Our Expensive Health Care System

The other day, I was reading an entry by Ronni Bennett in her blog posts in which she reviews an article entitled:  Bitter Pill: Why Medical Bills are Killing Us,  a report written by Steve Brill, the founder of Court TV and American Lawyer.  Shortly after reading her review of the article, I came across several other reviews of the same article.  I am very happy that this topic is beginning to be looked at.  I have written on the topic of expensive health care.

Although Ms.Bennett had some issues with Mr. Brill, she states:

Nevertheless, “Bitter Pill” is the best damned report about the sorry state of the U.S. Health care industry I’ve ever seen (and I read a LOT about health care).

What makes it so good is its clarity. It is filled with case and interview details, comparisons among costs, charges and profits, and written not for lawyers, doctors or policy wonks with the intention to obfuscate, but for you and me, the average reader.

Plus, it reads like a good novel in the sense that you can’t wait to get to the next paragraph, the next page. By the end, Brill shows what we old folks already know – that in health care delivery and in cost control, Medicare beats private coverage every time.

Brill’s conclusions about what to do to rein in health care costs appear to me to be weak but I want to spend more time considering them. What’s important, however, is that he gives us plenty of information to use as a basis for an honest, public conversation about how to change American health care.

Not that I’m holding my breath given the power of the medical industry lobby.

from the article, Ms. Bennett shares some interesting statistics.  According to Mr. Brill:

we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.

We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care.

Medicare pays $11.02 for a CBC [complete blood count] in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient…..But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61.” [which the hospital charges for the same test.]

In 2008, Gregory Demske, an assistant inspector general at the Department of Health and Human Services, told a Senate committee that ‘physicians routinely receive substantial compensation from medical-device companies through stock options, royalty agreements, consulting agreements, research grants and fellowships.’”

MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.”

”More than $280 billion will be spent this year on prescription drugs in the U.S. If we paid what other countries did for the same products, we would save about $94 billion a year.”

Ms. Bennett concludes:

Brill’s report reinforces more vividly what others before him have shown many times over – that what is wrong with our health care system is not Medicare, it’s the private sector.

When I googled Steve Brill’s article, there were pages and pages of respondents from around the United States.  Most seemed to support the contents of Mr. Brill’s article.  Although I have as yet to read it myself, I do look forward to it.   I quote Ms. Bennett’s response to the article because in reading her reflections on Mr. Brill’s article, they  reflected my concerns about our healthcare system.

© Yvonne Behrens, M.Ed  2013



What is this Website All About?

Recently, a friend who is a social media guru, told me that my site did not effectively communicate what my message was.

Being a person who is aging in a society wherein aging is looked at in negative terms,  I decided to begin a website that explored all those aspects of life/society that affect the aging person, positively and negatively.  I am interested in exploring a more positive outlook towards aging.  Baby Boomers make up a large percentage of the population.  We should be working together to pro-actively create twilight years more to our making and liking, not follow, like sheep, society’s definition of what aging is all about.

Where does the story begin?  In some societies, the elderly are venerated.  In other societies, they are taken care of.  In our society, unbelievable amounts of energy and money are expended to avoid the aging process and to avoid death.

The real problem with all of this is that gerontology is looked on as dealing with “old” people and our concept of “old” is decrepit , demented, incontinent. Until we reach “old” (at least in our society) no one wants to deal with “old” and so the image of “old” continues to be perpetuated in the above fashion.

People need to recognize that those of us who don’t age, die. In other words, unless something else takes us away, we are all going to age. Unless those of us who are aging now (but are denying that fact, other than to laugh about “senior moments” or complain about the “new aches and pains,”) take responsibility for this fact, buy into it and prepare for it, we will not have the infrastructure in place to deal with it properly (which is where we are today in our society). Time for a paradigm shift. Unless the baby boomers (46-66) create that paradigm shift, we will have quite a mess on our hands.

Why do I say that we will have a mess on our hands?  In sheer numbers, the baby boomers outnumber those following them.  Studies show that younger folk do not seem to be attracted to service oriented jobs.  The traditional definition of family has been expanded to several parents/siblings/grandparents by virtue of high number of divorces and re-marriages, which will also have an impact on care-giving.  Not only that, but we, beginning with our parents, are the highest users of pharmaceutical drugs, all of which have some side effect which causes some other problem which necessitates taking more pharmaceutical drugs.

Now all of this is glorious news for the health care industry (note the word industry — their term, not mine).  What better scenario for profits than having an individual with a chronic illness who is totally dependent on the health care system?  And better yet, particularly for the insurance companies [– one part of the triage that makes up the health care industry, the other two being pharmaceuticals and hospitals/doctors –]  is a person who is on medicare and has all these chronic problems because then 80% of the cost for their care is covered by Medicare.

This is a scenario that I find dismaying and will speak out against again and again.  We should never have allowed a service industry to become a profit making industry.  When we did, health no longer became the focus — profits did.  Making money did.  And when that happened, individuals’ health became compromised by the very system that claims to be proponents for health.

So in a nutshell, this website will (mostly) focus on our aging process and those steps we can take to better prepare ourselves (boomers corner) and it will focus on the health care industry by presenting articles that demonstrate the need for a major overhaul of that industry in the hopes of recapturing its original intent: health. (Health Blog).

At least for now…..

I would appreciate any thoughts you may wish to share with regard to this.

