For too many US citizens, even after passage of the PPACA (Patient Portability & Affordable Care Act, usually referred to as Health Care Reform, or, pejoratively—Obamacare) and the minor improvements in the US economy after the zenith of the Grand Recession, the delivery of health care in the country is inadequate, mostly due to unaffordable cost. A USA Today poll in 2007 found that, “an overwhelming 80% of respondents said they were dissatisfied with the total tab the nation spends on health care…” Not much has changed between then and now. Federal politicians are, by their natures, unable even to begin a process of workable correction in a timely manner. No state alone can correct the national problem, and it is doubtful if even the most progressive and efficient state can fully correct even its own internal problems. There are a host of competing interest groups and industries, all with their own agendas and little incentive to compromise. We, The People, have an American problem, and the American public must become the catalyst to get useful and lasting improvements done. We must view it as a war, one which can only be won by a good faith and determined volunteer effort by a heretofore disinterested but perhaps now aroused public after the recent election cycle. Only then will our government act decisively.
Costs of the “System”
The problem is serious and getting worse. Utah Senator Bob Bennett commented on conditions since President Clinton’s universal health care plan imploded in the early 1990s, “In the intervening…years, the whole system has just gotten continually worse, more expensive, less responsive, and it desperately needs to be addressed”. That is true in 2013. Former Utah Governor and unsuccessful Republican presidential hopeful, Jon Huntsman said, “The way we go about handling health care is economically unsustainable.” The National Coalition on Health Care (NCOHC) observed that, “by several measures, health care spending continues to rise at the fastest rate in our history”. The Kaiser Family Foundation tells us that “premiums for employer-sponsored health insurance…have been rising four times faster on average than workers’ earnings since 2000”. According to Thomas R. Russell, MD, FACS, speaking for the American College of Surgeons, “The fragmented and labyrinthine schematics that define our current health care system regularly frustrate surgeons’ efforts to deliver, and patients’ attempts to receive optimal care. Consumers, surgeons, other physicians, health care professionals, policy-makers, and other stake holders all recognize the need for patients to receive care that is more coordinated than our current system allows…[T]hese cumbersome processes lead to wasted resources, unaccountable voids in coverage, loss of information, and a failure to build on the strengths of all health care professionals”. Everyone of those statements applies in 2013 and would have applied if expressed ten and even twenty years ago. We are losing ground.
Reports indicate that some 125+ million Americans have chronic illnesses, disabilities, or functional limitations. For example, in 2004 there were an estimated 11.4 million US adults aged 18 and older who were diagnosed with chronic obstructive pulmonary disease. That disease alone constitutes a staggering cost–$32 billion per year–for American insurance companies, their customers, and American taxpayers. 122,283 Americans died from the disease in 2003. And it is largely preventable by getting people not to start smoking (80-90% of cases were caused by smoking). Some 78 million out of our population of 300 million have undiagnosed, Type I, Type II, or pre-diabetes mellitus and 1.3 million new cases are diagnosed every year of this disease which is the sixth most common cause of death in our country. There is a direct correlation between obesity (a preventable condition) and diabetes. The disease is highly manageable, but costly.
Heart disease and stroke—the two leading causes of death–are as much as four times more common in diabetics. Hypertension effects more than 65 million people; nearly 1/3 of the population. 90% of middle-aged adults will develop high blood pressure in their lifetime at a cost of $63.5 billion for one year alone (in 2006); and despite a monumental effort by the governments at all levels and care providers, we have hardly improved at all. This disease, too, is fully treatable. Chronic gastro-esophageal reflux disease (GERD) costs Americans nearly $2 billion a week in lost productivity, and those symptoms are largely treatable, but with very expensive medications. In 1990, the most recent year for which verifiable estimates are available, the indirect costs alone of mental illness imposed a $79 billion loss on the US economy. Direct costs from diagnoses, hospitalizations, medications, and providers in 1996 for mental disorders including psychoses, dementias, and substance abuse ($13 billion) were on the order of $100 billion. 53% of the costs came from public coffers. In the past twenty years, the annual growth rate of these costs was 7% overall with 23% increases in Medicare and Medicaid for mental illness. Among the consequences of our overly expensive and demonstrably inadequate mental health care system is the spate of gun and automobile homicides and mass murders in the country. Practically speaking, a dollar spent in one government health care program is a dollar less for another program.
