Miscellaneous

Stating that our health care system is broken should not drop any jaws.  But just exactly how broke is it?  You’ll be shocked.

For me, the most recent updated cardiovascular “prevention” guidelines creating such controversy the past few days outlines just how bad it has gotten.  Basically, a panel of which 8 of 15 members had strong financial ties to an industry that produces the statin class of drugs.  The potential outcomes of the new recommendations is that statins (my personal favorite pharmaceutical drug) should now be given to millions more patients.

For a drug that is just short of worthless that should be used LESS to be pushed for expansion illustrates how far we have come from what medicine was intended.  There is no longer any value to medicine, with the exception of a small number of scenarios.  In other words:

Mainstream medicine has FAILED in its stewardship of our health.  There is no other way to put it.

Just in case you think I’m way off base, I present this particular article.  In it, the author looks at health care financial data from public records sources.  Here’s a summary:

1. In 2011, US health care encompassed 17.9% of the US gross domestic product (GDP) to 17.9%.
2. Yearly growth exceeds any other industry.
3. Government funding increased from 31.1% in 1980 to 42.3% in 2011.

So.  There is no doubt that health care costs are increasing in this country at a rate that exceeds any other industry as well as any other country.  But what kind of bang are we getting for our health care buck?  A very poor one.  Multiple health metrics such as life expectancy at birth and survival with many diseases shows the US trailing its peer nations.

There are many fallacies that are floated around (especially as it relates to political maneuverings), but there are some surprises that run contrary to popular belief:

• Since 2000, price of hospital charges (+4.2%/y), professional services (3.6%/y), drugs and devices (+4.0%/y) and administrative costs (+5.6%/y) produced 91% of the cost increases in healthcare.  (As a side note, I can tell you that my fee schedule from insurance companies have NEVER gone up in my 15 years of practice, although we did take a 50% HIT in 2011 from BC, Cigna and Aetna)
• Demand for services or aging of the population did not factor into the equation of increased costs.
• Personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%;
• Chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly

Costs are going up, but who’s to blame?  Listen to the tort reform lobby and they would tell you it’s from doctors being sued, but what’s the reality?  Three factors have produced the most change:

1. Consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups.
2. New technology, in which investment has occurred but no real value.
3. The patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software.

Overall, it is a financial mess, with no additional value being added to the patient.  We have massive waste in the system with an almost god-like reliance on medications in lieu of lifestyle changes for chronic diseases (the strongest cost driver).  Basically, our society has been created where drugs are the answer to everything, although in truth, they are rarely an answer to anything.  We just can’t step back and look a patient with high blood pressure in the eye and say, “We have nothing for you.  Either you make these changes or you will die an early death from a heart attack, stroke or dementia.”

Instead, we lure patients with a false sense of security, thinking that Drug A will fix the problem and there is no real need for the lifestyle change.  But, when the numbers are fall out on the end, the drug did very little to change the original trajectory, merely adding massive costs and side effects that frequently leave the patient worse off then the disease it was meant to “fix.”