Picture of an Obese Teenager (146kg/322lb) with Central Obesity, side view.Self Made Picture of an Obese Teenager (Myself) (146kg/322lb) with Central Obesity, Front View. Feel Free to use. (Photo credit: Wikipedia)
American Health Care Delivery Performance
Our health care performance statistics fall short of the rest of the industrialized nations in many areas. However, during the past two decades, J.P.Morgan analysts, describing the situation on Wall Street, stated that, “anticipated rate hikes [for insurance companies] should more than cover their rising costs…insurers and managed-care companies reaped profits from insurance premiums of 12-18%”. The J.P. Morgan report assured investors that the companies should be able to continue to achieve the same high levels, “thanks to a combination of higher rates, higher co-payments, and higher deductibles”. The researchers predicted equally glowing future success for CIGNA, Wellpoint Health Networks, UnitedHealth Group, Oxford Health Plans, Health Net, Humana, and several Blue Cross Blue Shield plans. Bully for business, and not such great news for We the People out there trying to get by and to get good affordable health care.
We have a great national resource in our health care providers; life expectancy climbed to 77.8 years for a baby born in 2004, an improvement of three years over 1990, and life expectancy continues to inch upward. Mortality from heart disease, stroke, and cancer–the three main causes of death–continued to decline somewhat in recent years. We can do better: life expectancy in 1999 in the UK was 77.4, in Canada, 79, while, at that time, that figure was age 76.7 in the US. In 2013, we do better than that, but almost all developed nations continue to do better than we do. We should be able to do as well as those other comparable capitalism based economies. Our problem as Americans is to extend the benefits of all the commitment, work, and science extant in our truly marvelous American health care resources to every one of our citizens with a delivery system that we can afford, and that will take great compromises. Other nations do it successfully; so, we should not accept a third class status whatever our excuses may be.
An individual, as a consumer, employee, or employer, in America pays out money for health care in one form or another to governments at all levels, private commercial insurers, traditional and nontraditional health care service providers, to merchants for traditional and nontraditional medications, manufacturers of devices and technology, to the courts and legal systems, and for societal expectations. People without insurance who do pay for their care get nothing of the discount afforded employees of large businesses and insurance holders; on average they pay double. Over the past several decades there has been an upward sea change in health and financial costs with more and more people being left behind.
Unhealthy Lifestyles:
In 1976 fifteen percent of Americans were obese, and the numbers began a steeper ascent in 1980. In 2006 thirty-two percent of Americans on average were obese. The statistics are even worse in some states. There are 72 million obese Americans, a far higher number per capita—and one that keeps on growing–than most of the rest of the world. Type II diabetes in the earlier era was a relatively uncommon problem, but with the rise in obesity, there has been a concomitant rise in diabetes with all its financial and human costs including heart disease and stroke. Obesity contributes to 300,000 US deaths each year; obesity in adulthood contributes to a decrease in life expectancy on a magnitude similar to smoking, the number one behavioral contributor to death. A child with one overweight parent has a 40% chance of being obese; with two overweight or obese parents, the child has an 80% chance. Obesity is associated with an increased risk of hypertension, diabetes, dyslipidemia, cardiovascular disease (CVD), obstructive sleep apnea, GERD, gallstones, gout, asthma, pseudotumor cerebri, cancers—breast, colon, and uterine—major depression, and suicidality.
Obesity rates appear to have come to a plateau at thirty-four percent, an unacceptable level which appears to be a new social “normal” despite herculean efforts at education from all informed sources. Among the obese, the obesity develops earlier, even in childhood, and is more severe. Experts concur that half of Americans will have diabetes if the current trends persist. Half!!. We cannot afford what we now have. Imagine that chronic disease wreaking almost twice as much trouble. Much of the etiology of obesity comes from sedentary lifestyles and preferential and habitual consumption of high glycemic (sugar) foods and foods high in fat, as are found in most fast food fare. Simple changes in choices could stem the tide and even virtually eradicate the problems of obesity and attendant diabetes with all of its complications. Federal laws are in the making to mandate healthy foods in schools, but that measure may be too-little-too-late. There are powerful social and business impediments to implementation of diets for children that are good for them and that they will eat. Parents need to resume control of their children’s diets and to educate them about the value of healthy choices. We, The People, need to have a respite from paying for the aftermath of such choices made by a significant minority of our population.
