Sunday, May 7, 2017

Health Care Costs - A Reblog from Nonfiction Book by Warren William Luce

This is a reblog for Health Care Costs
Since there is so much discussion about this topic
right now, I thought there might be a need for
some statistics and information on the subject 
from a non-fiction book by Warren William Luce.
His common sense and efficient approach to "tough"
subjects, according to some, is exactly what I needed to
understand and determine my own position on the matter.
It may help you as well...

Consider as you read, The need for reduction of per capita costs Versus the need for a nation-wide plan while ignoring the continuing rise of medical procedures and medications...

Used by Permission


The other major budget buster besides the military industrial complex and intelligence is health care costs. The Affordable Care Act was intended to provide health care to all citizens. Prior to its enactment, there were about forty million Americans without health insurance. At the end of the first year, less than seven million were signed up for insurance. That is far from achieving its purpose. There are both good and bad provisions to the act. The claim that it will lower health costs is very questionable. Premium increases are rising significantly and taxpayers are going to be billed for subsidies to those who can't afford insurance and tax credits to the middle class income earners and businesses.

It's not a good act, and rather than working together to fix the problems, congressional members played the blame game, trying to affix all the fault to the administration to gain political advantage. There was plenty of blame to go around including the insurance companies, but the primary criticism needed to be directed at Congress. There is that old adage, the administration proposes, and Congress disposes. Congress makes the laws; the administration enforces them. Costs will increase due to extensive free screening care costs billed by the insurance companies, subsidies to those who can't afford insurance and tax credits to the middle class income earners and businesses.
We're spending $3.3 trillion every year on health care or almost $10,000 peer capita. With average life expectancy at 78.3 years, we rank 36th in the world. Almost every country ranking higher spends half or less per capita that we do. Most have health care systems that are on par with ours. Japan, ranking first with a life expectancy four years greater than ours, spends about a third of what we do per capita.
Obviously, there is something drastically wrong with our health care system. If other countries can provide good health care at $4,000 per capita or less, so can we and should. We can save $1.45 trillion every year in health care costs when we correct the flaws in our system. The individual, businesses, the insurance companies, and the government (taxpayers) will all benefit.

So, why are our health care costs twice as high as they should be? The Institute of Medicine reports that the health-care systems wastes $750 billion every year with millions of unnecessary and expensive tests, inefficient delivery of care, excessive administrative costs, inflated prices, and fraud. The Arizona Daily Star reported that about one third of the health care that is provided is not needed and does nothing to benefit the health of the patient. That's almost a trillion dollars spent unnecessarily every year. Medicare and Medicaid constitute about 40% of the health care costs, which means that we could save the government (taxpayers) almost $400 billion every year.

The ACA does nothing to address that enormous waste but rather increases it. The Act requires that insurance plans cover preventive immunizations, and free other basic services. How naive can you get? There is no such thing as free medical care. You will pay as the insurance companies raise premiums. Medicare and Medicaid costs will go up as the taxpayers are billed by insurance companies for those "free services."

"Preventive healthcare services" as the way of screening for early detection are a major factor in the unnecessary care provided. They're incredibly expensive. About 13% of American women will get breast cancer. That means 87% will not, yet they will be tested for it. Of those, tests often produce false positive results, which require more expensive testing and sometimes invasive procedures.

Applying that concept to the many other diseases means that a vast majority of healthy Americans will be tested for diseases they don't have. We're talking about hundreds of millions of unnecessary tests. It doesn't take a math genius to understand the immense costs that will be incurred. The concept of screening, preventive healthcare services if badly flawed. It's especially egregious as we know how to actually prevent disease. Screening is okay where special circumstances exist such as a family history of a disease. Yes, preventive screening will save lives, but many, many more will be saved when we focus on keeping people from getting sick, which we know how to do but give it little attention. We'll look at this in more detail a bit later...

Tens of millions of unnecessary medical tests are given to people during checkups and routine visits to the doctor and hospitals. Millions of older women don't need a bone-density scan for osteoporosis as often as it's done. Women under 65 do not need bone scans at all unless certain risk factors are involved. Pelvic exams are often a waste of time and money, and sometimes do more harm than good. When they show false alarms, they can lead to unneeded follow-up care... Cancer screening is greatly overused. Mammograms are given too early or too often, and prostate cancer tests are in the same category. Expensive annual EKGs and other cardiac screenings are unnecessarily given to patients who have no heart heart disease symptoms or family history of it. Also, Cholesterol testing and pap smears are prescribed entirely too often. The Annals of Internal Medicine lists 37 scenarios where testing is overused.

