Tag: Cost of Health Care

Can Socialized Medicine Work?

In the upcoming election this November the question of socialized medicine is likely to play a big role. This issue has been visited and revisited innumerable times in the past, but with the rise of the socialist agenda in this country this concept needs to be reassessed once more. While there is clearly a need for some form of universal health care, that does not mean that universal Medicare or socialized medicine controlled by the government is the right way to go for all of us. In fact, it is probably the worst way to go. Dealing with a huge monolithic organization such as Medicare and expanding it in order to be able to cover all persons in the country would add a gigantic financial burden to our economy. There is no “free lunch” here or anywhere else. Someone has to pay, and that would be the taxpayer one way or the other. By the way Medicare, Medicaid and even the VA for that matter can all be considered forms of socialized medicine. Medicaid is a state run health care program for people with low income. It is funded by the state and subsidized by the federal government as well. The VA Health System is for our veterans and paid for in large part by the federal government though depending on income criteria, whether the illness or injury was service related and other factors, the veteran may be responsible for some costs and co-pays. So as a nation we have already had experience with some forms of “socialized medicine,” and that experience has not always been good.

We all contribute to Medicare during our working lives. Upon reaching age 65 we begin to receive the benefits of the contributions we have made to the Medicare program during our working years. This is the medical insurance program designed to provide health care coverage as most of us start to reach retirement age and will no longer be the beneficiaries of our employment health insurance program. Medicare for all of its faults is an essential program for our elderly population. Without it the great majority of our retired elderly population would have no health coverage at all.

However, the bureaucracy of Medicare is enormous, and a Medicare for All program would complicate this bureaucracy even further. It would also lead to even greater financial deficits and more wasted dollars for a program that is already financially strapped yet crucial to the care of our elderly. More importantly the quality of medical care would likely suffer. In Canada and Great Britain each of which has its own form of socialized medicine, it may be relatively easy to see a family practitioner or nurse practitioner for a simple problem. This may account for some of the popularity of these programs, but for serious problems it could take weeks to get to see a specialist, have the proper testing or procedure done. So it may be a matter of the healthy getting good care or perhaps unnecessary care expeditiously, but the not so healthy getting not so good care. In a study done by the congressional budget office a few years ago comparing U.S. health care to Canadian, a number of interesting things were found. For example, the proportion of middle aged Canadian women who had never had a mammogram was twice that of the U.S. rate. Three times as many Canadian women had never had a Pap test. Less than 20% of Canadian men had ever been tested for prostate cancer compared to 50% in the U.S., and only 10% of Canadian adults had a screening colonoscopy compared to 30% of U.S. adults. This might account for the higher mortality rates in Canada for breast, prostate and colon cancer. From my own personal experience practicing at a major New York City medical center for many years, I saw many patients coming from Canada, Europe and elsewhere for treatment that they could not get in their own countries in a timely fashion.

In a study done by the Fraser Institute in 2016, 63,000 Canadians left their country in 2016 to have surgery done elsewhere. A study published in the New England Journal of Medicine showed that in Canada, despite it’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services. Another study showed that high-profile patients enjoyed quicker access to specialized care.  Moreover, among the nonelderly white population, low-income Canadians were found to be 22% more likely to be in poor health compared to their U.S. counterparts.

I have singled out Great Britain and Canada as examples of socialized medicine with less than desirable results, but most other forms of socialized medicine are similar.

Apart from the statistics what are the real issues as to why socialized medicine is may be bad medicine? Let’s take a closer at some basic points from a patient’s point of view.

  • First, although it is great to not have to pay for health care, at least not directly, we as patients always pay a price one way or the other. As I said before “free health care” is not free. Some one has to pay the piper, and we as patients will pay through increased taxes.
  • Second, socialized medicine will likely lead to rationing of health care. The bond between you, the patient, and your doctor will be weakened. Your doctor may act as your advocate against the behemoth of socialized medicine, but his effectiveness will be weak. There will only be one game in town, the socialized game. It’s hard to fight the government.
  • Third, the government will try to placate you by giving you free eye glasses and gym memberships with the mantra that preventive health care is great, and it is. However, you will be short changed on big ticket items which are more important such as your permitted length of stay in the hospital; your allowed rehabilitation days; what diagnostic tests you can get; which procedures you are allowed to get; which medications and so forth.
  • Fourth, your choice of doctors and hospitals will be limited.
  • Fifth, and perhaps most importantly, your ability to contest anything about how you are medically treated will be essentially eliminated. The bureaucracy will overwhelm you. What other choices will you have? The answer is none. It will be a one provider system. There will be no competition for your health care dollars. It all goes to the government.

