By Russ Nelson, on November 10th, 2009
The whole health care reform thing totally baffles me. Where do all these idiots (and yes, you ARE idiots) who support health care reform think the money is going to come from for all these improvements? Cost savings?? Sorry, idiots, but if savings were already available, insurance companies would have already gotten them, and kept them for themselves. Is that not completely obvious? Its GONNA cost more, and its GONNA cover less.
There is a way to get more for less, but it requires that people understand and accept that free markets actually work. And yet there are so many people who are convinced that somehoww health care is some kind of magic market where the laws of economics don’t fly, where pigs do fly, and where everyone can get all the health care they want for almost
no money.
And a pony.
By Anthony Luafalealo, on October 16th, 2008
Former nurse and retired attorney S.J. Robinson, author of The Price of Death, has practiced law dealing with medical malpractice and insurance companies over the last 30 years. Her book focuses on issues such as health insurance reform, oversight for prescription drug production, and the growing power of healthcare conglomerates. For more information about Robinson and The Price of Death, visit www.sjrobinson.com. (Interview conducted by R. C. Anderson and Dr. J.C.)
In a capitalist healthcare system focused on profits, what is the most effective reimbursement structure to reward providers for care while also managing costs?
We need a regulated system – a private/public partnership [that…involves payment to the government for healthcare and government-monitored, private health insurance companies administering payment to privately employed doctors and privately run hospitals]. Over the last 20 years, we have been depending on the free enterprise system to bring costs down. Over that time, healthcare costs have risen faster than the rate of inflation. That is because we don’t really have a free enterprise system. The free market is skewed by politics. The large healthcare companies have huge amounts of money to pass along to Congress via lobbyists, who influence Congress to pass laws that benefit big business healthcare.
What we are not cognizant of is the tremendous amount of profit realized by these companies, healthcare insurance, managed care, and pharmaceutical companies. These companies drive up our healthcare costs. We have the most expensive healthcare in the world, spending 17% of our GDP. France, Italy, Germany, Japan, and Taiwan spend roughly 8-9% of their GDP on healthcare, cover everyone, and have extremely happy patients.
We are told that the only alternative to the system that we have is the Canadian style system. That is a false story put out by the beneficiaries of our current system, primarily the insurance companies.
One obvious consequence of bringing down big pharma and device companies is that they will no longer spend the huge R&D on blockbuster drugs if there is no capital reward via reimbursement. Thus one clear consequence of making healthcare more affordable is a slowing of discovery and advancement. How can we incentivize advancement in medicine while controlling costs?
Big pharma spends 10-15% of its profit on research and development and 30-40% on marketing. Professor Karl Lauterbach of Germany said in a PBS interview on Frontline, titled Sick Around the World, “I don’t know of a single economist who would buy into that argument. I think this is a lobbyist argument. A market works best if there are no inefficiencies, and higher-than-necessary prices are inefficiencies. And the drug companies now spend more for marketing the drugs than for innovating the drugs. This clearly is an artifact which comes across with this system of subsidized and too-high prices.”
Do you think that class-action lawsuits by providers against insurance companies are a good solution to balance the inequity of power insurance companies wield in the current healthcare climate? Or does this merely clog the judicial system and become a distraction from what providers should be doing: helping patients?
Class actions and lawsuits in general are very wasteful of resources because the outcome is extremely uncertain and the suits are very costly in time and money. They would take time away from healthcare and possibly put health care workers in an unfavorable light vis-à-vis the public. As I said, the outcome of lawsuits is uncertain, and I think they should be used as a last resort. The better approach in this case is to influence the public and Congress for the development of a new healthcare system: a public/private partnership which eliminates the excessive profits of health insurance companies, big pharma, and managed care.
In your August newsletter, you describe the many and varied problems the U.S. has had with contaminated or improperly supervised drugs coming from China. Would it not solve a lot of the U.S.’s problems as well as poor patient outcomes if we simply stopped accepting drugs from China and instead paid a bit more for drugs that are properly supervised in countries that care to ensure it? What do you think it would take to reduce consumerism from China, especially given that drugs are not the only problems we have had, but also melanin contaminated products and lead contaminated toys?
