Friday, July 10, 2009

Costly Health Coverage

Recently, I read an article in The New Yorker with this central theme: hosptials view you as an ATM rather than a patient. Instead of focusing entirely on how to treat you the best way (even if it won't profit as much), they sometimes will offer additional treatments and procedures, just to jack up some costs.

This article, "The Cost Conundrum" by Atul Gawande, caught my attention. After watching Michael Moore's documentary Sicko, my ears were pricked. America's health care system has been a debatable issue in the past few years, especially as Obama has been suggesting some major changes in this past year. But, I think he's right. Something is definitely off and not working in our health care system.

From the article: "In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control." Sounds good to me.

I think it's disgusting that health care practices seek profit from their patients in order to survive. Sure, it's a business, but their main goal should be to help people, not greedily empty their pockets. Everything is just so expensive too, nowadays. It blows my mind when other countries have better health policies--free health care!--and instead of shaking in their boots when someone is diagnosed with a terminal illness, they know they can get the best health care possible, and not because of discrimination. It makes the process all that more easy.

Why is it all about money?

"No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not. You must pay attention to insurance rejections and government-reimbursement rules. You must think about having enough money for the secretary and the nurse and the rent and the malpractice insurance."

But, this does not count for ALL hospitals and health establishments. Some are more oblivious to financial implications, and other see money as a way to improve what they do. With more money, they can receive more equipment, better doctors, better treatments, and more access to information. But, sometimes and maybe more often than not, profits are greedy and unnecessary, and that's what's bothering me. Doctors are meant to HELP PEOPLE, not strip them of their money like a thief.

I can't get Sicko out of my mind when I think of health care: I think of health insurance companies denying people because of just one yeast infection. I think of those same companies rejecting patients with long-term illness. I think of someone uninsured who had to fly from Florida to Canada in order to be treated. I think of high prices for inhalers on single working women who don't have enough money to raise their children and buy medication in order to survive. I think of ex-9/11 workers who don't receive government money to aide their health problems.

I thought America was the land of opportunity where men were free? They are not free of problems though. I know what democracy prides itself on, but this health care system is not fairly representing what America should be. I think it's downright embarassing when it comes to this health coverage scare. We're one of the "best" nations in the world yet we have one of the worst health policies in the world. Something is wrong with that!

This article touches on some of these factors, but its main focus is on the indulgence in charging customers. The article tries to get to the root of the problem: why is everything so expensive? Mainly, it focuses on a hospital in McAllen, Texas that has the highest health costs in the entire country. The problem is, their health care isn't any better than anywhere else, so why is it the most expensive?

Here are some interesting facts and quotations from the article to ponder:

"Our country's health care is by far the most expensive in the world."

"Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn."

"The financial burden has damaged the global competetiveness of American businesses and bankrupted millions of families, even those with insurance. It's also devouring our government."

"Public health statistics show that cardiovascular-disease rates in the country are actually lower than average, probably because smoking rates are quite low. Rates of ashtma, HIV, infant mortality, cancer, and injury are lower, too." So why is everything so expensive? To compensate?

"We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes."

"Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state's quality ranking tended to be. In fact, the four states with the highest levels of spending--Louisiana, Texas, California, and Florida--were near the bottom of the national rankings on the quality of patient care."

"In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received 60% more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse."

"In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least 60 million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens."

"After all, some hundred thousand people die each year from complications of surgery--far more than die in car crashes."

"To make matters worse, Fisher found that patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu or pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed."

"Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor's pen."

And consider this final scenario on health policy based on doctors' responses in El Paso, Texas:

"I gave doctors around the table a scenario. A forty-year-old woman comes in with chest pains after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there's no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization."

Maybe this is the major problem with health care:

"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country's best electrician on the job [...] isn't going to solve the problem. Nor will changing the person who writes him the check."

Overall, the points that Gawande makes are clear and troubling. It sickens me how the medical system works. It sickens me that man is motivated by money and will even have poor and middle-class people open up their tight wallets to dish out a healthy income that is many times multiplied by the one giving the money. It just doesn't make sense. It seems shallow and greedy, and I don't see why anyone won't do anything about it. I know it's opening a huge can of worms and it would cause a lot of change, and no one really wants to get involved in something this messy and drastic. It just bothers me. I can't stand this kind of behavior, and it sickens me how frequent this is happening.

What do you think of health care, Sicko, the facts here, or the article "The Cost Conundrum?"

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