to improve the system both in terms of satisfaction and cost efficiency.
Over the past few months, the author has recorded multiple but certainly not an exhaustive number of areas of improvement for cost-effectiveness. In the May 1 article (the first), the stable patient with asymptomatic cardiac enlargement (cardiomegaly) who was admitted for no medical reason (this could’ve easily been handled as an outpatient without taking up an expensive telemetry bed). This likely happens thousands of times per day every day in the American Hospital system costing the United States (one would estimate) many billions per year. Later, we reviewed how 1 medication (a generic!) alone was overcharged to an estimated tune of $5,000,000,000 per year for the American public. End-stage renal disease cost the American public $55,000,000,000 per year (although, it should be noted that not 100% of these patients could be successfully palliated before reaching end-stage renal disease).
We now pivot.
The next steps in getting to this better medical system is to describe changes to be made. There has been enough discussion about how rife the system is with problems and how ripe it is to find solutions. The author will offer a number of changes to be listed in the coming months.