© Yvonne Behrens  2012

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Geriatric Medicine: Not Sexy; Not $ Lucrative

Finally, the last entry into the series of blogs that began with Anti-psychotic Drugs for the Elderly .  As I mentioned in that first entry, this all began because of a discussion I was involved in through LinkedIn “Elder Care Matters” on the care of older Americans and the use of anti-psychotic medicines.  Irene Teesdale CLC, a Gerontologist from North Carolina, www.EngagingInLife.com had shared a lot of statistics with us, which I share below.  Bottom line, young pre-med students do not think going into Gerontological care is “sexy” and or financially lucrative.

There are currently 7,162 allopathic and osteopathic certified geriatricians in the US — one geriatrician for every 2,620 Americans 75 or older.  There are far fewer geriatric psychiatrists. …. – one for every 10,865 older Americans. That ratio is projected to decrease by 2030 to one geropsychiatrist for every 12,557 Americans 75 and older.

Over the last 5 years, a declining number of US medical school graduates have been choosing careers in internal medicine and family medicine — the two fields that are the source of applicants for geriatric fellowship programs.

Becoming a specialist these days is a much more financially lucrative path to follow than being a general practitioner.  Specialty doctors such as plastic surgeons, dermatologists, radiation oncologists are the popular career tracks.  According to studies, one reason for this is because internal medicine and family medicine, precursors to geriatric medicine, make less money and the hours are less predictable.   (oh, dear, there is that focus on money over service again!)

Irene’s input to our discussion continued:

A career focused on caring for older adults can be particularly financially unattractive for physicians with increasingly large medical school loan debts. Physicians graduating from U.S. medical schools in 2010 owed an average of $158,996 for their education. Thirty-nine percent of these graduates said that salary expectations were a moderate or strong influence in determining their specialty.

Since in some cases Medicare reimbursement can be lower than private insurance (interestingly, no one also recognizes that premiums for private insurance are larger than for Medicare when they complain about the smaller financial return of Medicare patients!) and since, obviously, geriatric medical providers mostly deal with Medicare, their incomes do tend to be lower than the above mentioned plastic surgeon, etc.

Last year, when so much politicization was going on about “Obama care” and killing grandma, we really did end up cutting our noses to spite our faces.  Not many people seemed to recognize that by even-ing out the playing field, we might get back to healthcare being a service rather than a lucrative business.  This, in turn, might allow health care to re-focus on its original purpose,  keeping people healthy, rather than, as the current focus on profits might suggest, keeping them unhealthy.

Only a small proportion of practicing healthcare providers have formal training in geriatrics, with less than 1% of doctors, dentists, pharmacists, and nurses, and only 5% of social workers having certification or advanced training in geriatrics or gerontology.

Thank you Irene for sharing these figures with us.  Clearly we need to encourage young Medical students to enter the field of geriatrics and the only way that is going to happen is by providing the same attractive financial returns that plastic surgeons or oncologists get.  This is why, again and again, I tell people that our medical system has it all wrong.  It is looked on as  a profit generating business (and boy is it that and getting more so every day!) rather than as a health care service.

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Hidden Costs of Medicine

Hidden Costs

The whole question of insurance, drug costs, and pharmaceuticals is an area very dear to my heart.  This section is dedicated to the politics and relationships of these topics.  Another area of focus will be on Medicare and how pharmaceuticals, insurance, and hospitals interact with this government entitlement for those 65+.  We will also look at what is being discussed by our Congress and whether they are working to dismantle a system that has proven quite effective for the past 70+ years. Along with that, we will do a comparative study on the insurance coverage Congress gives itself and what is available to the average citizen.

As starters for this section, I will share a letter I came across while surfing the web. An anonymous author wrote a letter entitled Hidden Medication Costs for The Health Care Blog.  He/she learned the true costs of drugs after he/she retired and enrolled in Medicare.
This is what the writer wrote:

Just prior to retirement, my eyes suddenly began [to] tear and swell so much that it impacted my vision. The eye doctor diagnosed an allergic reaction and prescribed prednisone drops to reduce the swelling and antihistamine drops to combat the reaction. …….Per my employer’s plan I paid a relatively small co-pay for each prescription.
Three weeks later, on a follow-up visit, the doctor recommended that I continue the antihistamine drops for the duration of the allergy season. …. Now I was on Medicare so I checked the cost of the drops on the website of my Part D provider. It was $279. Could this be?? Oh indeed it could — and I had a high deductible and would have to pay all of it!! Of course, if I continued to need the drops, the plan would eventually assume more of the expense.”

As many do in these circumstances, the writer began to question whether there was not a cheaper alternative that would do the same trick.  As it turned out, yes, indeed there was.  The author continues:

“…. there were, in fact, two reasonable options: one a prescription which was ½ the price of the current prescription; the other a medication that had previously been script-only, but was now available OTC – the cost for this was $14.79. He [the doctor] suggested that I experiment with the alternatives to see if they were as effective as the current drops. Fortunately, the $14.79 version was just fine. Of course, it might not have been, but it was.

The last point that this author makes is probably the most important point in the article:

….had I not asked, it would not have been offered.  And had I not had a plan that exposed the cost of the expensive prescription, I would not have asked.

Believe it or not, there are many stories like this one: a patient learns of the forbidding costs of a drug or a procedure or a, you name it, and seeks to find a less expensive alternative, usually finding it.  One might go further and wonder why the doctor did not offer the cheapest option at the outset?  Tune in over the months as we present people’s stories and reflect on why such stories exist.