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The Rising Costs of Health Care Explained |
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I have been a doctor for 50 years. I am a just retired Prof of Medicine from UCLA. I have created a non-profit 501c3 corporation No More Medicines, Inc. We have a website, nomoremedicines.com. Our mission is to reveal and explain the reasons for skyrocketing healthcare costs, so that some sort of realistic corrective actions can be taken. Okay I admit, that’s a very tall order.
The National Debt has reached $11 trillion with no upper limit in sight. One driver of this is ever rising health care costs. In fact, the real National Debt, including unfunded (and unfundable) health care obligations for the soon to be retiring baby boomers is $56 trillion. (Google PGPF for a more detailed discussion of the national debt crisis.)
When I started in Medicine there were few meds for high blood pressure and cholesterol, and type 2 diabetes was called “maturity onset diabetes” because we only saw it in patients >50 years old. The American diet and Big Pharma have changed all that. When I started in Medicine, McDonalds was new, a hamburger was 25 cents and you could hold it in one hand. Fries were 15 cents. “Supersize Me” had not been invented yet. Most people still ate “slow” food. You could only eat Pizza if/when you visited Rome. In 2009, the newest McDonald’s offering is a burger with 4 patties - one for each chamber of your heart! Kid’s meals at many restaurants meet or exceed 1000 calories. Baskin Robbins’s Large Heath Bar Shake has 2310 calories, 266 g sugar and 108 gm fat. You know what they call that Heath Bar Shake? Your Last Meal!
In the last 50 years the rise of the fast food industry, the appearance of huge grocery stores selling large amounts of prepared foods (so working moms can feed their families), and the upward creep of serving sizes at all restaurants (a favorite marketing ploy is “all you can eat”) has “fueled” (pardon the pun) the pandemic of diabesity. There are now teens with diabetes who will be on kidney dialysis in their 30s. There are now children with “diabesity” who will need dialysis in their teens. Life expectancy on dialysis is only a few years. There are not nearly enough dialysis centers to meet the demand now. Transplantation is an option for only a lucky few. Transplantation causes you to be sick in a different way. The cost of your care goes down very little. Sadly most patients reject the transplanted organ and end up back on dialysis.
Heart disease risk factors are showing up at earlier ages. Pediatricians are now recommending “statins” for 8 year olds and up who have high cholesterol. There are a lot more of those kids than you would imagine. The average teenager has pre-hypertension (120/80 – 140/90). Unless you get health religion, pre-hypertension always progresses to the real thing. This “echo boomer” generation will not live as long as their parents.
David Walker (former head of the GAO) has been on a nationwide tour crying “Hey you guys, the sky really is falling!” The US can not afford providing all the needed Health Care for old people and poor people right now. Nor can we afford Health Care that the government is obligated to provide over the next 20 years. Medicare and Medicaid seemed like a good idea back in the 60’’s when “diabesity” had not been discovered yet. And when there were a lot fewer sick old people qualifying for the latest and most expensive medical therapies.
Here is the explanation our budgetary woes. We have this whole new way of practicing medicine, involving decades of regular MD visits for expensive but relatively ineffective preventive measures (red pills, blue pills, green pills and more pills) followed by years to decades of high tech, ruinously expensive rescue care with a cadre of specialists. So how in the world did we get into this mess?
- Almost everyone gets high blood pressure. Defined as >140/90, 90% of Americans get there before they die. Defined as >120/80 (the newest cut-off) it is close to 100%. Most of those folks have high cholesterol and many have diabetes too. This combo is called the Metabolic Syndrome. You do not want to end up in a nursing home with the Metabolic Syndrome: bed sores, blindness, amputations, heart, lung and kidney failure. Most feared of all: “losing it” upstairs… senile dementia.
- As a consequence, 10s of millions of Americans, starting in their 20s, 30s and 40s are going to their doctor regularly, not because they are sick yet, but because they have various “risk factors” for getting sick. They have to get stuck for blood tests and stand in line to fill several very expensive prescriptions which health “insurance” may or may not pay for – every 6 months for the rest of their lives. Unless… we’ll talk about that in a minute.
