Tuesday, October 16, 2007

Health Care Questions Not Being Asked

I. Where is all the money going?

Why not get a forensic accountant to figure out where all the money is going? How many % end up in laywers' pockets via lawsuits? How many % end up as malpractice insurance company profits due to litigation? How many % go to needless tests because doctors are afraid of possible lawsuits stating that they "didn't do everything"? How many % are profits for the HMOs? For Big Pharma? How can you even talk about socialized health care without reigning in cost? It will just be expensive for everyone, and some special interest groups stand to make even more money.

II. Health Care in the USA is the most expensive in the world, yet one of the lowest quality in the First World, today. What was it in the 60s?

If health care was better in the USA in the 60s vis a vis other first world countries, what changed?

III. Why can't I buy health insurance like car insurance? Would you like to buy car insurance that covers routine maintenance but which doesn't cover being totalled by a drunk driver? "Oh sorry, you're not covered because you didn't disclose the pre-existing condition that your neighbor is a habitual drunk driver". But that's exactly what a lot of HMOs do. They cover piddly little expenses, but if you need a very expensive operation, they may not cover it.

It makes WAY more financial sense to be covered for events that are UNLIKELY but FINANCIALLY CATASTROPHIC. That is exactly what insurance is supposed to be for.

I would like to buy some health care program that covers say, the first 6 family doctor visits a year (for prevention, which saves money) and then only covers anything over a yearly deductible of $5,000 per year. If I needed $5,000 of health care in one year, it would sting, but wouldn't bankrupt me. A $200k operation, on the other hand, would.

I have some partial answers. In 1973 Nixon passed the HMO Act. It gave tax subsidies to companies that provided health care in the model of the HMO, to the detriment of companies with other business models. The result was that HMOs grew and grew into the size they are today, with no competition from other business models (e.g. health savings accounts)

This is exactly the kind of government regulation, meddling in the free market, that creates
distortion and cartelization, that makes the middle class suffer.

Here are 2 articles talking about deregulating health care:

The HMO Act resulted in the illogical coupling of employment with "discounted" (via tax breaks) health care. If you quit working for a corporation, and try to purchase the same kind of health coverage, you will likely have to spend twice as much. (This is yet another example of laws benefitting corporations)

Re: the above, I can hear the argument, "When you buy insurance as part of a group, like if you work for a corporation, you are pooling risk with your co-workers, so insurance should be cheaper". This is FALSE. If an HMO had 100,000 existing customers, then, if you add yourself alone, from a statistical point of view, you ARE POOLING RISK WITH THEIR 100,000 OTHER CUSTOMERS. It makes no difference then if you join their 100,000 as part of a group of 100, or you join them by yourself.

I think that doctors are way too quick to prescribe expensive, dubious prescriptions drugs, instead of lifestyle changes.

For example, a friend was diagnosed with high cholesterol. His doctor prescribed an anti-statin drug. My friend, displaying more wisdom than the doctor, said "No thanks, I'll try losing weight first". He proceeded to lose 80 lbs in one year (and now looks fit). His cholesterol, HDL, triglycerides etc, are all well within the normal range.

Statins have had dubious drug trials and potentially serious side effects with long term use (which have not been tested).

The American Medical Association is a monopoly. They artificially restrict the supply of doctors, ensuring high salaries (and thus cost to you and me). They also espouse expensive "mainstream" procedures instead of better, lower cost remedies. My realization was when 2 people I know were told they needed surgery to remove their gallbladder due to gallstones. They performed a gallbladder flush, which involves apple juice, some fasting, grapefruit juice, olive oil, and epsom salt. Out the stones went, and an ultrasound confirmed, no more gallstones. I know it sounds incredible, and I've posted about this before, that people are trained to reject anything "outside the mainstream".

Another example is a friend who was found to have some plaque buildup in his heart's blood vessels. He reversed it with Chelation Therapy. Predictably, the doctor poo-poo'ed him, despite that fact that he was surprised at the reversal.

The dollar amount spent on prescription drugs has more than doubled since 2000. This came out in the newspapers recently, but in typical shallow mass media fashion, the question "why?" was never even asked.

The FDA famously protects the interests of Big Pharma, while attacking all manner of "natural remedies" (read: non-patentable drugs, nutrition, or preventives). A google search "FDA lies" will give over a million hits.

