Harvard Medical School professor: U.S. health system nearing collapse

Harvard Medical School professor emeritus Dr. Arnold Relman says current U.S. health system cannot be sustained.

Throughout his hour-long talk, Relman, who favors a non-profit system with salaried physicians, kept a single slide on the jumbo screen which read: “A healthy man has a thousand wishes; a sick man has only one.” Photos: K Stone

In his 2007 book, A Second Opinion: Rescuing America's Health Care, Dr. Arnold Relman, professor emeritus of medicine and social medicine at Harvard Medical School, unraveled the myth that investor-owned medical care facilities are more efficient than comparable non-profits. In fact, he provided evidence that for-profit health care systems often provide lower quality services at higher costs.

The senior physician-academician and former editor of the New England Journal of Medicine didn’t pull any punches when he delivered the keynote address at the American Association of Physicists in Medicine (AAPM) annual meeting last week in Houston. 

While physics-based medical technology has undeniably improved medical diagnosis and treatment, that same technology is overused and its expense is contributing to America's exorbitant healthcare costs, said Relman.  

Hundreds of billions of dollars are spent on high-tech medical imaging and therapy, contributing a slice of the $2.5 trillion spent on healthcare in the U.S., said Relman. That cost is bankrupting the system and reform is badly needed, he added.  

Relman outlined what he sees as the reasons behind technology overutilization: profits for those who invent, manufacture, sell, prescribe, and supervise technology; little or no analysis of technology's cost-effectiveness or routine comparisons with less expensive technologies; popular demand for new technology; and insurers willing to reimburse for most technology once it is approved by the U.S. Food and Drug Administration (FDA). Relman’s message was that many -- investors, technology companies, scientists, physicians, health care facilities and the FDA -- are culpable for creating the world's most expensive system that fails to provide care for 50 million of its citizens.

He told the AAPM audience that the most expensive physics-based technology, proton beam therapy, is commonly used as a treatment for some conditions such as prostate cancer when other less expensive therapies may be just as effective. 

If you don't believe the U.S. healthcare system is in free fall and needs overhauling then Relman advises: “talk to the 'green-shaded' economists at the Congressional Budget Office" and other economists who are predicting a collapse of the healthcare system.  

Strategies for reform 

The medical community should enact reforms that ensure the continued introduction and availability of worthwhile new technology, while curtailing procedures that cannot be justified. Diagnostic and surgical procedures should not be left solely to physician discretion; the FDA should take a more active role in regulating the adoption and use of diagnostic and surgical procedures, Relman said. 

Views similar to Relman's are being voiced more openly as the United States nears a change in the White House and amid citizen demand for a change in priorities and policies. But neither Sen. Barack Obama nor Sen. John McCain is addressing the healthcare situation in a meaningful way in their presidential campaigns, according to Relman.  

"Both say they want to achieve near universal healthcare coverage, either government-aided versus market-focused," but neither plan indicates a method for controlling costs, Relman said.  

The economic incentive to overuse expensive medical technology even when its advantages are unproven or marginal should be removed, said Relman. 

AAPM President Gerald White Jr., a medical physicist in practice in Colorado Springs, CO, said he invited Relman to speak at the presidential address to spur discussion among his organization’s members.  

White acknowledged that the topics raised by Relman may have caused attendees some "dissonance," but he hoped it also leads to some "cognizance."

Relman was surrounded by supporters after giving his presentation, “Technology and the crisis in the U.S. Health Care System,” to the American Association of Physicists in Medicine July 28 in Houston.