- The same unhealthy diets and lifestyles that cause the above problems can lead to insomnia, anxiety, restless legs, heartburn, ED, ADD, IBS, etc. That adds many more doctor visits. To encourage everyone to visit their doctors regularly, there are DTC ads on TV explaining which pills to take for which symptoms. These ads always end with “Ask your doctor….”. Marketing works. Lipitor (one of 6 statins) annual sales are $12 billion. “Soap operas” got their name because all their ads were for Tide, Rinso and Cheer, etc. Now these daytime serial dramas should all be called “prescription drug operas.” Check it out, I did. You’ll be amazed. My new nickname for Big Pharma is “the Somali Pirates of the Health Care Industry.
- The staggering and ever rising costs of taking care of all these folks has made health insurance unaffordable not just to 50 million Americans but to most employers and even States as well. Health insurance for Americans is unaffordable for the same reason that flood insurance is unaffordable in New Orleans and hurricane insurance is unaffordable in Jamaica and the Florida Keys. Too many people need to use it too often.
- If we took as poor care of our cars as we do our bodies, auto insurance would be unaffordable too. People want “pre-existing conditions” to be covered by newly purchased health insurance. Do you think you could buy fire insurance from State Farm if the fire engines were already on the way to your house? Duh! (That’s not “insurance”. That’s “you’re good friends with the president of State Farm” if you can pull that one off.)
- Despite taking multiple pills for multiple risk factors and symptoms, most Americans end up admitted to the hospital in their 50’s, 60’s and 70’s with all the same problems the pills were supposed to prevent. Now they can qualify for rescue care. Rescue care in 2009 is really expensive!
- Prime example: Bill Clinton, who has had health insurance and the best doctors, ended up having a heart attack before he turned 60. What do you think his urgent coronary artery by-pass surgery and hospital stay cost the taxpayers? Tim Russert (Meet the Press) died at age 58 despite all his pills and regular “good doctoring”. By dying suddenly at work he saved his insurance company a bundle.
- The latest, high tech rescue care appears frequently on the nightly news. Docs can clean out heart arteries by manipulating robot arms via closed circuit TV from another city! You’re too ugly, you can get a face transplant! The newest/highest tech rescue care: stem cell implants. Bush is out, Obama’s in, and it’s a new day for all those unwanted fertilized eggs. As shown on ABC World News recently, scientists have destroyed all the muscle in a rat’s heart, and then replaced all the muscle with stem cells, causing the rat heart to start beating again normally. (That is indeed good news for ex-Vice President Dick Cheney.)
- Bottom line: decades of regular “preventive medical care” leading to years of “rescue medical care” is “catapulting” us into bankruptcy. David Walker has stated that the Medicare Problem is 5x worse than the Social Security problem and will explode in our faces decades sooner. The date he has projected is 2018. The Medicare Part D (drug benefit) brings the date a year or two sooner. That will certainly bring the troops home from Iraq.
- It gets worse. Many doctors don’t accept new Medicare, Medicaid and SCHIP patients because the reimbursement rate is too low. (I still find it hard to believe that doctors would refuse to care for old people and poor people and kids because of money issues, but that is our brave new world in 2009.) The proposed new health insurance for the 50 million poor and uninsured is not likely to pay any more generously than Medicare. Well I guess poor people could always catch a slow boat with Michael Moore to Cuba, where doctors are good and healthcare is free. The line starts in Atlanta.
What’s to be done? We have to get the food industry to help us out. For starters, every place that sells prepared food (both restaurants and deli’s) must have Heart Healthy® items identified. Let’s eliminate all trans-fats in the food supply, an idea whose time has come. (The only safe use of trans-fats is to wax the floors!) Let’s ban “all you can eat”, one of the worst ideas the food industry ever came up with. Put a weight limit on people who can be admitted to restaurants and grocery stores. (embed scales in the floor at all entrances) No ordering fast food by phone unless you have been certified by your doctor. Charge care-givers who continue to feed people who are too obese to get out of bed with felonious life endangerment. Close the drive by windows at all fast food restaurants. Come on now, that’s a no-brainer! Once you’ve gotten out of your car, gone inside and placed your order, you can’t get your food until you (and everyone in the car) have walked around the block at least two times. You all will wear GPS bracelets to monitor compliance.