I don’t think it likely that world trade is going to be turned back, and it may not even be a good idea. We already pay two to three times more for pharmaceuticals than other developed countries, for example Canada. We have been told that we must pay more in order to safeguard our drug supply and promote the development of new drugs.
U.S. drug companies are making record profits but still want to make more. They are having their drugs made in China to increase profits. Because we pay a premium for pharmaceuticals, I believe that we are a target for counterfeit pharmaceuticals, not more protected. Counterfeiters have no compunction about who they kill and want to make the most money. In my book, The Price of Death, I discuss the point of view of the Chinese on counterfeiting. Because this administration has actually reduced funding for the FDA despite the fact that world trade has increased, we are at great risk. At its current rate, the FDA will be able to inspect the 700 plants now open in China in the next 40-50 years. What we should do is require importers to pay a government fee to have their imports inspected. There is no reason that they should be making record profits and putting the consumer at risk as they are.
There was a problem with Baxter International heparin earlier this year, which, according to the FDA, probably came from China. The FDA says that the manufacturer used oversulfated chondroitin sulfate (OCS) instead of chondroitin sulfate (CS). The relative cost of the bogus chemical was only $9 per unit vs. $900 for the correct ingredient. There had also been a reduction in the availability of other materials to make heparin because it comes from pigs, and there was a pig epidemic in China. While it is difficult to prove, one can speculate why the plants would have substituted the new ingredient when stocks of other ingredients fell short and became more expensive. I say that it is difficult to prove partly because the Chinese government had not admitted that the OCS was the cause of the problem even though the FDA has indicated so on its website. The bogus chemical fooled the standard tests [about the protein content of the product], impeding immediate discovery of the problem.
Now Here’s Your Chance to Ask the Questions (and Win One of Three Copies of The Price of Death, Too!)
Do you have a question that we didn’t ask? Here’s your chance to pick S.J. Robinson’s brain. Submit your questions for her in the comments section, and she’ll be available for a week to answer them. Also, by submitting your question, you will be automatically entered into a drawing next week in which three winners will receive a free copy of her book. (Sorry, you must be a U.S. or Canada resident to participate in the drawing.) Please see our Book Giveaways information page for complete details and ask away!
By Evelyn Black, on September 1st, 2008
Brandy Brady and Rick Huggins of Lake Charles, Louisiana, met in February at a Mardi Gras party and fell in love. They both feel certain they would have eventually married each other regardless of their current circumstances, but the fact that they decided to marry each other by April, after dating for only two months, was so that Brandy could be added to Rick’s Blue Cross/Blue Shield health insurance policy.
Brandy Brady has end-stage renal disease. After a kidney transplant last year left her with lots of medical bills, an unpredictable medical future, no job, and no healthcare, she met Rick, and the rest was a no-brainer. According to a recent New York Times feature article which tells Brandy and Rick’s story and others, more and more couples are marrying, divorcing, or staying together when they want to divorce because of health insurance issues.
A recent poll conducted by the Kaiser Family Foundation (a health advocacy group) found that 7% of all participants had at least one family member who had recently arranged marriage or divorce around issues of insurance coverage. More and more often, marriage is becoming a financial necessity driven by factors of health, legality, and the constraints imposed upon a financially struggling society by the insurance industry.
I can personally validate that poll, if not scientifically, at least in my own gut reaction. I personally know of at least three people who would obtain a divorce today were it not for the fact that the partner with a chronic, serious illness would be instantly thrown into such dire straights that not even Rasputin would have the heart to go through with it. So they carry on separate lives, married in name only, so one of them can stay  alive.