Costs are often incurred in testing because of drugs that have been prescribed. Many drugs have serious side effects, so continuous testing is done to check on the condition of the body and its organs. Law requires that one must visit a doctor to refill any prescription over a year old, which often requires extensive testing to determine any adverse effect of the prescription drug. The visit to the doctor and testing happen millions of times each year, contributing unnecessarily to health care costs.

Testing of children as eary as eight years of age for cholesterol and feeding them statins to control the cholesterol is outrageous. About a third of American children are obese or overweight, and it's estimated that 10-13% have high cholesterol. The medical experts proposing the testing said not one word about the cause of the high cholesterol, which generally is diet. That is the problem that needs to be corrected. Treat the cause, not the disease. Statins suh as Lipitor and Zocor have many side effects such as diarrhea, joint pain, memory loss, liver problems, and each kidney failure. Do you want your children subjected to that?

The use of statins by the medical professionals to manage cholesterol is out of control and extremely costly. Thirty-three million Americans are on statins when the vast majority of them don't need to be. Statins have become convenient pills that do work while allowing patients to continue their lifestyles that are health risks. High cholesterol levels are caused by liver dysfunction brought about, for the most part, by lifestyle of poor food choices, being overweight, and lack of exercise along with smoking, too much alcohol, or stress.

Although periodic tests are no longer required to test for liver damage caused by statins, liver enzymes must be checked one time prior to initiating the drug or in the event the patient displays any symptoms of possible liver enzyme elevation/failure such as unexplained nausea or loss of appetite, yellowing of skin or whites of the eyes (Jaundice) and severe lethargy or abdominal pain. Given the numerous side effects of statin drugs, you can be sure a great deal of testing is going to occur.

Most people can generally get their cholesterol levels back to normal by getting plenty of exercise, eating plenty of fruits, vegetables, whole grains, oats, good quality fats, avoiding foods with saturated fats, getting adequate sleep, bringing bodyweight back to normal, avoiding excessive alcohol, and stopping smoking. Additionally, this healthy diet will have numerous other health benefits.

Another serious problem in prescribing of statin drugs is that there is massive conflicts of interest in the medical profession. We have a situation where 2/3 of medical research is sponsored by pharmaceutical companies with many doctors receiving money from pharmaceutical companies. Steven Nissen, cardiologist at Cleveland Clinic, suggests that a new risk calculator from the American Heart Association may drastically overestimate the number of people who should be taking cholesterol lowering statins such as Lipitor and Crestor.

Doctors and hospitals prescribe extensive testing that provides no benefit to the health of the patient but to protect themselves from law suits. Tens of millions of unnecessary tests are prescribed every year by the doctors and hospitals as "defensive medicine." Tort reform is badly needed not only to protect the medical care givers but also to cap the exorbitant monetary awards often given by juries that want to sock it to what they think of as the "deep pockets" insurance companies. Caps are needed on the plaintiff attorney costs, which is usually around 30% contrived fees plus a big chunk of the settlement, often leaving small amounts for the victim of the medical malpractice.

Most doctors are dedicated and honest. But, there is a faction that prescribes testing that increases their income through their vested interest in the testing facilities. Medicare and Medicaid frauds by individuals, doctors, clinics and hospitals amount to $60 billion every year. More intense efforts by HHS and DOJ are required to reduce this.

Prescription drugs account for about 10% or $290 billion of healthcare costs each year. Drug prices in U.S. are the highest in the world and rising significantly faster than the rate of inflation. Pharmaceutical is the highest profit sector in the U.S. The drug companies claim they need to charge high prices to fund their research and development of new drugs, which will benefit the health of people worldwide. The fact is that only 14% of their expenditures involved R&D with much greater amounts going to administration especially marketing. The industry spends $300 million every year lobbying the government to give them special dispensation such as limits and controls on generic drugs, which are just as effective but cost only a fraction of their products.

