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Krieg Barrie

Patient and wise

Healthcare | Two practical ways to spend less for healthcare

Issue: "What price conscience?," April 19, 2014

Ask any family doctor, and you’ll get approximately the same general answer. As many as 70 percent of all medical ills in the United States that end up in family doctors’ offices would take care of themselves if the patients were—well, let’s just say, a little more patient.

I heard that statistic most recently from a physician friend of mine, and a long-time WORLD reader whose wisdom I have noted in this column from time to time. Dr. F. Edward Payne was for 25 years a professor in family medicine at the Medical College of Georgia, instructing and shaping a new generation of young doctors in that division of the state university system.

Dr. Payne is something of a radical. He’s always made me think hard about the realities of medical care—and his “70 percent” comment was just such a prompt. If we Americans are spending $2.5 trillion annually on medical care (that’s close to $8,000 every year for every man, woman, and child), and if about two-thirds of one major component of that bill would just go away if we disciplined ourselves to wait out a few of our maladies—well, why not?

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Let’s suppose that family practice accounts for only 10 percent of the whole medical establishment, and that we’re spending just $800 annually per person for this primary care. Could it be that, just by exercising a little restraint every time we’re inclined to run off to the nearest clinic, we could reduce that $800 by as much as two-thirds? And even if Dr. Payne’s figure of 70 percent is only half true, the potential for savings is enormous—coming to $90 billion annually—and all that just in the area of primary care.

If “family practice” suggests a focus that includes kids and the sniffles and playground accidents that accompany them, Dr. Payne suggests savings that may be even bigger at the other end of life. Here, he says bluntly, something like 30 percent of all Medicare expenses go for just the final year of recipients’ medical costs. Death, of course, is the ultimate enemy, and the closer it gets, the more we seem ready to spend to avoid it. But Dr. Payne suggests that in joining such a cultural tide, we impoverish ourselves and our families. We end up stealing financial resources from our children and their fellow citizens of the next generation. And we miss an opportunity for Christian witness about our biblical perspective on death.

On both sides of this divide—primary care earlier in our lives and death-defying care in the late years—Dr. Payne says Christians need to learn to distinguish between high-tech and low-tech healthcare. We are naturally enamored of the dazzling accomplishments of high-tech medicine, he says. Modern research has produced both chemicals and hardware that couldn’t have been imagined a generation ago. Dr. Payne credits modern emergency rooms, for example, with life-saving capabilities that border on the miraculous.

But much of the best in healthcare, he insists, comes from the low-tech side. In pointing in that direction, Dr. Payne stresses the actual healing benefits of simple human acts of care and compassion; he seems only incidentally to be noting the gargantuan financial savings. When I asked Dr. Payne for examples of the greatest advances in healthcare during his lifetime, the hospice movement was high on his list. “It’s not a specifically Christian outreach,” he says, “but it creates a model and sets a standard Christians might well follow as they think about having a big impact—without spending vast sums of hi-tech money.” In all that, Dr. Payne is emphatic to avoid anything that sounds like an endorsement of euthanasia. “None of this is designed to bring on death. It’s just a reminder that there’s only so much we can do to stop the inevitable.”

On both fronts—one earlier in life, and the other later—here were practical opportunities to spend a good bit less on healthcare than our society is accustomed to spend. No organization to join. No lobbying needed. Just the simple good sense to do a bit of research and then in a radical but good-natured way to say to your doctor next time: “No, that’s a procedure I really don’t think we need right now.”

Joel Belz
Joel Belz

Joel, WORLD's founder, writes a regular column for the magazine and contributes commentaries for The World and Everything in It. He is also the author of Consider These Things.


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