On the other end of the spectrum are married people with medical debt who divorce so that the one carrying the debt can file bankruptcy and they can continue with their lives with a roof over their heads, the only difference being a document saying they are no longer man and wife. It doesn’t take much to pile up unfathomable medical debt anymore, even with insurance. A triple bypass or a bout with cancer will do it quickly. But even a lesser emergency can cause a financial strain severe enough to leave people throwing romance aside and shuffling through their legal options just to stay afloat.
With recent data showing inflation at 17 year highs and real wages dropping like SUVs pushed off a faulty infrastructure bridge, considerations of marriage are once again drifting back to the practical and the necessary. Today’s healthcare crisis adds a final straw to the already crushing financial weight pushing against the lofty principals of love, affection, and holiness we used to demand in matrimony.
Let’s not kid ourselves: it takes two incomes, sometimes three or four, to successfully run a household these days, and somebody in that household better have some health insurance that covers all the members. Frost that with a love story if you can. Love makes it all more palatable, but it doesn’t change the fundamental reality facing today’s families.
I’m reminded of something I learned as a freshman psychology student: Maslow’s hierarchy of needs. Abraham Maslow, a famous humanist, posited that in order for human beings to self-actualize (become their own best true selves), they first had to have basic needs met. In other words, people who spend 18 hours a day hunting and gathering don’t create art or philosophy; that sort of elevated activity only comes about in a society that is well-fed, sheltered, and healthy.
Reading Maslow in college in the 1970s left all of us feeling sad for the third world unfortunates who were so busy pounding taro root in the hot sun that they would never get to, well, read Maslow. Who knew that thirty years later we’d be looking for books on how to pound taro root? Actually, those old psychology texts are heavy enough to pound grain, and they’d also keep a small household warm for several nights if that household is lucky enough to have a pellet stove.
All kidding aside, we need a single payer national healthcare plan and we needed it yesterday. I’m under no illusions that such a plan will materialize quickly if ever. In the meantime, lonely hearts with great insurance plans are in luck!
At least say you like long walks on the beach, though. It makes the whole thing a little less awkward.
By Jennifer Bunn, on July 29th, 2008
Medical tourism may be defined as seeking healthcare outside one’s own country. This is becoming more common as people search for affordable healthcare. In the U.S., patients travel to countries that perform the procedure they need for a fraction of the cost of the same procedure done domestically. In Canada, where healthcare is essentially free but where wait times may be unacceptably long, people are choosing to go to places that can perform the necessary procedure on the same day of arrival if desired. Some patients like to kill two birds with one stone and combine surgery with a holiday in an exotic locale.
What are the advantages for patients/consumers? As mentioned, costs may be considerably lower in other countries, allowing patients to combine a holiday with their procedure. Having surgery in another country can also cut down considerably on wait times for those patients who come from countries such as Canada, where wait times for elective surgery may be months. For example, wait time for a hip replacement may be longer than a year in Britain and Canada. In the U.S., restrictions on the patient’s choice of facility, surgeon, and the type of prosthetic used may be factors in patients choosing to receive medical care out-of-country. Additionally, many international hospitals have improved their facilities and standards of care to attract international patients. Many international hospitals have become JCI-accredited, which makes them even more attractive to foreign patients.
What are the disadvantages for patients/consumers? One disadvantage is that patients traveling to foreign countries for healthcare may actually expose themselves to infectious diseases to which their immune system has had no experience in dealing with (i.e. TB, malaria, hepatitis). Also, travel after some surgeries may not be recommended for some time and may be very uncomfortable. Post-operative care may not be to the same standard that some patients are used to, although many foreign hospitals are striving to remedy this.
Other considerations concern legal issues. Patients who are dissatisfied with their surgery results, or who have an adverse outcome, may have little recourse in other countries. Doctors in other countries may not have to adhere to the same insurance and malpractice standards as physicians in countries such as Canada and the U.S. Patients who suffer a poor outcome may have a difficult time finding a doctor in the U.S. who is willing to take on their care.
