Value in Health Care: Not Our Concern

Another in the series on health care costs by Elizabeth Rosenthal in the New York Times—The Odd Math of Medical Tests.

Over use and over charge seem to be the watchwords of American healthcare.  Why?  read below.

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades.

Read the article for more details.

Medicynical note:  There are interesting contrasts between the U.S. approach and the experience elsewhere in the article.  The end result is that we pay much much more for the same services….that are done many many more time/unit of population.  Our costs are double most other industrialized countries.  Sustainable?  No.

Why?  In the U.S. there are no restraints on gouging the “system.”  Everyone is in the business to make money for themselves and stockholders—its their “fiduciary” responsibility.  Quality patient care and appropriate use of technology and medical care is really not their concern. 

America Lags Behind: Even with Medicare

Even with Medicare the U.S. lags behind other countries in healthcare access,  costs and quality.  This graph from the Commonwealth Fund survey of older adults says it all.

Among American seniors, 21 percent had out-of-pocket medical expenses that topped $2,000 and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.

“As good as Medicare is – it provides excellent coverage over all – it still isn’t as protective as the coverage people get in other countries,” Ms. Osborn said. Its deductibles and cost-sharing requirements still leave many Americans scrambling to afford drugs and doctors – which also cost more here.

Read the article for more.

Medicynical Note:  The basic premise of those involved in healthcare in the U.S. is different than in other countries.  Instead of assuring   value, quality and access, our system is devoted to assuring excessive financial returns to providers, insurers, drug companies and hospitals.  Protections are in place not to assure good quality affordable health care but rather to guarantee profits.

Some examples of this include congress forbidding the government from negotiating price of drugs purchased by Medicare part D; the generation long monopoly afforded new drugs without assuring reasonable pricing (one of the requirements of the Dole-Bayh law that is not enforced); the obscured price of services at medical facilities–insurers pay half of what an individual would pay for the same service.  It’s worse than buying a used car. And so on.

American Exceptionlism, Again: 42.9 million Americans have unpaid medical bills

Another only in American moment. 

Nearly 20 percent of U.S. consumers with credit records — 42.9 million people — have unpaid medical debts, according to a new report by the Consumer Financial Protection Bureau.

The findings suggest that many Americans are being trapped by debt because they are confused by the notices they get from hospitals and insurance companies about the cost of treatment. As a result, millions of Americans may be surprised to find they are stuck with lower credit scores, making it harder for them to borrow to buy a home or an automobile.

Medicynical Note:  Not only do we have the most expensive, inefficient health care non-system in the world, but we also lead the world in medical debt and bankruptcy (a category of bankruptcy unknown in other industrialized countries).  Even with the Affordable Care Act, this problem persists. 

Instead of doing something about it our new republican congress wants to make it worse by doing away with the Affordable Care Act (the only progress in 30 years) and replacing it with …………….nothing.  Amazing. 

America isn’t fit to lead the world until it gets it’s own house in order. 

Healthcare Theater of the Absurd: I’m an Obama supporter. But Obamacare has hurt my family.

This poorly reasoned self pitying whine appeared in the Washington  Post.  In it the author bemoans having to pay about 13% more for insurance  than she paid in 2013.  Part of that was the yearly increment of insurance and part just and increased payment for better coverage.  The author and her spouse are in their late 50’s he has prostate cancer and a history of  heart surgery.

Since his heart diagnosis in 2005, Jim, who probably couldn’t have found a policy as an individual because of his condition, had been covered by small-business group insurance — because his self-storage business in Banning had one other employee. But his work, and his coverage, were always subject to change.

I remained vulnerable as a freelance writer and part-time university professor who had to pay for her own health insurance. I also had had a few health hiccups, including surgery to repair a herniated disk from spinal degeneration, and so I lived with the daily realization that one bit of bad health news could cause my policy to be canceled

Absurdly she complains

We have no choice to opt out of the required pediatric dentistry or maternity coverage we’ll never use, so we’ll eventually have to settle for less generous policies, with higher deductibles and out-of-pocket maximums.

But she notes that in the first year of coverage it more than returned the additional cost in better coverage for her husband’s cancer–which in turn was funded by people who had no need for cancer treatment.  But that’s the way insurance is supposed to work.  Read the article for more:

Medicynical Note:  Yes the system, thanks to the republican opposition to a simple single provider approach, is convoluted and complicated.  Yes you have to have comprehensive coverage that includes some things that you don’t really need at this time.  But in this woman’s case she and her spouse get guaranteed insurability at an affordable rate.  Pre-health reform it was normal for people with illnesses like her husband’s to have their insurance cancelled or their premiums doubled.  Paradoxically in that non-system the goal of insurers was not to cover sick people so as to maximize profits–health care is really not their primary concern. 