Now let’s take a look how socialized medicine will affect practitioners.

  • First, practitioners will essentially become government employees. While socialized medicine may try to instill a sense that the practitioner will still be independent, this will most definitely not be the case. The practitioner may be working for the government as an “independent contractor,” but once again there will be no other game in town. So if you as a practitioner do not like the way care is being rendered to your patients, you have no options.
  • Second, medical care will become more impersonal. It will become an issue of quantity over quality. Arbitrary “guidelines” will be established dictating how many patients should be seen an hour. Fail to met the quota and your salary will be affected.
  • Third, more errors will be made because time constraints will prevent more thorough evaluations and follow up, but don’t worry malpractice insurance will be covered by the government. The problem with that is that it may be cheaper for the government to pay off a case than defend you against a wrongful accusation.
  • Fourth, professional satisfaction will diminish. Being a medical practitioner will no longer be a profession but rather a job and will be treated as such by the practitioner.
  • Fifth, like most government run programs practitioners will be overwhelmed by tons of unnecessary paperwork which will only serve to distract the practitioner from the real work at hand which should be to take care of patients’ needs.

So having said all of this, how do we get around the problem of providing good quality care without skyrocketing costs for those of us who have so called “private insurance” and perhaps also for those of us on Medicare, Medicaid or in the VA system? How do we take good care of patients in a way that is fair, sensible, effective, and less expensive than what we are paying for now? How do we do this in a way that is also good for practitioners most of whom at this point are frustrated and demoralized by the complexities, inconsistencies and hardships of practicing in the current systems of healthcare delivery?

More thoughts about how we can set up a health care system or systems that will do just that in following blogs.

Finally A Plan To Help With The Cost Of Drugs In The US

For decades the citizens of this country have been ripped off by the big pharmaceutical companies and their intermediary distributors. I’ve written about this previously (What’s Wrong With The U.S Health Care System?), but now with the stroke of a pen and by executive order President Trump has finally been able to do what preceding presidents and congresses have never been able to achieve. There will now be a system whereby the cost of drugs for citizens of the U.S. will be on a parity with other countries. This a great day for all of us whether Republican or Democrat.  Let’s see how his works. Here are a few of the key points. 

  • Health and Human Services (HHS) will end the “kick back” system that allowed  middle men distributors to jack up the price of drugs that are sold at the pharmacy. Medicare patients will see these “kick backs” as discounts in their Medicare Part D plan instead of the money going to the middlemen. 
  • There will be particular savings on insulin products dispensed through federally qualified health centers (FQHCs). This will be especially helpful to many uninsured or underinsured patients.
  • Through the Medicare program seniors in the U.S.  will pay no more for Medicare Part B drugs than patients in other economically comparable countries.
  • A pathway will be created for safe, imported lower cost drugs.

This plan may not solve all of the problems regard the high cost of pharmaceuticals in the U.S., but it is certainly a step in the right direction.  This is a step which previous presidents and congresses should have taken decades ago.  No longer will U.S. citizens be the only ones paying for the innovative research which the pharmaceutical companies often use as an excuse for the exorbitant costs of their products.

 

Drug Costs

What Have We Learned From Covid-19

Hopefully we are drawing to a close of the Covid-19 pandemic or at least getting it under better control although the recent rioting the country has experienced may be leading to a new wave of infections far worse than the resurgence that was previously predicted. Nonetheless, the pandemic seems to have slowed down a bit for now so now may be the time to reflect on the state of the pandemic and some lessons that we may have learned.

