The Trial and Tragedy of the Medical Fiscal Cliff

Healthcare costs are leading us  for fiscal disaster in this country. This is only the first trial/tragedy.

The inflation rate for healthcare costs has usually been 2-3 times the general inflation rate during my thirty years as a physician. We now spend twice as much per person on healthcare as the average per person cost of all developed countries.

Obviously, this level of healthcare cost will be ruinous.

The human costs are, however, the more important tragedy.

Even though we are the richest country in the world, we are the only developed country in the world that does not have universal health insurance. Unbelievable! Currently, 40 to 50 million Americans have no health insurance largely because they or their employer can't afford it. With the costs to every business, whether or not they provide health insurance to the employees now set at $63/head, there appears to be little hope of stemming the tide of rising costs.

Healthcare cost crisis will drive us to a real fiscal cliff within 10 years unless we get really behind the concept of proactive preventative care provided in a setting of physician-patient mutual trust.  Only in this "system" where trust abounds and "patients" become "partners" in a decision-making process that allows rational decisions to be made about healthcare – rather than the emotional decisions too often made today out of fear and/or greed.

We need to develop comparative data – and make it readily available – that tells us what works and what does not, in other words what is "cost effective." Medical homes need to be able to explore what services really do improve outcomes.  This information needs to be gathered, analyzed and best-practices standardized.

Any proposals about healthcare reform needs to be evaluated on the basis of how well they promote this kind of primary care. I have come to believe it is our only hope in mitigating cost while actually improving care.


It appears the FDA and Health and Human Services departments are finally waking up. It is about time! Lifting barriers to treatment with medications like Suboxone is a step in the right direction. Disallowing the propagation of narcotics without the implementation of effective deterrents to their abuse and diversion is another step in the right direction. 

As a family physician, with many years of experience in treating addiction, the avalanche of deaths, both intended and unintended, from inappropriate opioid prescribing is heart wrenching. I would absolutely agree with the other respondent that the implementation of effective counseling along with medical therapy to treat both the psychological and physical aspects of addiction leads to much better outcomes than use of either one modality alone. Reducing the cost and Other barriers to receiving psychotherapy would be another step in the right direction. I strongly disagree the making methadone more available would be helpful. While I certainly agree that it is cheaper than Suboxone, it's long duration of action and abuse potential outweigh any benefits that would accrue to making it more available.