The Affordable Care Act has enabled millions of uninsured to get coverage but it does need to be viewed as a first step.  The process needs simplification; insurers need to become more efficient (their 20% or so profit is unacceptable); and yes costs need to be controlled.  It should be noted that this year we had the lowest increase in health spending in 30 years.

But despite the progress, our conservative friends can still revel in the facts that the U.S. still has the most expensive, least efficient health care in the world.  We are number one in costs, uninsured and bankruptcy from medical costs.   They seem to like it that way.

It’s NOT a Health Care System

The Times reports on bribes given to health care providers to prescribe their patent protected product.  In this case it’s a addicting medication.

Dr. Judson Somerville, a pain specialist in Laredo, Tex., received $67,000 in speaking fees, travel and meals in 2013 to promote a powerful and addictive painkiller called Subsys, according to a new federal database of payments that drug companies make to physicians.

But while Insys Therapeutics, the Arizona company that makes the product, was paying Dr. Somerville to promote it, he was under investigation by the Texas Medical Board. Last December, the board ordered him to stop prescribing painkillers after it found that he had authorized employees to hand out pre-signed prescriptions to patients and after it learned that three of his patients had died in 2012 of drug overdoses, most likely from drugs that he had prescribed.

Read the article and weep!

Medicynical Note:  Health care in the U.S. is not systematically provided and the way it is delivered is not a “system” to provide it.   Rather what patients received is carefully designed “system” to maximize revenue for providers, hospitals, insurers, technology developers and pharmaceutical manufacturers.  The well-being of their stock holders and investors are much more important to them than the well-being of patients. 

Pre-existing Illness, or why you should not travel to the U.S.

Yet another mind boggling adventure in the American healthcare.

Jennifer Huculak-Kimmel, a Saskatchewan resident and Canadian citizen, was six months pregnant when she and her husband, Darren, decided to travel to Hawaii on vacation. She checked with her doctor, who said it would be fine to take the trip, and bought travel insurance just in case. When her water broke and she had to be airlifted to a Honolulu hospital, she should have been able to take advantage of her six weeks of mandatory bed rest, reassured that she had taken the right steps to ensure proper healthcare coverage. Right?


After about a week in the hospital, Blue Cross contacted the couple to let them know that their coverage had been denied because of a preexisting condition — a bladder infection that had not threatened the pregnancy. The insurance company maintained its stance, despite the company receiving a letter from Huculak-Kimmel’s Canadian doctor ensuring them that the pregnancy was not high-risk. They would be responsible for the hospital bill, which, due to the baby’s premature birth and critical condition (the baby had to stay in a neonatal intensive care unit, which cost more than $10,000 per day) had risen to $950,000.

Medicynical note:  Another unique adventure in health care in the United States.  The only country in the industrialized world with a category of bankruptcy related to health care expenses.  

And our republican friends support the right of insurers to deny coverage if you are sick (pre-existing illness).  Yet another sign that our health care system isn’t about health care but rather about money.  Yet another example of American exceptionalism.


Medically Induced Bankruptcy: An American Disease

In the U.S. we have no system of health care but rather a well oiled revenue generating infrastructure that incidentally provides care while charging excessive amounts.  This distorts our entire economy.  We spend nearly 20% of the GDP for medical related expenditures.  It’s literally your money or your life (Thank you Marcia Angell).

Even with the affordable care act in force this still happens.

The woman tells WISC-TV [via Reddit] that in Sept. 2013 she went into cardiac arrest and was taken by ambulance to a hospital that was out of her insurance network instead of the one — only a few blocks farther away — that accepts her Anthem Blue Cross coverage.

Had she gone to the in-network hospital, she’d only have been hit with about $1,500 in expenses. But since she was taken to the other hospital, she now has to pay the huge difference between what her insurance company paid the hospital and what the hospital charges.

“I was in a coma,” explains the woman. “I couldn’t very well wake up and say, ‘Hey, take me to the next hospital.’”

Read the article for more.

Medicynical note:  For my friends who think the “free market” is the solution and that we merely need to shop for the best price and become informed before purchasing,  this woman’s situation typifies health care.  It is not discretionary, it is often emergent, there may not be another option locally, pricing is unclear,  often obfuscated and not fully apparent at the start. 

The U.S. remains the only industrialized country in the world without a national health program, the only country in which people go bankrupt from health care expenses, which are by far the highest in the world. 

And the newly elected republican congress wants to make things worse.  America is truly exceptional.