“Unhealthy life styles account for about 40% of the costs of health care. Obesity accounts for $91 billion; one in five (20.8%–45.3 million in 2006) Americans smoke, and smoking costs $137 billion (it is the leading cause of preventable disease and death in the nation), drugs and $300 billion, and trauma about $260 billion,” according to Dr. Blair. STD rates, including HIV/AIDS, gonorrhea, herpes, and even syphilis are on the rise with all of their attendant personal, social, and economic cost. The US Center for Disease Control and Prevention (CDC) estimates that the number of Americans infected with the AIDS virus is 50 percent higher than previously believed and the number of infected Americans is now between 55,000 and 60,000—a number that is growing despite a barrage of earnest communications about the dangers of the lifestyles and practices that spawn STDs. The medications are astoundingly expensive, are required lifelong (which is usually many decades); and, because of the debilitating character of the disease and the drugs used to treat it, many victims are unable to pay for their care; and the victims become unproductive drains on the public purse who are living longer and are costing more and more as time passes.
Death rates from motor vehicle related injuries have remained stable at 15 deaths per 100,000 people per year. Many of those deaths are related to careless driving, excessive speed, intoxication, and excessive drowsiness all of which are avoidable. Many injuries and deaths occur in the uninsured, and, in the end, the American taxpayer pays the cost. The National Health and Safety Administration estimated for 1994 that 4% of all traffic crash fatalities involved drowsiness and fatigue as principle causes. The cost was calculated to be $83,000 per fatality with a total cost of $12.5 billion, much of that from workplace loss and loss of productivity. Proper diagnosis and treatment of obstructive sleep apnea and excessive daytime somnolence would greatly alleviate that cost; use of night time CPAP and day time use of a relatively new drug, Modifinal (Provigil) by people with the conditions would be a benefit for all Americans. Our motorized vehicles are far superior in terms of safety and survival after an accident than they were in the “good old days” of heavy, gas guzzling, steel vehicles. That should not much of a comfort to those of us who must foot the bill for the cost of such accidents, whatever the level of improvement there is.
A drug use survey conducted by the University of Michigan Institute for Social Research and released December 11, 2007 by the White House revealed that fewer young people use marijuana, and methamphetamine, or some other illegal street drugs, as reported by Theo Milonopoulos of the Los Angeles Times. But, the gradual decline in the “softer” illegal drug use has been offset by serious trends in teenage drinking, heroin, and cocaine use. Even more concerning is the developing misuse of prescription drugs such as Oxycodone, Hydrocodone, and Oxycontin. The Salt Lake Tribune, in its communication about the Times article, quoted Nora Volkow, director of the National Institute on Drug Abuse which financed the University of Michigan’s survey. She observed, “Despite all of the successes of reduction of all of the illicit substances, the use of prescription medications has not budged.” Ten percent of teens reported that they have used Hydrocodone, the generic for Vicodin, for nonmedical purposes within the past year. The illicit use of prescription Oxycodone and Oxycontin, increased 30% since 2002. 71% of the young people found their drug of abuse in their parents’ medicine cabinets. Although the report indicated that 860,000 fewer children use drugs since 2001, as President Bush announced, most of that decline is due to a cutback in marijuana use which is the least dangerous of the street drugs. That is, of course, a good thing; one marijuana cigarette is the equal of five regular tobacco cigarettes in the amount of harm done to the user’s health. Cocaine and heroin use has remained steady, and the use of highly addicting prescription synthetic pain killers is growing at an alarming rate. The financial cost is daunting—to all of us–and the human cost is incalculable.
Pediatric specialty societies are becoming alarmed at a relatively recent fad for young girls to adopt vegetarian diets without having any idea how to maintain adequate protein intake. This results in osteoporosis, spinal, and long bone pathological fractures, dental and jaw bone demineralization loss with resultant destruction of teeth. This expensive problem is avoidable with proper education and parental intervention. Physicians are seeing a resurgence of rickets, a vitamin D deficiency syndrome which was rare a few years ago and should be nearly universally avoidable today. People, especially children and the elderly, are not getting out into the sun for even the twenty minutes a day required. They sequester themselves indoors with television and electronic gadgets at the expense of healthful outdoor exercise. They do not drink milk—most of American milk is Vitamin D fortified. They get hyperparathyroidism, hypercalcemia, and have falls (in the elderly). They and the taxpayers pay a significant price for such an unhealthy way of living.
A disturbing number of Americans choose, for one reason or another, not to be vaccinated and not to have their children vaccinated. Not only does that decision result in more disease and suffering—witness the frequent outbreaks of whooping cough and their effects on schools, children, families, and the health care system. (The disease is preventable)—but there is a considerable financial burden to be borne by all of us because of people who become infected due to exposure to these preventable infections. They consume health care dollars, miss work, and decrease productivity. For reasons of protection against disease and cost, The Church of Jesus Christ of Latter-day Saint’s extensive missionary system no longer permits un-immunized missionaries to be sent out of the nation in which they live. Despite the beliefs and protests of those who oppose vaccinations, the benefit is readily apparent even in a single disease, measles. For decades, the number of new cases of measles that originate in the United States has been zero, and that is a direct outcome of vaccination programs and successes that have eradicated that most contagious of epidemic communicable disease which used to result in severe adverse effects and death at such an alarming rate. Eventually, measles, like smallpox will be a scourge of the past. On average, we see only about 200 cases of measles a year in the US; and every one of them originates from exposure outside our borders. Vaccinations work, and they save both lives and mountains of money.