First, it is clear that we were by no means well enough prepared for an event such as this. We had had warnings that something like this might happen, but we failed to recognize the warning signs. SARS, MERS and the H1N1 viruses were the warning signs that a worse virus was likely to occur at some point in the future, and it did so in the form of SARS-CoV-2.

The orginal  SARS (severe acute respiratory syndrome) broke out in 2002. SARS first affected people in southern China, but it eventually spread to 29 countries. It apparently started in animals, but then spread to humans. There were at least 8,000 cases world wide, and it killed about 800 people giving it a death rate of about 10%. The SARS virus is very similar to the current  SARS-CoV-2 virus which causes the illness that we now call Covid-19, but by 2003 there were only 8 laboratory confirmed SARS cases in the US. H1N1, otherwise known as the swine flu, is a different type of virus more closely related to the influenza virus. Between 2009 and 2010 it caused 60.8 million infections in the US and 12,469 deaths. Another coronavirus (MERS-Cov virus) first reported in Saudi Arabia in 2012 also caused a severe respiratory illness known as the Middle Eastern Respiratory Syndrome with (MERS). Only two people in the US have been know to come down with this virus and both survived. 

The U.S. should take Covid-19 as a warning and start preparing for the next pandemic as soon as possible. There are many reasons why this is likely to occur. Spontaneous mutations of the Sars-CoV-2 virus and introduction of new viruses from the wild into human populations are just a couple of reasons why this might happen. Given the interconnectivity of people traveling throughout the world, the spread of a new contagious virus in a pandemic fashion is very likely to occur. Shi Zhengli, a Chinese virologist, has warned that we are now dealing with the “tip of the iceberg” when it comes to impending viral epidemics.

This should tell us that we need to expand work on antiviral agents that will have as broad a spectrum as possible in terms of antiviral coverage especially since vaccines take a long time to develop and are not effective once the virus has taken hold in a patient. Think of vaccines  as preventive treatments, but treatments that may need to be changed frequently since the vaccines are often very type specific. We also need to develop better pharmacologic agents that will block entry of the virus into the cell so that it does not have a chance to propagate within the cell,  and treatments that interfere with the replication of the virus if it indeed manages to enter the cell.  Furthermore, we need to work on developing treatments for effects that the virus has on the body if it manages to enter the cells and replicate. This is what triggers intense inflammatory reactions such as the “cytokine storm” and “the multisystem inflammatory syndrome.”  So from a patient management point of view we need to work on three things: better antiviral agents with a broad spectrum of coverage; the ability to adapt manufacturing processes for vaccines quickly because the virus will change and new ones will appear; better regimens for treatment of the effects of the virus once it enters the body. Of course all of the above has to be achieved in such a way that we are never dependent on a foreign country, much less a potential adversary, to supply us with the medicines, vaccines or anything else needed for us to treat another pandemic. 

We learned that social distancing, as controversial as it may be,  likely had great impact on the mitigating the spread of Covid-19, and it is a practice that in all likelihood should be implemented again quickly as soon as the next pandemic arises.  The current pandemic showed us that certain areas of the country were more impacted than others for a variety of reasons that we are still being investigated. 

Very importantly this pandemic was also a lesson in logistics that should not be forgotten, and it goes hand in hand with the evidence that not all parts of the country were similarly affected by this virus. There has to be mobility in terms of the delivery of healthcare in any crisis situation we may face in the future so that we can deliver medical personnel, equipment and medications where they are needed. This includes the ability to to get mobile hospitals up and running anywhere in the country they may be needed. We demonstrated some of that capability when the Javits Center in New York was converted into a hospital, the hospital ship Comfort arrived in New York and Samaritan’s Purse set up camp in Central Park to help out with the hospital bed shortage. However, for reasons that are as yet puzzling and distressful, none of these facilities was used effectively in terms of terms of relieving the overwhelming burden of the those city hospitals that were inundated with Covid-19 patients.  For future medical catastrophes, which are sure to come, we need to be able get mobile hospitals up and running quickly wherever they may be needed. 