I learned of this first-hand when I started getting a lot of migraines. I traced it to my starting the use of Splenda. (BTW Aspartame also gives me migraines). I've since found a substitute, Stevia, which tastes much better, and has no reported side effects in Japan and South America, where it's popular. Aspartame and Sucralose, on the other hand, have had thousands of complaints filed with the FDA.

Why haven't you heard of it? Turns out that the FDA gave "generally recognized as safe" status to Aspartame and Sucralose, but "has not tested" Stevia, and so it is marketed not as a sweetener, but rather as a food supplement, over which the FDA has little jurisdiction over. The FDA went so far as to seize Stevia cookbooks from a small business.

More details here: http://www.vegsource.com/davis/sweeteners.htm
The Aspartame/FDA story involves Donald Rumsfeld: http://www.stevia.net/aspartame.htm
Incidentally, Rumsfeld made millions on the fake Bird Flu media scare and Tamiflu. Remember all the nonstop fear-mongering coverage of the Bird Flu by the media? Read this:

In the 1960s health care was much better. This is a really good article:
Some people say "modern technology" has made medicine more expensive.
How is it that modern technology has caused the price of each Gigabyte of memory and Hard Disk Space to drop year after year?

Finally, Presidential candidate and Congressman Ron Paul got a standing ovation when he spoke to medical students at Dartmouth on Health Care. H'es the only candidate who's an M.D.:
Paul began his remarks by telling students that, “the medical system is going well except for a few groups: the patients, the doctors, the hospitals, the labs, and the politicians. Everybody else is happy.

(In the 1960s)
The amazing thing was it was the city hospital and there was no government; there [was] very little insurance and nobody was turned away whether they were illegal or legal, and nobody, nobody was quizzed. If you didn’t have the money, you didn’t pay, and people came in, and it wasn’t that bad. People didn’t lay on the sidewalks. You’re more likely to hear stories today of people being neglected in emergency rooms…and dying on stretchers—because we have managed care.” Paul often came back to this point in referencing the health problems of today.

He is certain that the problems with today’s health care stem from too much government involvement, not too little. “This whole idea that we need centralized economic planning in anything is a fallacy, and it’s a temptation to say, ‘Yes, we can’t have central economic planning for electronics, televisions, and cell phones because we want efficiency of delivery service, but medicine is different.’

Paul was also highly critical of current insurance schemes, claiming that the only things that should be insured are surgeries and other high cost possibilities. Instead of insurance for things like a check-up, Paul favored a medical savings account. “We should allow every individual to take a $3,000 tax credit, and they can put that away and use it to go and pay for their doctor visits.

A major problem with today’s society, according to Paul, is the confusion of “needs” and “rights”: “We have rights to our lives and liberty and we have a right to pursue our happiness and we should have the right to keep the fruits of our labor. We have a moral obligation to help our fellow man.” "That doesn’t mean, however, that we have a right to affordable health care."
Perhaps surprisingly for a doctor, Paul encourages more competition in the field of medicine. Noting that many alternative methods of care have sprouted up in recent years, Paul said the competition would be in the best interest of the patients. The only thing he cautioned against was fraud..

“Under the Constitution, government shouldn’t be in medicine.”

1 comment:

Anonymous said...

Thanks for your article. I agree 100% with your remarks, and offer a few additional points.

I am an accountant with heavy experience in cost analysis, and I'd be thrilled to get my hands on a hospital to find out what's really going on. My principle suspects are malpractice insurance (take a tort reform and call me in the morning), technology costs (gee whiz, does this friggin' MRI really cost 5 grand), and hospital mergers (seller cashes out, buyer now has a quasi-monopoly). It all stinks to high heaven.

Speaking of stinking, how do hospitals manage to get away with gouging the uninsured with inflated bills 5 or 6 times greater than those paid by insurance companies due to discounts. Hospitals are colluding with insurance companies to freeze out the self-insured. "Health insurance" is not "health care"!

A basic warping of the market that we suffer is the provision of health insurance as a tax-free fringe benefit. If benefits were taxed, employees would no doubt opt for more efficient arrangements such as HSAa.

Finally, those with public assistance such as Medicare and Medicaid are receiving benefits equal to a top-of-the-line private plan that would typically cost $800 per month. Clearly, those receiving medical welfare should be no better off than those who pay their own way. For Medicare recipients, higher deductibles and co-pays are in order. For Medicaid, public clinics offering bare-bones care would be more in keeping with a safety net philosophy.