Vincent Anku, M.D., knows all about fighting disease.
Anku, an oncologist at Southwest Community Health System and Hospital in Middleburg Heights, Ohio, has spent 20 years helping patients fight cancer. Now, he is turning his attention to another sickness: America's struggling and expensive healthcare system.
His new book, Health of the Nation, outlines what's wrong with the system,Physicians
how it got off track and what can be done to fix it. He said it shares a theme with an earlier work, his 1993 book What to Know About the Treatment of Cancer.
"The current system is a form of economic cancer," he said during an interview at his office at the hospital. "The longer it's allowed to exist in this form, the harder it's going to be to correct."
Contrary to some political rhetoric, there is a healthcare crisis, Anku said. It comes in the form of "excessive and unaffordable costs" that lead to a series of negative consequences, including slower job growth and the inability of many Americans to gain access to the healthcare system.
"You can't spend $1 trillion a year on healthcare, still have 37 million without insurance and not have a crisis," said Anku, a native of Ghana and a graduate of Cornell Medical School. "When I look at it carefully, I believe the U.S. still has the best system in the world. We have a system that will work if we fine-tune it."
The problems are basic but numerous. Anku contends the expense of healthcare has skyrocketed because patients aren't encouraged to cut costs, physicians order too many unnecessary procedures, and the country's litigious atmosphere adversely affects doctors' decisions.
"After a patient has paid the deductible, the perception is that someone else is paying for (medical care)," Anku said. "We have to have a system that acknowledges there's a value in encouraging everyone to be economical without compromising the quality of care."
Former HHS Secretary Louis W. Sullivan, M.D., who wrote a forward to Health of the Nation, said Anku's prescriptions for change "seek to preserve the advantages of a viable health system" by offering "economic incentives to control costs."
In the book, Anku advocates the use of controversial medical savings accounts. MSAs allow employees to set aside a portion of their income, before taxes, to be used to cover healthcare costs. If that money isn't used in a calendar year, the money can then go into a special savings account. MSAs typically have higher deductibles than traditional insurance plans.
Anku said MSAs would give Americans more control over their healthcare spending and enable them to build significant savings to cover future healthcare expenses. They also would reduce the anxiety that comes with losing a job-and one's health insurance coverage, he said.
"They represent a way to uncouple your insurance with your employment and.....allow consumers to save money that's now going toward profit for insurers," he said.
Not everyone is so enamored of MSAs.
Blue Cross and Blue Shield of Ohio, for example, adamantly opposes the idea. The Cleveland-based insurer argues that while MSAs are a windfall for those healthy and wealthy enough not to drain their accounts, they're potentially disastrous for the poor and the sick.
John Burry, chairman and chief executive of the Ohio Blues, called MSAs "the ultimate `cherry-picking' scheme invented by some insurers to guarantee themselves large profits by insuring only the healthiest among us."
But even a well-structured MSA plan wouldn't get the healthcare system off the critical list unless it were accompanied by other reforms, Anku said.
Doctors need an incentive to reduce the number of tests and procedures they run. That won't happen unless the legal system is reformed so physicians are convinced they need not take extraordinary-and in many cases, unnecessary-precautions to guard against lawsuits.
"Basically, all (doctors are) doing now is protecting themselves," Anku said. "The intimidation factor is what's really causing the problem. What happens is like a lottery for a few people to win big. For everyone else, it drives up the cost of healthcare."
Americans also must come to grips with choices in the difficult final days of life, he said. About 30% of medical costs come in a patient's last month, often when no amount of care will change the prognosis.
"We need to have a system that doesn't prolong life when it's detrimental to do so," he said. "That's why living wills are becoming so popular. It solves a significant part of this problem to have these issues resolved before an illness strikes."
Anku's a realist. He knows there are many voices in the healthcare debate and hopes Health of the Nation raises the level of debate.
"The hope is that when people have knowledge about a subject, they make better decisions and can clearly advocate for the system they want," he said. "And politicians listen to people."