 

 

 

What’s Wrong With The U.S Health Care System?

blue and silver stetoscope
Photo by Pixabay on Pexels.com

CaduceoBasic Problems with U.S. Health Care

I am writing this series of articles as a commentary on some of the basic problems in United States health care delivery as I see things today based on my experience as a practicing physician for over 40 years. I realize that the problems with the health care system in this country are numerous and extremely complex, but in order to solve them I think we need to ask some basic questions about how health care is delivered and financed. I don’t pretend to have all the answers, but I think it is time for some fundamental changes in the concepts about how health care is delivered. We are in need of a paradigm shift in our thinking as it relates to health insurance coverage, pharmaceutical pricing, physician/patient interaction, malpractice insurance, and many other aspects of medical care as it is provided to the public at this time. To continue to try to “fix the system” as we are now doing by creating more complex insurance coverage plans is ultimately doomed to failure.  When a system is broken beyond repair sometimes you need to start from scratch. I think the country is finally at that point when it comes to health care.

Why Are Prescription Drugs So Expensive in This Country?

First in this series of articles we will consider why prescriptions drugs are so expensive in this country and what can be done to remedy this. One of the major reasons for this problem is that the United States lacks any central agency that regulates the cost of pharmaceuticals. This is in contrast to most other countries around the world where government agencies negotiate prices with pharmaceutical companies and distributors. Currently U.S. laws actually protect pharmaceutical companies from free market competition.  Medicare and insurance companies are in general are not allowed to negotiate prices. Even though governments in other countries negotiate prices for the drugs which their citizens require, the pharmaceutical companies still make big profits in those markets. The pharmaceutical companies in this country spend huge amounts of money lobbying our legislators  to protect their interests. Our legislators, the people we elected to serve and protect us, have failed to institute legislation that would protect us from the exorbitant charges we encounter when we need to purchase these pharmaceuticals. Could it really be that powerful pharmaceutical companies effectively lobby our legislators to prevent this from happening? The inescapable conclusion is that this in fact the case. To make matters worse for consumers in the United States it is technically still illegal to “import”  less expensive yet identical medications from other countries into this country for personal use.

The pharmaceutical companies often justify the excessive costs that are passed on to the consumer as being necessary because of the expenses entailed in the research and development of new drugs. However, there are many drugs that come to market as really what I call “me too” drugs. These are simply drugs that are fundamentally the same as drugs already in production that have been proven to be effective. For example, there are numerous drugs for COPD, asthma, cholesterol, hypertension and other illnesses that are really quite similar to each other. In actuality there is often very little difference in terms of the mechanism of action or effectiveness of  many of the drugs that are used to treat these disorders when the data concerning them is carefully scrutinized. Yet millions of dollars are spent by the pharmaceutical companies to bring these “me too” drugs to market. Why is this so? The reason is simple. The market for illnesses such as those I have listed above is huge. So a “new drug” coming to market for these illnesses is likely to generate a great deal of revenue for the pharmaceutical manufacturers. Consequently, once this new drug gets approved by the Federal Drug Administration millions of dollars are next spent on marketing by the pharmaceutical company that developed it to get a larger piece of the pie. From the pharmaceutical companies’ point of view this makes excellent sense because it generates more revenue, and the pharmaceutical companies often justify these enormous profits because they claim the money is needed for further “reasearch and development.”  However, from the consumers’ point of view, particularly the U.S. consumer, it is still an outrage.  The same drugs that we use here in the U.S. are sold at a fraction of the cost elsewhere in the world. We in the U.S. are providing the bulk of the money that goes for “research and development” by the pharmaceutical companies. Furthermore, only a portion of that money actually goes toward the development of truly new and innovative drugs because that is a much more risky undertaking. Why risk millions of dollars on the development of really new innovative drugs when you have a sure bet on a “new drug” that is nothing more than a modification of an old drug, and all you have to do is market it effectively in order to make more money? This is not to say that truly innovative, wonderful new drugs do not come down the pike once in a while and that the development of these drugs is not costly, but a lot of the research and development money seems to be plugged into the creation of “new” products that are really variations of preexisting drugs. Even with the creation of really new drugs, which in many instances may be lifesaving and may profoundly improve quality of life, the profit margins appear to be enormous with the U.S. consumer providing the bulk of these profits.

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