All specialties and providers agree that there are woeful inadequacies in patient-to-provider and provider-to-provider communication. There is documentation that about half of patients leave an office visit not understanding what the physician said, and only about a quarter of primary care physicians receive a specialty consult report within a month of the time that their patient saw a specialist. There are financial roots to this problem: there are too few physicians who see too many patients for too short of a time and are paid for rapid throughput, a decided change from two decades earlier. Only recently have states and municipalities begun requiring that providers and hospitals publicly divulge their performance, errors, success and failure records—a measure that has resulted in drastic changes for the better for some hospitals and the people they serve. A survey of physicians carried out by the Annals of Internal Medicine indicated that some 45% of physicians do not report their own or other physicians’ errors, however. The PPACA has legal requirements for medical care delivery to be patient centered and accountable and has introduced a strong push for instant computer records and messenging. Unfortunately, at the grass roots level—and even at the state level in many states—there has been a great deal of confusion and intentional foot dragging, and not much has been done.
There are superlative models for how these aspects of health care can be managed, such as the Mayo Clinic, Marshall Clinic, Kaiser Permanente, and Intermountain Health Care for example, but many of the rest of the nation’s clinics, large and small, lag behind and, when scrutinized, present a rather poor comparison.
In the ten years between 1993 and 2003, according to John Maa, MD, FACS, et. al, demand for emergency room care increased rapidly; emergency room visits grew nationally by 26 percent, an increase fueled in large part by the number of Americans without insurance—more than 47 million of them, 1/6th of the population. The other uninsured group comes from the ranks of undocumented immigrants, many of whom (of the 12-20 million illegally in the country) receive their primary care in ERs because they cannot afford to or dare not to have a primary physician or to see a specialist otherwise. Utah businesses that provide health benefits to their employees pay a “hidden” 17% premium tax to cover the cost of care for the 300,000 uninsured Utahns including 90,000 children, according to the Utah Hospitals and Health Systems Association (UHA)—360,000 according to Utah Governor Jon Huntsman. Fewer than 60% of Utah businesses now even offer health insurance to their employees. Although the PPACA mandates insurance for almost all Americans, the impact of the law will not be felt until after 2014. For the time being, we continue to languish in inefficiency and mediocre care for many of our most vulnerable citizens.
A Brigham Young University (BYU) study revealed that many companies are now offering wellness programs. Their findings indicated that for every $1 spent on wellness classes and programs resulted in a savings of $3.50 in care costs and $4 in absenteeism. Some employers are even suggesting that their employees go to Thailand, Singapore, and 25 other countries to get medical care for high-cost procedures. Jan Woodman, author of Patients Without Borders, expects the number of outsourced operations to exceed 200,000 per year for Americans, Canadians, and Europeans at a cost of nearly $3 billion. Granted, 70% of the procedures are cosmetic, there are, nonetheless, a substantial number of hip replacements, gall bladder surgeries, rotator cuff repairs, and the like, being done outside the United States. What a commentary that is on the delivery of health care to Americans.
Over 40 million American citizens cannot afford adequate health care and go without prescribed drugs (19 million), eyeglasses (15 million), medical procedures (15 million), or dental treatment (25 million) according to a federal government report released in mid-December, 2007, and that set of statistics is only worsening. A study by the American Cancer Society published in the journal Cancer demonstrated the grim fact that uninsured cancer patients are twice as likely to die within five years as those with private health care coverage. The Associated Press reports data that indicate that 20,000 people of the 560,000 cancer victims in the US are uninsured at the time they die. Medicare and Medicaid may not be available or, due to their administrative inertia, may provide the necessary care too late.
During the past ten years, the number of emergency departments in the United States declined by 425, and the number of hospital beds declined by an astonishing 198,000. The losses continue to mount since those statistics were announced a few years ago. A major contributor to the failure of these providing institutions is the inability to continue financially in a system that requires that everyone receive medical care but provides woefully inadequate or no compensation at all for too many recipients even after passage of the PPACA in 2010. Dr. Maa, in his article in the Bulletin of the American College of Surgeons, went on to document that “ambulances are frequently diverted from overcrowded emergency rooms to other hospitals that may be farther away and may have inferior services”. In 2003 alone, the authors assert, “ambulances were diverted 501,000 times”. Nothing has happened in the intervening decade to change the abysmal fact. This is chaotic and unhelpful at best and dangerous at worst. The overcrowding, long waits, and significant financial losses associated with this unfortunate set of facts exacts a serious financial toll on the American public in having to prop up suffering institutions and to subsidize the health care of a huge proportion of the body politic who contribute less than the cost of their care, to say nothing of the human toll.
To be continued…
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Carl Douglass – Author
Carl Douglass Books
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“Neurosurgeon Turned Author Writes With Gripping Realism”
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