Brenner Calls Health Care System Irrational

With the rollout of the Affordable Care Act, the issue of health care has taken center stage across the country. MacArthur Foundation Genius Grant recipient Dr. Jeff Brenner spoke with NJ Today Managing Editor Mike Schneider about health care and how it operates.

America is spending twice as much as any other country in the world on health care, Brenner claimed. He also said that he thinks the number one reason for bankruptcy in America is because of health care and the majority of the federal debt is related to health care.

Brenner practices medicine in Camden and said in that city, 1 percent of the patients are responsible for 30 percent of the cost and 5 percent of patients make up about half the cost.

“That basic ratio turns out to be true everywhere you look. If you look at a group of employees, if you look at the whole state of New Jersey, if you look at the whole country — a small percentage of patients often drive much of the utilization, much of the cost,” Brenner said. “The question we need to ask ourselves is are we taking great care of those patients or are we wasting money? And the answer that we found in Camden is that we are wasting a huge amount of money, not taking care of those patients.”

Brenner explained the patients that make up the highest costs are often success stories because advances in technology allow medical professionals to bring people back from conditions that would’ve been fatal in the past. He said the downside of the advances is the complexity. Sometimes a patient can have 10 different doctors coming in and out of a hospital room to assess and treat and none of the doctors speak to each other.

“You leave a hospital with a chicken scratch discharge summary. Maybe half the meds are wrong. We’ve created an incredibly complex system and we haven’t really caught up with that complexity,” Brenner said.

The health care system has just started to utilize computerized systems. Brenner said that even though doctors have the technology, that does not mean they are going to use it correctly or that it is definitely going to fix the delivery system. “There are much deeper problems in our health care system than are gonna just be fixed by electronic records,” he said.

Reimbursement rates have often been criticized by medical professionals who say the money they get from programs like Medicare and Medicaid and private insurance companies doesn’t cover their costs. Brenner said he chose to devote his life to providing family medicine in Camden. He had a private Medicaid practice that has since closed because of financial reasons. He explained that before he closed it, he was getting reimbursed $19 to $35 per visit, which isn’t a lot.

Brenner said in his observations, the problems within the health care industry aren’t caused by bad people, but are the product of a poorly designed system.

“I think it’s an irrational system that has misaligned incentives where it’s in everyone’s interest to do the wrong thing. And none of this is in your best interest or your family’s best interest,” Brenner said. “And at some point, we the public need to stand up and say we’ve had enough. … What I’m seeing around the country, state by state by state, is governors and legislators are beginning to stand up and say, ‘We’ve gotta rethink how this system works.'”

Brenner said officials shouldn’t wait for the federal government to fix the problems, adding that health care is highly regulated at the state level.

“We have the power in the state of New Jersey to stand up and say that we’ve had enough,” said Brenner.