Prescriptions drugs are widely and often unnecessarily used. According to a study by Harvard Medical School's Dr. Steffi Woolhandler and colleagues, about "25 percent of all Americans 65 or older are given prescriptions for drugs that they should almost never take: drugs that produce amnesia and confusion, and others that cause serious side effects like heart problems or respiratory failure." Rx drugs can often be more harmful than beneficial. A University of Toronto study reported that "bad reactions to prescription drugs were from toxic reactions to medications and two million suffering from serious side effects."

We have developed a culture that is entirely too dependent on the medical field for our health care. We run to the doctor or clinic for all kinds of ailments such as headaches, backaches, stomachaches, earaches, colds, flu, minor pains, indigestion, and depression to name a few. Most of those will eventually go away or can be taken care of by us. Our fairly recent ancestors were a hardy bunch that adhered to that philosophy. Now, we seem to have become wimps when it comes to taking care of our own health.

So, how do we eliminate this one third of health care given that does nothing to benefit the health of the patient? First, everyone needs to be aware of this problem and its serious effect on health care costs. There has been very little discussion of it perhaps because we like the status quo. Everyone is making bundles of money, and the patient is getting his and her health problem taken care of--failing to realize that it unnecessarily costs the government (taxpayers) enormous sums of money and increases the deficit and our national debt.

This enormous waste, estimated at one trillion dollars every year, is not being seriously addressed. Rather, other questionable cost reduction methods are being proposed such as replacing Medicare with a voucher system, reducing the amount of payments to healthcare providers (a bad idea as some providers, especially hospitals, are already struggling with their costs versus payments, having to take care of the indigent without payment, and doctors refusing to accept Medicare and even leaving their practice), increasing cost to individuals and raising the age eligibility. None of these is necessary when the better and much more cost effective way is to purge the wasteful spending on those unnecessary procedures. Everyone, which are the patient, doctors, politicians, hospitals, insurance companies, the pharmaceutical industry, and government, must do their part responsibly with integrity. By eliminating that unnecessary care, profits will decrease. But that's okay because a reasonable profit will still be made.

The good news is that elimination of that unnecessary one third of the care will not cost jobs. There is plenty of illness and disease to keep everyone in the medical field busy. Thousands are dying of AIDS. A million people are dying every year from heart disease and 600,000 from cancer in the US. Diabetes and arthritis affect a large percentage of the population and are on the rise. 75% of the elderly population has arthritis to some degree. Asthma is plaguing the younger generation. 75 million people suffer from allergies. Depression, high blood pressure, and obesity are rampant in our society. And 20 million surgeries are performed each year in the US.

There is another aspect of the enormous cost of health care that needs to be addressed. A preponderance of the costs is the result of irresponsibility primarily due to the patients' harmful lifestyle of irresponsibility involving lousy diets, lack of exercise, drug abuse, and smoking. And those are the leading causes of obesity, heart disease, cancer, diabetes, and other illnesses that plague us. Unprotected sex result in sexually transmitted diseases (AIDS is extremely costly to treat), and having children without the ability to care for them are both very expensive. The care needed for those without the means to pay constitutes a huge health care cost to the government (taxpayers).

The problem is that we have gone down the wrong road when it comes to health care, the road of cure! Get the disease, and we will cure you with the scalpel and drugs. Or we'll spend billions on research for a pill you can pop to cure or control the disease and still let you go on with your debilitating lifestyle. Research is good, but too much money is being expended there when it should go to promoting prevention, not preventive services. We know how to actually prevent disease.

According to the National Research Council, "at least eighty percent of cancers are caused by identifiable factors that can be controlled. Thirty percent are attributed to tobacco, but an even great number--thirty-five to sixty percent--are caused by dietary factors." Just think. We have the complete ability to prevent 80% of those 600,000 cancer deaths and eliminate the huge costs that are incurred. But little effort is made to do so. The primary effort is to cure by means of the scalpel, chemotherapy, and radiation.

