Hospitals should spend more on care, less on ads

Commentary. By Michael Greenberg, MD, amednews contributor. Jan. 24, 2000.

COMMENTARY

Observations on the state of medical practice and medical life

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A fierce Chicago wind buffeted the late afternoon shoppers as they played dodge-em with the grocery carts abandoned in the parking lot. A well-dressed woman stood by the supermarket door, a can in her hand. She politely requested a donation for a local hospital.

"No, thank you," I said.

My wife, Geri, stopped dead in her tracks. "It's a legitimate charity," she said. "Give her something, Michael." I continued toward the door, ignoring them both.

The woman launched her secondary salvo. "The donations are for a new children's wing."

Geri, a school social worker with a soft spot for needy kids, was confused by my response. Charity is important to our family. I collect cloth poppies made by veterans (despite their ironic symbolism to the drug problems that plague so many), rolls of sticky hard candy, boxes of Girl Scout cookies and paper tags of every color and shape. And I don't just flip quarters into the cans placed in my open car window at red lights during rush hour. If the charity is worthy, I give $10 or $20.

"No thank you," I repeated. "Tell the hospital administrators that sent you out to stop squandering millions of dollars on advertising so nice people like you won't have to beg."

She gazed at me as if I had just arrived from Pluto. But I felt the good feeling one gets after having spoken the truth. "Ad campaign?" she asked, genuinely confused.

"Don't you watch television or listen to radio?" I asked. "Or read the local newspapers? They're loaded with hospital commercials and advertisements. Do you know how many people could be treated if those fat media budgets were spent on actual health care? And you can also tell them I think the commercials are insulting and the actors are dreadful."

Advertisements for hospitals and insurance companies are chock-full of the Madison Avenue buzzwords the public wants to hear. Good-looking, white-coated actors promise Americans' world-class health and, worse than that, tell them they can have it without cost, red tape or paperwork. The public is guaranteed that brilliant, compassionate physicians will listen to them and solve their medical problems (even as those same insurers and their managed care plans push their doctors to spend less time with patients and do less for them).

As a physician, I'm embarrassed by and angered by the many hospitals and insurance companies that compete with sleazy lawyers for prime advertising space. I pass three billboards touting the glories of insurance companies on my 20-minute ride to work. During my daily one-hour Stairmaster climb, I am subjected to a dozen television spots for managed care plans and hospitals. I am embarrassed by the content of the ads and angry that so much money is being so foolishly wasted.

It could be argued that advertising is necessary to inform the public of their health care options. And the money spent is only a small fraction of the entire health care budget. So why get so upset? For one thing, the ads -- as they are supposed to do -- don't inform, but seduce. Even then, it's a mostly empty gesture. Many employers choose the health plans their companies offer based on hard numbers; the employees rarely have much input. And in the case of hospitals, does anyone really not know what hospitals are in the community?

My greatest objection to the ads is that they represent the most visible but hardly unique expression of this nation's muddled priorities when it comes to health care spending. They drain money from the system just as surely as the ever-expanding bureaucracies of the government and insurance companies do. And no matter how small a percentage of the total health care budget, it's money that won't be spent on patient care.

The government and insurers say they want to make sure that every health care dollar is spent on actual care. They tell the American public that waste and fraud must be eliminated. I agree. Let's start with the most visible waste -- those ads. Or at least let's insist that they be required to include a disclaimer: "Warning. The cost of this advertisement is being paid for by dollars that are being diverted from your medical care."

Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/). You can contact him by email (offped@aol.com).