So what do we do if they say no? The tree hugging earth-firsters who go around smashing new Hummers on car lots might be convinced that near universal diabesity will ruin the planet and kill us all sooner than global warming. They could go from city to city, picketing all the non-compliant grocers and restaurants. By picketing I mean you the public don’t cross the line to go inside. Or they could slip something loathsome into the feed of the entire nation’s livestock. Hey, we’d end up with a bunch of skinny cows and pigs, and everybody in the country with lower cholesterol. That would work! Burning down most of the big grocery stores only contributes to global warming which will piss off Al Gore, so we don’t want to do that. But it’s tempting.
You understand? We are a nation in trouble, big trouble. Procrastination is not an option. Desperate times require desperate measures. (Ok, insert your own favorite “doomsday” cliché here.) You have some ideas, write your Congress person. Email the Mayor. Twitter the Governor. Make a video that gets on YouTube. We are all in this mess together and there are not nearly enough lifeboats. Maybe Paris Hilton could be our spokesperson. Hey, she’s skinny, and if she’s good enough for John McCain, she’s good enough for me. We need constant press constantly, and not necessarily all good.
There are just too many teens walking around schools now-a-days, with needles that are not for crack or smack, but for their twice daily insulin shots.
What we are doing right now to handle the Health Care Crisis in America is akin to putting a band aid on a recent decapitation.
Cleaves M. Bennett MD FACP
I haven’t the knowledge to comment on much of this article, though I would hazard that many Americans could indeed be much healthier if they were eating healthier.
I do, however, know enough about restless legs syndrome to know that it is not caused by bad eating habits or lifestyles. In at least 50% of cases, it’s genetic. I grew up eating exceptionally healthily and had RLS as a pre-teen. As does my mother, grandmother, uncles, etc.
The other 50% who tend to get RLS are often people with celiac, kidney failure, and who are pregnant. Um, definitely not all things caused by unhealthy lifestyles! A portion of the 50% who do not appear to have a genetic link also don’t appear to have any other known cause. These people have nothing in common - including a poor diet or a healthy diet. Some find that they are low in iron, ferritin, magnesium, or B12. Others? They are fine. They just have RLS.
RLS is not new, it wasn’t created by big pharma, and it’s definitely not caused by an unhealthy lifestyle. Oh, and the latest research? Seems to show that at least some of those ADD and ADHS cases are potentially kids with RLS. Again, not a dietary issue.
I’m not sure why you chose to lump RLS in here. I hope that you choose to find out more about it and learn that it’s not at all related to an unhealthy lifestyle in the vast majority of cases, if ever.
An explanation of why I added %u201CRestless legs syndrome%u201D to the list of lifestyle related problems. This is a new medical diagnosis. In the Encyclopedia Britannica Medical and Health Annual the term does not appear in the 1994 edition. In the Textbook of Primary Care Medicine, 1996 edition (a 2000 page comprehensive discussion of all known medical problems) there is no mention of restless legs syndrome. In Harrison%u2019s Textbook of Medicine most recent edition it states that restless legs syndrome is of unknown etiology (cause) but it is worsened by stress. My own educated guess is that without the stress RLS would be very rare. Like many conditions there appears to be a genetic component although that could be psychological factors common to everyone in the family. It is worse at night and often interferes with falling asleep. Multitasking often follows people, especially women into the bedroom. RLS is thought by some to be associated with deficiency of dopamine, the feel good brain chemical we all love so much. There is every reason to believe that low dopamine in most people is related to lifestyle. The drugs to treat RLS increase dopamine. My simplistic explanation for RLS is: if you have been multitasking all day long and it is time to go to bed, your body is still ready to fight or flee. You lie there with your legs and nervous system still in flight of flee mode.. You can take a pill or learn to turn off your emergency nervous system. One docs opinion.