Heart disease claims almost one million lives every year in this country. We know how to prevent almost every one of those deaths and do away again with the immense costs that are involved. Doctor Dean Ornish has scientifically proven that diet and lifestyle not only prevent heart attacks but can actually reverse the clogging of the arteries. Dr. William Roberts, Editor in Chief of the American Journal of Cardiology, says, "Dr. Ornish is on the right road and we need to get on it also." Why isn't the medical establishment getting on with the non-surgical program for preventing and reversing heart disease as Dr. Roberts suggested? The use of bypass surgery, angioplasty, and drug treatment for heart disease is a $15 billion-a-year business in this country, which undoubtedly has a lot to do with it!

Preventing disease is no secret. It does receive attention but, unfortunately, many people just don't care to educate themselves about disease prevention or they ignore the advise given by their doctors on how to do so. What is needed is a massive education effort by the medical community and the government and even the schools and parents to move from cure to prevention. We need a new paradigm of health care where the individual takes primary responsibility for their own health care; thus, each of us becomes our own primary care provider. The doctor will be secondary.

We must change our lifestyle if we want to enjoy good health and keep it that way. We're eating the wrong kinds of foods in large quantity. In the 1970s, the experts on weight control got it all wrong, claiming there was too much fat in our diets and putting America on a low fat diet. Fatty meats, eggs, and all dairy products were the culprits. We needed to consume less of them and more carbohydrates. As a result, all kinds of flour products, potatoes, rice and sugar started to dominate our diets. Unfortunately, they're the wrong kind of carbs. They are all very high in starch, which is the real culprit in weight gain as well clogging our arteries and contributing to poor health...

Mother was right. We need to eat our fruits and veggies, the good carbs. We don't have to give up all the breads we love, potatoes au gratin, rice pilaf, pizza, pasta, or cut out all sweets. It's okay to have a donut day once in a while. But as they are a major part of our diets, we need to reduce their use rather sharply. Meats, eggs, and dairy products are good for you but in moderation, and of course, eat more fruits and vegetables. Experts say we need five helpings of fruits and vegetables daily. Try that, and you will soon get sick and tired of them. Try smoothies two or three times a week. You can blend eight or ten different fruits with a bit of water to give it the right consistency. Using fruit juices improves the taste, but you need to be cautious about bottled juices that contain added sugar. Use vegetable smoothies as well. Let's be honest. They aren't "delicious" but good tasting ones can be prepared. Add a variety of nuts and seeds to both smoothies like almonds, pecans walnuts, sunflower seed and flax seeds that are packed with health giving nutrients. You can use water or pure vegetable and fruit juice for the right consistency. Use one of the high-powered blenders that are available since they break down the fruits, vegetables, and nuts for better digestion and nutrient absorption...(the rest of the chapter continues with advice and thoughts on good nutrition, toxins, etc.)


There is one more factor that's perhaps the most important, and that is our attitude about our health, how we think about our health...Actually, the length of our lives is not too important. We're all going to die sooner or later. It's the quality of life that is important... And as a result you'll save yourselves and other taxpayers a hell of a lot of money helping to reduce our annual deficits by $350 million.
~~~

I wanted to share a little more of this chapter. Note that the author is not a medical doctor; however, it is clear that he has done much research and/or experienced what he is now talking about...

The way it was presented was, I thought, the most important part of his words...Readers have an opportunity to read this overview and think about how it affects their own lives. If something is major for you, you can then pursue the topic further.

For me, I was shocked that the US is so far down on the list of adequate health care at a per capita cost. It made me sit up and consider this in my own life. I am not happy with the split off of having a GP who only works to refer you to specialists, who then spend a few minutes with you, never really allowing you to talk about what you'd like to discuss...
Then there are the tests... Recently I had a mammogram that didn't come out clear...I had two more, the last with the new super-duper equipment, and only got a notice that my results show density (which I already knew)...So when my doctor's office was going to set up the next one. I declined.
I also declined on a colonoscopy... If I get to a point where I am having problems, then, in my opinion, is when to seek further assistance...
I won't even go into the billing headaches I've had when my doctor's office was merged into a central billing office!
I know for a fact that the process is inefficient, the staff is poorly trained and have no idea of the overall financial flow of payments...
From this chapter, I learned that I had to take responsibility for myself and I have started to act accordingly...
Why are we fighting over a plan if we aren't able to made the changes about lowering per capita costs within America...that, to me, seems the major problem...NOT whether we have a nation-wide plan...