The two largest health care issues in America today

I am really sick (heh) and tired of what calls itself health care debate. The ‘reform’ that we’re looking at now is really no more than a stopgap; shuffle the money around a bit and everyone stays happy for a while. When most insurance comes through employers, mandating insurance coverage becomes nothing more than a tax on the poor and lower-middle classes.

The real issues facing health care in the modern world are as follows:

  1. ‘Basic’ care is too expensive. Somehow, care for common ailments has become prohibitively expensive for ‘everyman.’ I have a few friends who went this season to get tested to see if they had the flu. Cost: between $500-800. Ridiculous. Embarrassing. There are hundreds of other basic care needs that people simply cannot afford on their own. There must be a way to provide basic medical and pharmaceutical diagnosis and care to people so that it doesn’t cost hundreds or thousands of dollars per treatment. And I don’t mean, shift the cost to an insurance company, I mean that the amount of money changing hands for basic care should be affordable to a basic person. Anything else is a scam.

  2. Access to all possible treatments for everybody is held up as the standard, and it shouldn’t be! The garbage earlier this year about Obama’s ‘death panels’ clearly illustrates the bizarre sense of entitlement we all seem to have about receiving medical care. No matter how you parse it, at some point a choice has to be made about whether or how to treat various conditions. Not everyone is entitled to everything no matter what the expense. It may be a hard concept to grasp, but at some point treatment for illnesses becomes prohibitively expensive, and sometimes it’s right to focus on quality of life remaining rather than extending life.

If a super-rare disease actually costs millions of dollars to treat, then maybe we shouldn’t be treating the person who has it. We will all die of something eventually, and I am not entitled to everything that will prolong my life.

I’m not sure what the solution to these issues might be, but as long as someone continues to spend the massive amount on health care that we do in this country, the problem needs to go away. We need to cut the expense of health care dramatically, not merely change who is paying for it.

You make some good points, but for now I’ll only comment on this one. I agree with this in principle; however, it’s the kind of thing that is difficult to vote for. A politician who advocated this might as well commit political suicide. Almost everything thinks their life is more valuable than their neighbor’s. Considering the uproar the supposed “death panels” caused, I can’t see anywhere close to a majority of people voting for outright rationing of health care, no matter how necessary it may be.

It’ll probably be met with scorn, but I think the inability for people (either the patient or the family) to let go, and the concomitant waste of healthcare resources, is directly tied to the religiosity of this country.

I just get the feeling that it is the most pious and devout of people who either don’t want to meet their maker or accept that fate for their loved ones. Which I find extremely odd, seeing as for most of them ostensibly aspire to reach this afterlife when they’re healthy.

Well another issue is problems people bring on themselves.

Smoking is responsible for 85% of all lung cancer, some studies show more. So should we care about those people. AIDS is virtually 100% preventable. Should we care about them.

Obesity is over 50%. Should we care about heart attacks and everything else that follows from people who can’t close their mouths?

I feel if a person can be cured, they should be able to get treatment.

It all boils down to, do you consider healthcare a matter of public policy (like police, fire protection and education) or is it a matter of personal responsibility?

that isn’t a binary choice, though. not burning down your house is both a public policy issue and one of personal responsibility. you can only get spoonfed so much education, too.

So patients in the midst of a heart attack have to go before a gluttony panel before they get treatment?

Pretty heavy false dillema there, given the wide spectrum of issues that make up health care. Of course there is a major personal responsibility aspect, and that flows from education. But of all the myriad situations that people seek medical care, how could providers possibly single people out as unqualified due to bad eating and exercise habits and so on.

  1. I’ve always thought basic care was dirt cheap. I have seen physicians and nurse practitioners for $40. Visiting a dentist costs me $100 and fillings are $50. I get my prescription for $4/month. I’ve had bloodwork done for under $100. I’m sure there are tons of expensive primary care tests and treatments, but many are still affordable.

Bernie Sanders has a bill to expand primary care. he claims it’ll only cost about $8 billion a year to bring primary medical and dental care to almost 56 million americans.

http://www.sanders.senate.gov/newsroom/news/?id=b86054e8-d233-4271-aa36-651c435f1cfc

http://capwiz.com/results/issues/bills/?bill=13001351

However, spending 1 day in a hospital could cost 10k pretty easily. That is a problem. And diagnostics could run into the thousands if you need PET, MRI, etc.

  1. True. Some countries have boards (the UK has the NICE board) devoted to finding out how many years of health you get for every dollar you spend (or pound, or whatever). We should do that here.

There is a book called Disease Control Priorities in Developing Countries that looks at the most cost effective ways to improve health in developing nations.

http://www.dcp2.org/pubs/DCP

My point is yeah, we need that here too.

On another note, not only do we all want the best healthcare possible, we don’t want to pay for it. We want our taxes to go down while we get universal care and the best treatments possible. So it is politically impossible to get it.

No, the two biggest issues in health care today are that people eat poorly and don’t exercise. We could cut our health care bill by 75% if those problems were addressed.

Wow! 75%!!! I’m impressed with your analysis. I wonder if you could point me in the direction of, you know, some actual facts that might back up this incredible proposition of yours.

Number of deaths for leading causes of death:

Heart disease: 631,636
Cancer: 559,888
Stroke (cerebrovascular diseases): 137,119
Chronic lower respiratory diseases: 124,583
Accidents (unintentional injuries): 121,599
Diabetes: 72,449
Alzheimer’s disease: 72,432
Influenza and Pneumonia: 56,326
Nephritis, nephrotic syndrome, and nephrosis: 45,344
Septicemia: 34,234

The bolded diseases are largely due to lifestyle choices. Go into any hospital and you will see obese and out of shape people taking up the beds. Any doctor will tell you this. Most disease is preventable.