Diabesity? It with us and has remained unchecked.How so? Food science seems to be reluctant to admit failure and to place blame on the designers of the infamous US Pyramid food guide, the Canadian Rainbow guide and worldwide copies.
Hart Oldenburg, the author of Hart Smart Living and hartsmartliving.com which contains the obesity solution in “Living Smart”.
I also own thehalfportionplace.com web site.
I have 25 unpublished articles–food and life— which are looking for publication.
The master title, my newly issued word: Carbohydritis, the root cause of obesity explained.
Best regards———- Hart Oldenburg————-
with 70 million baby boomers graduating into the roles at social security and off the work roles, most ill prepared and all on Medicare coupled with the fact that it will be next year that Social Security goes negative, we are living on fiscally borrowed time.
Real Healthcare Reform:
Changing Priorities, Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One
If you have the financial resources of Bill Gates or Warren Buffett you needn%u2019t pay money to a health plan each month, since if you get sick or injured %u2013 even very seriously - you have more than enough money to pay all your medical bills yourself.
But those of us who have significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.
Enter the concept of %u201Chealth insurance%u201D.
Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a %u201Chealth plan%u201D. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason %u2013 if they have put more money into the pot than was taken out to pay all their medical expenses - wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.
Many Americans covered by some form of health insurance don%u2019t seem to fully understand or perhaps choose to ignore the fact that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Keeping members of a health plan healthy by preventing illness and injury is critically important, but is something not currently given the high priority and attention it deserves.
Some Americans believe that healthcare should become a %u201Cright%u201D of every American citizen. If a nationalized single payer health plan were enacted, every American citizen who became ill or injured - for any reason whatsoever - and incurred significant medical expenses would for the most part have his or her medical bills paid by U.S. taxpayers. Many Americans oppose such a system for America recognizing that significant difficulties such as long waiting periods and rationing of care exist in such types of all inclusive government healthcare systems that currently operate in other countries such as Canada and the United Kingdom.
For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. %u201Clegitimate%u201D doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.
As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan%u2019s big pot from which %u201Ccovered%u201D healthcare expenses are paid. But also from this pot are paid all the health plan%u2019s administrative expenses including what may be big salaries and golden parachutes for CEO%u2019s and other %u201Chealthcare executives%u201D %u2013 individuals who may be paid to find technicalities of one sort or another in the health plan%u2019s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude %u201Cbad risks%u201D from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.
Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of both meeting the needs of health plan members and simultaneously develop the ability to keep costs under control, priorities, incentives, and the rules by which the game is played all must be changed.
The good news is that a lot of illnesses and many injuries are actually preventable. But how will prevention ever become a top medical priority when doctors, hospitals, and other providers get paid largely for diagnosing and treating illness and injury, not for preventing it?
Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our %u201Csickness and injury care system%u201D actually have no significant financial incentive whatsoever to spend any significant time and energy in genuinely promoting health and helping to prevent disease and injury.
Much to the contrary. Other than the actual members of a health plan %u2013 patients and potential patients - and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system - because of the way they are paid - have an enormous (if unspoken) financial incentive for massive amounts of disease and injury %u2013 much of which is preventable %u2013 to continue to occur in America. Strictly from a financial point of view, for those whose incomes come solely from the treatment %u2013 not the prevention - of illness and injury, the more illness and injury that occurs, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in an intensive care unit, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are %u201Ccovered%u201D by %u201Cgood insurance%u201D, i.e. health plans that are reliable bill payers.
This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals - although they are paid on a fee for service basis to care for illness and injury %u2013 who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.
It should also be recognized that some existing health plans %u2013 e.g. Kaiser and Group Health - combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone - including all the health plan%u2019s doctors - a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment. But unfortunately the above examples represent only a small part of the sickness and injury care system that currently exists throughout America.
For the most part - because of the way they are compensated %u2013 the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys - among others - depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.
Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game is the real task and challenge of %u201Chealthcare reform%u201D.
What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual%u2019s health and wellness. These healthy behaviors can all be confirmed by simple tests performed or ordered in a doctor%u2019s office. Why shouldn%u2019t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less in premiums to their health plan each month than those who don%u2019t?