Pneumococcal pneumonia kills more Americans than any other infectious disease agent and adds a very large monetary cost to the health care system. There are 50,000-63,000 cases of S. pneumoniae bacteremia and 13-19% of cases of meningitis are due to S. pneumoniae in the US each year. Prior to vaccination with conjugated pneumococcal vaccine, 200 children died each year of meningitis. In the US in 2005, there were 4,500 cases of antibiotic resistant S. pneumoniae. In Utah alone in 2006 332 Utahns died of pneumococcal pneumonia and 6000 were cared for in hospitals. They incurred costs ranging from $3,907 to $14,695. For patients with co-morbidities, the cost was even higher—ranging from $2,814 to $38,314, according to the Utah Medical Association (UMA).
Much the same can be said for influenza vaccinations. The disease has killed 36,000 Americans a year every year since 1990, and in not infrequent epidemics there resulted an average of 226,000 excess hospitalizations despite the existence of two safe and effective vaccines. Efficacy is 77% and 91% respectively for the two vaccines and serious adverse reactions (Guillain-Barre’ Syndrome, anaphylaxis, and seizures) occur at a rate of one per million vaccinations in persons not allergic to eggs; otherwise 10-20% minor adverse reactions such as muscle aches and fever were all that happened. Jeannette Moninger, writing in Parents Magazine, December, 2007 said, “Only 18% of children age 6 months to 2 years are vaccinated despite the fact that an estimated 20,000 babies and toddlers with influenza need to be hospitalized each year according to the…CDC.” The American Academy of Pediatrics noted that in the flu season of 2003-2004, 153 children in 40 states died and therefore the Academy recommends all children from six months to five years of age be vaccinated. Money need not be a barrier; the CDC’s Vaccines for Children provides free vaccines for Native Americans and Medicaid eligible children or children without insurance or with insurance that does not cover vaccines. CDC researchers assure the public that vaccines are safe; in a New England Journal of Medicine article, they reported their extensive research and concluded emphatically that “there is no association between autism and vaccines”. Similarly, no relationship between autism, or any other complication, has been found from the tiny amount of Thiomersal used in some past vaccines. 30% of US school age children get the flu each year and spread the virus to other people; that does not need to happen, and we cannot afford it.
In the pre-vaccination era, Hemophilus Influenza B (Hib) invasive infections and meningitis occurred in one out of 200 children under the age of 5 with about 20,000 cases a year being diagnosed resulting in a case-mortality rate of 2-5%, often due to suffocation from epiglotitis. Brain infections (encephalitis) occur, and the survivors are often neurologically and intellectually devastated. In the post-vaccination era, there has been a 99% reduction in invasive Hib cases and deaths, and serious adverse reactions to the vaccine are very rare and largely preventable.
Poliomyelitis is a great success story: in 1952–the pre-vaccination era–there were 21,000 cases of paralytic disease in the US and an overall case fatality rate of 15-30% in children and 25-75% in adults depending on the type of polio. In the post-vaccination age when 95% of the population is vaccinated, the last known case of wild virus polio infection in America occurred in 1979, affecting a little Amish girl who was not immunized for religious reasons. The risk of contracting polio from live attenuated vaccine is one in 2.4 million doses—a statistically negligible risk. It is costly and personally and publicly unconscionable to withhold vaccinations from children.
Human papilloma virus (HPV), the causative agent for cancer of the cervix and some head and neck cancers, now has an effective vaccine. Unfortunately, because of the sexual and moral implications, a disappointing number of women and parents of girls avoid getting immunized or having their children immunized. Combined with Pap smears, cervical cancer could well be eliminated, but to this date the human and economic costs continue to be high. The benefit to risk ratio for all immunizations is only slightly less than 1.0 (perfect). Many of those infections described could be prevented altogether by obtaining universal immunizations, and still, despite all of the readily available evidence of safety and efficacy, many people avoid having immunizations for such flimsy reasons as fear of the needle.
The onus for all these unhealthy lifestyle choices falls unfairly on We, The People. When insurance companies pay the costs, we absorb them by our increased insurance premiums. Medicaid, Medicare, and other welfare security net programs exist from our taxes.
To be continued…
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Carl Douglass – Author
Carl Douglass Books
www.carldouglass.com
“Neurosurgeon Turned Author Writes With Gripping Realism”
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