US Medical - Part 3

The Congressional Budget Office found that "about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology." On January 23, 2012 we heard about Ultrasound Therapy, surgery without a scalpel that’s been approved by the FDA for fibroids and is being tested for other surgeries; the recovery period can be as little as 10 seconds with less complications; I would think this type of technology change would reduce cost not increase it. In December 2011 the outgoing Administrator of the Centers for Medicare & Medicaid Services asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the health care system, (4) burdensome rules and (5) fraud. I already talked about the failure to coordinate so I’ll talk about the other items.  

1)  In 2011 a Journal of the American Medical Association study suggested that half the angioplasties performed on stable non-emergency patients are either unnecessary or uncertain. It was also reported that $25 million in unnecessary Cat Scans are charged to Medicare as smaller community hospitals don’t have the resources of the larger teaching hospitals to make quick and efficient diagnosis on their own. In addition to the patient being put to an unnecessary higher risk of radiation, I think money would be better spent on providing the best equipment to all facilities; there could be a savings in 10 years. On January 19, 2012 we heard that Medicare pays for bone testing every 2 years, doctors are concerned only 13% of women are getting the baseline test by age 65; however the New England Journal of Medicine said women whose bones have been tested as good don’t need to be retested for another 15 years if they continue with calcium, vitamin D and walking; tests showing moderate bone loss need repeating every 5 years and severe loss every year; signs that can vary testing needs are a family history of osteoporosis, a broken bone after age 50, the consumption of more than 2 alcoholic drinks a day and taking medicine with steroids. People complain that old people cost too much in their last few years of life without a change in outcome – death. I wonder why the old and those with debilitating diseases are forced to live if there is no hope of living with dignity - we should suffer and die slowly while putting our families or the government through such financial burden. I would think assisted dying (not murder or suicide) would be an alternative. We’ve taken the first step with Do Not Resuscitate instructions. We have compassion in putting our animals to sleep so they don’t have to suffer; perhaps Jack Kevorkian understood that humans should be given the same compassion if it is what is desired by the person suffering.

3)  I believe that just a passing grade is all that’s needed to enter the medical field and there are loopholes that allow doctors to practice without a valid degree or sufficient sleep. I don’t believe that medical schools and licensing boards are doing enough to catch cheaters that shouldn’t be practicing. I’m assuming that facilities that hire physicians now have an expedient way of validating someone’s credentials as after the fact fines or lawsuits to not solve the real problem; some of our doctors are incompetent which leads to insurance companies charging outrageous malpractice fees to settle huge lawsuits. In 2011, I heard about 12 Southern California (CA) hospitals that were fined for errors that injured or killed patients. On January 6, 2012 Health and Human Services said 14% of hospital errors made on Medicare patients are being reported (others say it could be 1 in 10) and little is being done to stop them from reoccurring; Johns Hopkins pioneered a checklist of proper procedure and it reduced surgical deaths by 46%.

4)  Perhaps our strict laws on what is and is not to be used are a factor; people no longer needing a drug cannot turn them in to a doctor or pharmacist so they can be redistributed to others with a valid need. Although I understand why needles aren’t to be reused, I don’t understand why some instruments used in surgery are required to be thrown away instead of being sterilized and reused as with Doctors without Borders. 

5)  We need harsher punishments for fraud; in 2011 CA doctors were indicted for a $17 million worker compensation scam and 91 people in 8 cities were charged with Medicare fraud; on February 14, 2012, I heard federal authorities recovered $4.1 billion in health care fraud judgments last year.

6)  Other factors may include: US physicians' wages are double those in the Europe and US doctors are paid for procedures not results; some hospitals and doctors raise rates because they don’t get the full value of their services from insurance companies or the government and there’s the greed factor; changes in insurance coverage - the increased use of prescription drugs among adults who have drug coverage; rising prices - the US is one of 2 countries in the world that allows direct-to-consumer advertising of prescription drugs; ads cost money and raise the overall price; we deal more with vanity issues such as Gynecomastia, a condition that causes men’s breast muscles to swell and take on a female shape; anti-aging - the Human Growth Hormone costs $150 a bottle and the FDA has done nothing with this or indoor tanning both of which cause several medical problems; plastic surgery – Americans spent $10 billion in 2010; on January 19 we heard ice chambers and snake venom facials are the new fad; and the cost associated with artificial insemination or in vitro fertilization (IVF) is about 4 times higher in the US than in Israel (#1 for IVF use).