Wait. You thought the Affordable Care Act would go a long way toward reforming America’s health care system?
Not even close, contends John Leifer, a Kansas City health care analyst and author of a new book: “The Myths of Modern Medicine.”
The subtitle is “The ALARMING Truth about American Health Care,” and the all caps aren’t just a come-on. The book will reset your expectations about just how much critical reform our health care system still needs — despite Obamacare.
Leifer is the head of the Leifer Group, a health care strategy firm he founded in 1982 when he was 25. In 2004, the firm became part of Cbiz, where Leifer served as national director of health policy. In 2010, he accepted a consulting project at Saint Luke’s Health System and then became its senior vice president of strategic planning, a post he left in 2012 to write more about health care.
Leifer has taught at KU’s School of Medicine within the Department of Health Policy & Management, where he was its first executive-in-residence. He and his firm have been profiled in national magazines, and over the decades he has worked with scores of hospitals and other health care providers.
In an email interview, he said that a main impetus for writing the book was that “after 30 years of immersion in the industry, I had long-witnessed the unvarnished truth about our health care system. There was such a glaring difference between people’s perceptions of the care they receive and what health care actually delivers, that I felt compelled to try to open their eyes and dispel the myths under which they operate.”
The book’s introduction rings like a polemic: U.S. health care is “astonishingly expensive, remarkably variable in quality, and incapable of stemming the rising tide of chronic illness in our population.”
Leifer’s discussion of 10 so-called myths, blending anecdotes and data, is supported by research backed by footnotes. His conclusions are reasoned.
And eyebrow raising. Right from the get-go there’s Myth No. 1: “The United States boasts the best health care in the world.”
Leifer said we carry this irrational belief, “despite overwhelming evidence to the contrary,” simply because it’s comforting. But he notes there are dozens and dozens of studies over many decades showing it’s just not true.
Yes, it’s possible to get the best health care in the U.S., and doctors, hospitals and, yes, insurers all work for the best interests of patients. But for the population as a whole, Leifer points out, the U.S. medical system does not produce better outcomes for most people: We have higher infant mortality rates and lower life expectancies.
That’s not a matter of intent, access or inadequate insurance. It’s that compared with other countries, Leifer contends, we get substandard care, not the right kind of care, or even too much care. All at a much higher cost.
Leifer argues that profits drive the U.S. health care system much more than in other countries. The numbers he cites — breaking down how much we pay to hospitals, doctors and for drugs compared with other countries — are staggering.
He elaborated in our e-mail exchange: “Our nation’s health care tab has increased 20,000 percent over three generations, yet our care remains highly variable in quality and safety. It is impelled forward, with ever escalating costs, by those who feed at the $2.8 trillion health care trough.”
Among the other myths:
▪ “Shopping for health care is like shopping for a car; you base your decisions on good information.”
▪ “Medical interventions are based on scientific evidence of positive outcomes regarding best practices; as a result, patients receive precisely the care they need.”
In his email he explained: The “health care industrial complex includes physicians with a vested economic interest in the treatments they provide.”
▪ “My insurance company’s first concern is my health.”
And here’s one increasingly obvious:
▪ “When all else fails, at least the system will allow me to die with dignity.”
Leifer said he was outraged over the greed he contends riddles the system: “Costs are so out of control as to be mind-numbing, yet little is being done to rein in these costs.”
While the Affordable Care Act is working as intended to expand access to insurance, Leifer said, it “was far from a fix…. In many ways, by broadening access, it simply opened the funnel wider, allowing more people into a desperately broken system.”
Some might be disappointed Leifer does not offer a top-down solution: A single-payer system or other governmental mandates imposing reforms.
Policy makers and industry leaders should read the book for Leifer’s big-picture view of the issues, but Leifter wants well-informed patients and their families to pressure doctors, hospitals and insurers. His epilogue offers several ideas on how to do that.
“The most important message I can deliver,” he said, “is that the quality, value, safety, effectiveness and appropriateness of the care you and your family receives may vary greatly based upon your selection of doctors and hospitals. If you wish to receive the best care possible, you are going to have to roll up your sleeves and begin to learn about the health care industry and its many woes.”
▪ If you think Leifer’s too far out on a limb, take note of recent books by disenchanted doctors. As Liefer said, “Physicians are no longer the stewards of the industry.”
Among the books: “Being Mortal,” by Atul Gawande; “Doctored: The Disillusionment of an American Physician,” by Sandeep Jauhar; “What Doctors Feel: How Emotions Affect the Practice of Medicine,” by Danielle Ofri; and “The Doctor Crisis: How Physicans Can, and Must, Lead the Way to Better Health Care,” by Charles Kenney and Jack Cochrane.
They’re all discussed in a depressing article in the November Atlantic magazine.