It seems the trend of medical tourism is here to stay. Patients who are considering receiving their care in a foreign country should thoroughly research the doctor and hospital where they will be receiving their care. They should also research insurance options for themselves before departure. Lastly, choosing a facility that has been JCI-accredited may provide some reassurance that the hospital they have chosen is maintaining basic standards of care.
Reference:
Health News Today, July 10, 2008. Washington Post, Wall Street Journal Examine Issue of Medical Tourism. http://www.medicalnewstoday.com/articles/114520.php.
By Jennifer Bunn, on July 20th, 2008
As the recent campaign for the Democratic nomination has shown, there is always much debate surrounding the issue of delivery of healthcare; specifically, what is the best way to deliver healthcare to citizens in the most cost-efficient manner? The U.S. healthcare system has provoked criticism due to its high cost and the fact that there are approximately 45 million people in the U.S. with no healthcare insurance.
The Canadian healthcare system has been offered up as an example of what Americans can aspire to; yet it has its own share of problems. Although every Canadian is entitled to free healthcare by law, wait times for some procedures and surgeries, as well as a shortage of doctors in some specialties, means that there is an increasing number of Canadians who believe that privatizing Canada’s healthcare system is the answer to the problem.
Is there a happy medium? Why is it that a model of healthcare hasn’t been developed that takes the best of each system and combines these virtues into a healthcare system in which every citizen has equal access to insurance that is affordable?
It has been suggested that the Canadian government should allow privatization of some parts of the healthcare system, such as diagnostic and surgical centers, in order to decrease wait times for some procedures that have excessively long wait times. Most Canadians have balked at this idea and fear that allowing privatization in some areas will lead to a two-tier system. Yet something must be done as the system is foundering.
The U.S. healthcare system is also foundering as many of the nation’s population have no access to healthcare despite living in one of the richest and most powerful nations in the world.
There is no easy answer to the problems of either country. Undeniably, each country will have to continue to look for a cure for their own particular woes. And, although we are allies, it is unlikely that the U.S. and Canada will look to each other for answers to these problems because then we would each have to admit that we have a problem.
By J.C., on July 12th, 2008
These are exciting times for all of us given the increasing interest in healthcare during a presidential election. One key theme in the transformation of our medical system has been whether universal healthcare is something we want, something we can afford, and something we want to make happen.
When people think of universal healthcare, they often look at the rosy view – that every person should have access to healthcare. This is an ideological change from the previous view that healthcare was a privilege and a fringe benefit. For those of you who don’t know, the health insurance industry really came about for the need for companies to recruit great workers. Many of these potential workers were war veterans and needed medical care. Thus, medical “benefits” was indeed a fringe benefit that was only previously afforded by the elite or those with good jobs. Interestingly, if you think about it, every one has “access” to medical care these days. There are no barriers from anybody walking into a doctor’s office or a hospital. Whether you can pay for it is a different story. Thus when we say “access to care” we really mean “care that is paid for by someone else”!
In this day and age, many people are viewing healthcare as a right. Thus, in other words, people expect to receive medical care that is paid for by someone else; simply because you exist in this world, you have the right for healthcare. That “someone else” happens to be the government, which passes on the cost to every person in the United States via some tax somewhere.
But one of the consequences of universal care, which I view as somewhat of a socialist concept, is that all care will be the same. In other countries where universal care is in place, you do not get a “choice” to go to the doctor you think is better than the other. What you get is the right to see the doctor who you see.
We Americans are truly a spoiled lot when it comes to consumerism – the medical industry is not spared. We want to go to the best doctor possible. We want choice, and we will pay for choice. If there is a special procedure, we want it done. What we do not realize is that those choices and tiers of medicine are only availed through a profit-driven capitalist medical industry. Where do we think all of those drug and device discoveries are coming from? From the company that spent billions of dollars researching it and who sells it at a handsome profit and whose stock is listed in the public markets!
Are we ready to give up choice to establish a “standard” of care from which no patient receives anything different? I really don’t think so. I really think we love the idea of “fairness,” but when it comes to ourselves and our bodies and our health, we want the best even if it is what others cannot afford.
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