Within the world of finance, people and organizations can make very bad bets and invest huge sums of money in very bad investments. Look at the 2008 housing bubble collapse. Massive sums of money went into building homes for people who could not afford them. Certain very astute investors saw the mismatch and placed bets against where most of the money was going. As the movie "The Big Short" showed, they were viewed initially as crazy and then as visionary. They ultimately served an important function in redirecting investment away from poor investments.
Within health care, we are also investing huge sums of money into a variety of investments. I am not talking about specific stocks or equipment but instead I am referring to our investments of specific clinical care delivery activities with the idea that these investments will result in better health returns for individual patients. For example, does the investment of time, money, and effort on every patient over age 50 years of age getting an annual physical have any real tangible return on this investment? If not, why is this investment of resources not like buying penny stocks? My question is, how can I short the annual physical?
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I took a poll this past year at a journal club among about 10 of my colleagues and only one, a pathologist, said they get an annual physical. The annual physical for healthy individuals that is enshrined and paid for by virtually all insurance companies and even Medicare--even when some essential treatments may be denied--is another example of the Potemkin village that health care is becoming. Creating the illusion of caring for patients becomes more important than actual treatment. This is reflected in the new marketing slogan that has been adopted in several variations by different academic medical centers: "Everything we do is all for you." It is ironic that on my drive to work that in addition to our billboards there are several billboard advertisements for a casino that use the same slogan.
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