Op-ed-author: Diagnosis: insufficient outrage

I am not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although there is crime in this sense in any case. I'm rather talking about the violation of an ethical standard, the very "call" of medicine.

To help people health care, enrich not provider. But the manner the prices increase, it begins less like may help as a highway robbery. And those benefit providers - hospitals, doctors, universities, pharmaceutical companies and device manufacturers.

A number of publications – including the present - great reports about the exorbitant cost of American health care were published recently. In March, time magazine, a cover story exposing outrageous prices of $108 for a tube of Bacitracin ran hospital - ointment my mom put on the scratches I as a child and that costs $5 at CVS - $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.

Of course, Medicare will have none of this – it sets its own prices. And private insurers negotiate discounts. So actually no one here pays these amounts.

Please, inform the. Are not insured. They are predominantly young and used (when even bad) and have little education. So, the biggest medical bills go to the least able to pay.

At what point is it a crime?

Consider a more current change in the health sector: hospitals practice have aggressively my doctor. This would be desirable, a way the same health file to use, so that your primary care practitioner knows what your cardiologist doctors, indeed.

But that may not be the primary motivation for this consolidation. For years Medicare paid hospitals more than independent medical practice for outpatient care, even if they provide the same things. The additional payment means the facility fee and their offset public hospitals should - take the sickest patients and the complex care.

But now are hospitals buying up independent practices, moving nothing, still called it part of the hospital and the higher rate will receive.

North Carolina practice, has Duke health system aggressively local Cardiology which is the number of echocardiograms "in the hospital" carried out by 68 percent in a year, and the Medicare payments by $200 to $471, come to the Charlotte Observer and the News & observer, purchased in Raleigh.

It happened in my hometown hospital, Boulder Community Hospital, where my late mother was a trustee. Denver Post reported in may for a patient whose cardiac stress test costs around $2,000 a year and around $8,000 next after his medical practice was purchased by the hospital.

Same Office, same engine, same doctor, but it costs four times more. MOM wanted to know: what happened to the word "Community" next to the word "Hospital"?

The problem is not only the prices, but also the volumes: how we do much to patients, and how often. Consider colonoscopies. There are good reasons to believe that they can reduce the number of deaths by colon cancer. Expert Panel recommended that most people need a colonoscopy once every 10 years. But a study published in the journal of the American Medical Association in 2011 revealed that 46 percent of Medicare still had a repeated audit beneficiaries with a normal colonoscopy in less than seven years. For some gastroenterologists seems like it is the first finding of your colonoscopy, that you another.

Cardiology has a similar problem. Each year will cycle through millions of Medicare beneficiaries an echo kardiogramms. Half of them have reviewed the test period of three years. It sure looks as if some cardiologists annually are doing the test.

Finally, we have learned that the value of the new capacity: If you build it, she will come. Recently two proton beam facilities were admitted to Washington. One is already in Baltimore, only 40 kilometres from built. Perhaps there is some role for proton beam radiation children who have brain and spinal cord tumors, but there are only about 140 children per year in Washington and Baltimore. Three facilities have the ability to serve more than 10 times that. It is hard to imagine that some of the 8,000 men in the area determined to develop prostate cancer, next year will not beam proton therapy, given despite the fact, there is no good evidence that it better than standard radiation for their State.

But it is certainly more expensive: WINS one of the plants are expected to be nearly 16 million $ per year reach until 2019.

The word "Crimes" is terribly strong. Many prefer this call a problem of perverse incentives: good people working in a bad system.

We could make the system better. We could make sure having any access to the same prices as the Medicare fee schedule. We could stop the "fee for service" positive feedback loop--in which doctors and hospitals more they deserve for each procedure it do, lead to overtreating patients - and have a flat fee instead. But the incentives will be never perfect. Ultimately, society needs to conduct individual of ethical standards. And health-care systems, these standards are always damn low.

Too many of us have passively accepted the situation as beyond our control. A dose of moral outrage could use medical care in America. It would be best for all if it was self-governing.

H. Gilbert Welch, Professor of medicine at the Dartmouth Institute for health policy and clinical practice, is the author of "Overdiagnosed: makes people sick in the quest for health."

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