If you forced everyone to have a healthier diet and more exercise, they’d still die anyway they would just die 3 years later.

Also, the rates of stroke and heart disease have declined 60%+ since the 1950s, despite Americans getting fatter.

http://www.mindfully.org/Health/2002/Americans-Getting-Healthier13sep02.htm

Heart disease: Much of the improvement in life expectancy is traced to falling heart disease rates. In 1950, just over 585 people in the United States developed heart disease for every 100,000. By 1999, that had been more than cut in half, falling to just under 268 people per 100,000.

Stroke: In 1950, nearly 181 of every 100,000 people died of stroke and other cerebrovascular disease. By 1999, it was just 62 per 100,000.

They went down another 25% between 1999 and 2005.


Jan 22, 2008 – U.S. deaths from heart disease and stroke dropped about 25% from 1999 to 2005 – five years ahead of goals set by the American Heart Association.

That translates into 160,000 fewer deaths in 2005, the latest year for which the CDC has compiled detailed mortality data. If the trend holds, the AHA calculates that 2008 data will show a 36% drop in heart disease deaths and a 34% drop in stroke deaths compared with 1999.

Plus interventions that have nothing to do with losing weight like meditation, better sleep, stress reduction, more friends, etc. all help with many of those diseases.

So we’ve been getting fatter and lazier, but death rates from CVD and stroke keep going down anyway. It is not a tit for tat arrangement between lifestyle and death from CVD.

For the most part I shy away from healthcare delivery and reform debates because the issues are too complicated to spend time posting about.

Let me offer a couple of observations here:

It’s not very expensive to stay reasonably healthy, and ordinary primary care is neither expensive nor particularly necessary. You cite a great example: “I want to know if I have the Flu.” Might cost several hundred dollars, depending on how aggressively something/everything else is ruled out. You see, if you have a fever and aches, it might be acute meningococcemia, which is going to kill you in 8 hours. It’s probably the Flu, though. And here’s the other thing: why do you want to know? Current recommendation is to not treat the Flu with anything other than ordinary home measures.

So my second observation is that we love getting health care and we find a value in being treated and examined and taken care of that far exceeds the actual medical worth of our healthcare system exposure. Having a lot of money spent on ourselves makes us feel like we are worth it. “My bypass cost over a hundred thousand bucks…”

My third observation is that we have allowed ourselves to actually pretend that one cannot put a (market) value on the physical well-being of an individual. “How do we put a price on a human life?” we ask. This is absolute nonsense, of course, but it’s used as an excuse to spend millions of dollars, particularly at both ends of life, for relatively pitiful return.

Fourth, we divorce the cost of healthcare from the individual’s purse by creating a system of third-party payors–private and government insurance. This removes all incentive for providers to deliver less expensive care. The payor is the bad guy; the patient is interested in the most care they can get–like someone who’s paid a flat fee for a buffet–and the provider is interested in creating the most expensive product since the third party is actually paying for the buffet and the provider gets to raise the price of the buffet to the consumer indefinitely.

Finally, our sense of egalitarianism creates expensive care. If an 85 year old wants a new valve, why shouldn’t they get one? The 30 year old gets one and let’s not discriminate for age… If the wealthy get proton beam therapy for their prostate cancer, why not me?

And right now, the payor has no incentive to pay promptly. I needed an EKG several years back. My insurance provider took over a year to approve the treatment. My doctor, not having the information that she needed to diagnose my exact problem, put me on some medications, some of which I needed and one or two that I didn’t. Apparently it was cheaper for the insurance company to pay for those unneeded meds than to pay for the EKG. I, however, did have those copays…and I took meds that were not appropriate for me to take.

I think that if health insurance companies were held responsible for their medical decisions, this would go a long way to fixing our problems. Insurance companies need to act in a timely manner, and if they don’t, they should have to pay penalties. They should also be regulated in such a way that they have to reveal what percentage of premiums actually get paid out as health care. Oh, it would be nice to also see how much of a percentage they pay out in dividends and such, but they should be forced to reveal how much of the money they collect actually gets paid out in benefits.

Do you have any basis for saying that cancer is primarily caused by life style choices? is having a breast or prostate a lifestyle?

Al Franken said some states like Minnesota regulate insurance companies so they have to spend a certain % on healthcare. He claimed it was 90% in Minnesota.

How do you hold insurance companies accountable for medical decisions? Do they pay penalties or get rewards based on the health of their members? I know people are trying that with physicians (incentives based on how healthy or sick their patients are) so it might work with insurance companies too.

If people didn’t smoke, ate healthier diets, exercised, were screened properly and got proper nutrition (adequate levels of vitamin D, selenium, omega 3, etc) that would eliminate 50-70% of cancer deaths.

Having them both is.

Cite please that Diabetes Type 1 is caused by a lifestyle choice. I was always under the impression that juvenile diabetes resulted from autoimmune destruction of insulin producing beta cells of the pancreas. Your new knowledge is amazing!

Cite please that all Chronic respiratory deaths are caused by lifestyle choices. Many will certainly be caused by smoking,but ALL?

My point is that certainly diet and exercise are important, but your figure of 75% was pulled out of your nether regions.

Oh, I get it, having health insurance is a lifestyle choice.

That is a ridiculous number. When I was paying my medical costs out of pocket, my doctors office visits were about $50. Who are they going to that charging 500-800?