The nation has gotten some long-desired, important health care economic news: The country has “bent the cost curve,” seeing 2020 as the first year in at least six decades in which America’s health care spending went down. But this may not be a good thing.
As Drew Altman, president and chief executive officer of the Henry J. Kaiser Family Foundation (KFF), reported of his organization’s economic data:
“Year-to-date spending on health services is down about 2% from last year. Health spending for the calendar year may end up lower than it was in 2019. Adding spending for drugs, which are less affected by Covid-19 and have not fallen, total health spending is still down by about 0.5% from last year. At its low point in April when the pandemic first really hit, spending on health services had fallen an eye popping 32% on an annualized basis. This is the first time expenditures for patient care have fallen year-over-year since data became available in the 1960s. The largest drop-offs were in outpatient care as people put off elective services or [visits to] doctors’ offices and outpatient clinics shut down. Telehealth visits increased dramatically but did not make up all of the difference.”
It will be a while before experts collect sufficient information, so they can tell the public whether the postponement or cancellation of medical services, notably preventive care and diagnostic tests and screenings, resulted in poorer outcomes for Americans. Did skipping myriad appointments and procedures lead to more diseases undetected in appropriate times, worsening conditions, say, for cancer patients? Did patients forgoing care show significant unnecessary treatment in the U.S. health care system, or will the nation see a spike in preventable illnesses and deaths? As Altman observed:
“These data will trickle in as studies are published and will be critical to determining how much we can safely reduce health spending in the future. Historically external shocks to the system like recessions have had a larger impact on utilization and health spending than anything we have been able to do about costs in the health system. But Covid-19 is different; it’s a double shock to health spending. The Covid-19 economy, like any big recession, depresses utilization of health services because people have less money to spend for health care. But unlike typical recessions, Covid-19 also directly attacks the health system, filling up hospitals with Covid-19 patients, closing outpatient facilities and doctors’ offices, and causing people to defer or skip care for fear of becoming infected.”
The bad news with MD offices shutting
For too many patients, the pragmatic result of the drop in health care spending may be that they will need to find new doctors soon, as financially strapped practices, slammed by the pandemic, shut their doors. As the nonprofit California Healthline reported:
“Although no one tracks medical closures, recent research suggests they number in the thousands. A survey by the Physicians Foundation estimated that 8% of all physician practices nationally — around 16,000 — have closed under the stress of the pandemic. That survey didn’t break them down by type, but another from the Virginia-based Larry A. Green Center and the Primary Care Collaborative found in late September that 7% of primary care practices were unsure they could stay open past December without financial assistance. And many more teeter on the economic brink, experts say. ‘The last few years have been difficult for primary care practices, especially independent ones,’ said Dr. Karen Joynt Maddox, co-director of the Center for Health Economics and Policy at Washington University in St. Louis. ‘Putting on top of that COVID, that’s in many cases the proverbial straw. These practices are not operating with huge margins. They’re just getting by.’”
Reporter Laura Ugar found in her article that huge downside of medical practices closing, notably those who provide patients’ crucial primary care:
“When [doctors’] offices close, experts said, the biggest losers are patients, who may skip preventive care or regular appointments that help keep chronic diseases such as diabetes under control. ‘This is especially poignant in the rural areas. There aren’t any good choices. What happens is people end up getting care in the emergency room,’ said Dr. Michael LeFevre, head of the family and community medicine department at the University of Missouri and a practicing physician in Columbia. ‘If anything, what this pandemic has done is put a big spotlight on what was already a big crack in our health care system.’”
Indeed. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Supporting a system under duress
That said, the U.S. health care system requires more support than ever, especially as doctors, nurses, and other health workers, as well as hospitals, academic medical centers, and clinics battle the unchecked coronavirus pandemic, with deaths and infections hitting frightening highs from coast-to-coast.
It is hard to fathom the persistent resistance to public health restrictions aimed at attacking the pandemic and its spread, notably to ensure the U.S. health system does not collapse under the crush of sick and dying patients. Let’s all hum the pop tunes about the virtues of staying home for the holidays. There we can practice robust hygiene (especially lots of hand washing), cover our faces, maintain distances, stay outdoors as we can, and avoid closed, confined spaces, as well as prolonged contacts, especially with others from outside our immediate households.
It is not rocket science: a shambolic and all-but-disappearing federal response to the pandemic has left the nations vulnerable and exposed. We lack the testing, contract tracing, and personal protective equipment and other medical resources necessary to battle the coronavirus with best outcomes. Most important, resistant and knobby-headed behaviors are only fueling the pandemic toll — and frying up the invaluable and finite capacities in this country for skilled people to provide care. We can’t wave a wand and magically create more, desperately needed doctors, nurses, respiratory therapists, hospitalists, first responders — and more. We’ve got to care for them, as we expect them to care for us.
Further, Americans need to be clear about this reality, too: As the California Healthline reported, “Federal data shows that 82 million Americans live in primary care ’health professional shortage areas,’ and the nation needed more than 15,000 more primary care practitioners even before the pandemic began.” The United States, long before it was stricken by the pandemic, faced shortages of doctors and a rising lack of nurses. This situation was forecast to worsen as older practitioners, particularly baby boomers, decided to retire. The pandemic may have made choices already for too many doctors, nurses, and other health workers.
We have lots of work to do, not only to quash the coronavirus, but to figure how to put the U.S. health care system in a far better, more economically efficient, and humane place — including and especially for medical personnel — in the days ahead.