Even the CIA doesn’t trust your health care (12/03/10)
Your Survival is On the Line
In a time of Wikileaks revelations it’s hard for any story to stand out. When US diplomats are asked to obtain DNA samples of any significant foreigner they meet, and the Saudi King is telling the US how to bomb Iran, who cares that the CIA says the US now ranks 49th in the world in average lifespan?
You should. It’s your life that’s on the line. We used to compete effectively with Cuba and Lithuania, but not anymore. And things are about to get worse.
Health Care That Isn’t Healthy
American health care works something like this – in a horrible job market you finally land a job at McDonald’s. At least you enjoy the food – it’s the only thing your family’s been able to afford since you lost your real estate position three years ago. As you work wildly different shifts and get more stressed, you eat more and more – especially on the job.
When you experience horrible, sudden chest pain, the doctor in the ER tells you need a cardiac catheterization. The coverage you receive from your full-time fast food job, $2000 per year ,will pay for 5% of the “cut rate” $40,000 catheterization cost – except you just blew $1000 on the ER visit. The doc shakes his head, pointing out you should lose weight, exercise more and stop eating “industrial food” (McDonalds meals), except it’s still the only nourishment you and your family can afford – and cheap thanks to government subsidies to agribusinesses.
The doc shakes his head again, and points out at least you’ve got “some” health insurance, and 51 million people have nothing, and another 50 million are on Medicaid – “and that hardly covers anything, either.”
We’re Number One
A recent study by professors Peter Muennig and Sherry Gleid at Columbia’s Mailman School of Public Health states that the US is indeed Number One – in inefficient and ineffective health care. Comparing the survival rates for 45 and 65 year olds (know anyone in those age groups?) over a fifteen year period, they looked at the US and 12 other industrialized countries. According to World Health Organization data from 1975 to 2005, we increased our costs more than twice as fast as the others, tripling funding overall – and improved outcomes less than anybody. Once again, we were numero uno– the highest costs and the worse results. And don’t even think about what those excess costs do to American economic productivity.
Procedure Based Medicine – Follow the Money
There are many, many reasons why American health care works abysmally. Probably the foremost is that our debate is perennially about the wrong thing – health care, not health. Health is hugely affected by eating, smoking, lifestyle, and even powerfully by how much greenery there is in a city – differences between the longest and the shortest survival British groups more than halved if there was more parks and open areas in which they lived.
Yet especially since Medicare promulgated “relative based value” scales to pay doctor fees in the 1970’s, created by William Hsiao and others I got to meet as a youngster working at the Harvard School of Public Health, health funding in the US has gone to procedures, not health. With the best government money can buy, lobbyists control what gets paid for in your health care. You can inspect the 2700 page health care bill for the details. As I pointed out during the health care bill debate, the then-worried health insurance industry could have taken 1% of their revenues and paid $10 million into every Congressman’s campaign coffers and still had $2 billion left over to fund the media. In the end, the results cost them, the device and pharmaceutical companies far, far less. Compared to our national $2.4 trillion health care bill, buying politicians is cheap.
And many Congressmen are very understanding. Quite a few are former lobbyists or know them very well – like our new speaker of the House, famous for handing out campaign checks to fellow congressmen on the House floor – direct from the tobacco industry. He did say he’d never do it again – in the chambers of the House.
The business of the nation’s health is business. If you do have health insurance, getting paid for your cardiac catheterization means that GE, Siemens, Medtronic, and a large host of others with friends in Washington will get paid – so you can expect you’ll get that procedure.
And your doc knows her money comes from procedures, too. No one is willing to pay more than a pittance to give you health advice that might save your life plus oodles of money, but there’s big bundles of cash available for MOHS skin procedures, MRI scans, and liver transplants for those whose livers fried when they overdosed on Tylenol (don’t worry, Arizona is taking the poor off transplant lists.) One of my oncologist friends explained three quarters of her income came from her group’s chemotherapy infusion profits – only one quarter from the hard work she did. These days even relatively poorly paid internists are courted by large medical groups. Primary care docs can order lots of profitable tests – and many get nice performance bonuses for their test referrals.
What You Can Do
Don’t expect the national debate to approach sanity anytime soon. The idea that Health, not Health Care, is the issue, has not entered public consciousness. Congress keeps trying to fund Medicare at monthly intervals, knowledgeable that the money isn’t there. Their first, automated response – a 21% across the board cut in Medicare payments – won’t work, either. It might keep Big Pharma and the device companies in business, but should knock off the primary care docs who already find Medicare payments barely cover their increasing costs. And with potential political gridlock, Congress may spend much of its time restitching the deck chairs on the Titanic.
The truth is that more and more you’re going to have to rely on yourself. It’s not fair – luck controls much of what happens to your health – but that’s the way it is.
So you’re going to have to do what you can to up the odds in your favor. Knowing how your body operates, rebuilding itself rapidly and powerfully based on what you do each day, represents an enormous advantage. In a recent article, “Three questions than can save your life,” I tried to show very simple ways to help make your body in the way you want. For all of us, using your body the way it’s built will become the best health insurance you’ve got – a private health insurance no one can take away from you.
I’ll try over the coming weeks to show you more ways to improve your chance to live long and well. Don’t worry about the health care industry. They may not profit, but you will.
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