To really reform healthcare we must find ways %u2013 through changes in incentives and the rules of the game - to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its associated cost. We must find ways for participants to be part of our %u201Chealthcare system%u201D and not just a part of our %u201Csickness and injury care system%u201D.
Significant changes in the rules of the game for our legal system %u2013 tort reform %u2013 is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.
Truly transforming our %u201Csickness and injury care system%u201D into a %u201Chealthcare system%u201D by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.
One significant part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record %u2013 a computerized medical record - that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.
I applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record - for every citizen who wants one %u2013 created by your doctor with your assistance, with proper security and safeguards - is something that our national government can and should do as a part of healthcare reform.
If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. And having an accurate electronic health record for an individual will also facilitate appropriate health promotion and disease and injury prevention for that individual. Like the telephone and the computer, someday we will all wonder how we ever got along without individual electronic health records.
But all this requires action, not just words. Now is the time for Americans and their leaders and doctors and other health professionals to step up to the plate and begin the process of transforming our %u201CAmerican Sickness and Injury Care System%u201D into an %u201CAmerican Healthcare System%u201D that is worthy of our great country.
Robert Westafer M.D.
Any post WWII child and there children and there children..were raised on sub-leathal food ‘product’? food..wonder bread? yea its a wonder they call it bread..velveeta cheese?..so the maggots know theres a lot of rotton meat out there..why not harvest that?..and indeed so you see the flys lay there egges..and harvest there chem dyne..children..ah the ‘humanity’ of it all.
This is a great article that offers attainable goals for re-evaluating our poor on-the-go eating habits. We as consumers must come together to lobby against the fast-food industry as a means for redesigning our dietary environment.
I accidentally hit a button, but you get my drift. We want a quick fix for everything and we aren’t willing to pay the price for what we have done to ourselves. Blame everyone else including the big bad evil insurance companies. Take responsibility America. Take better care of yourself and maybe healthcare will cost you less.
Apparently my first comment didn’t come through - but basically, I said…
I love you and I love your article. This is exactly what this country needs, but we are spoiled Americans who want what we want when we want it and no matter the cost…. to someone else. The crisis around our healthcare delivery system is real and it is very complicated, but the basis of it rests with each of us and our lifestyles. How many of the 50,000,000 uninsured smoke cigarettes, ( 1 pack per day at $5 is $150 per month) have an expensive car payment, drink too much alcohol, eat expensive pre-prepared meals and then say they can’t afford health insurance? It is choice and it is lifestyle that is the basis of our current crisis and our politicians don’t care anything about that. They care about “change”. Doesn’t matter if the change is good or better than current, but they promised change and that is what we will get. If you think health care is expensive now, just wait until it is free.
Nancy dear, you love me already? There is more to come———-Hart—–
A lot of anger here splashing on any target that happens by. Good points, but politically confused.
No question, we are, as a nation, fat addicts and out of control. But we were, as a nation, nicotine addicts and out of control just a generation ago.
How did we get a handle on that? It wasn’t by preaching a self-congratulatory creed of “personal responsibility” or making fun of “elitists” who and their “silly” ideas about second-hand smoke. We got a handle on smoking by making the anti-free-market move of prohibiting advertising of tobacco products and placing “no smoking” signs everywhere we could … in other words, through a coordinated set of public policies %u2013 government policies %u2013?designed to make smoking less cool and harder to do. Thank goodness all this got started before our politics took a turn to the right. Otherwise we’d be boo-hooing smoking deaths while making fun of the “elitists” who were actually trying to affect change and subsidizing the tobacco industry.
If we’re serious about obesity and the tax burden associated with this epidemic, we’re going to have to do much the same thing. We’re going to have to regulate fast food advertising and make it harder to buy and consume vast quantities of fat.
Simple (and at the moment politically impossible) as that.
Ron Says?: Another case of blatant misrepresenting cause and effect, anti-tobacco half-measures which have advanced obesity. It is common knowledge that cessation of smoking brings added appetite to the table. Never, during the campaign, were people urged to curtail their food intake to ward against weight gain.