WHY IS HEALTHCARE SO EXPENSIVE IN THE USA?

Part One

A few days ago I came across a video entitled, The Real Reason American Healthcare is So Expensive. Almost 3 million people have watched it, You really should, too.

The Real Reason American Healthcare is So Expensive

In typing this just now, I couldn't help watching it again -- which made it my fourth time viewing it (it's that good).  What it shows is that the high cost of healthcare in this country is NOT because of what we spend on Medicare, Medicaid, and VA healthcare -- our versions of socialized medicine in this country. In those public expenditures, our costs are right in line with other countries. Where we exceed them is what we spend privately. That's where we go through the roof.

I love the enthusiasm of the young man in the video, who says he's "obsessed" with this data. He points out that we hear all the time that the government "can't say no, it's corrupt, it's inefficient, it's slow; if you want something done right you give it to the private sector. That is what we hear in America all the time," he says, "yet here we are, with the biggest private sector, spending the most."  And it's not because we Americans go to the doctor more, he says, showing that if anything, we go less. He goes on to state the obvious, that the capitalist free-market model, while it may be great for selling things, simply cannot work when providing healthcare to people, who, when they need it, are in no position to comparison shop for the best value, even if they knew the best thing to shop for. And when presented with a sky-high cost , they are in no position to say "no." We are left with a graphic of our healthcare system -- symbolized by a huge hospital building with many lines of "influence" running from it to the Capitol Building in Washington, DC,  Although there are no arrows to show in which direction the lines of "influence" are flowing, and the young man doesn't say so explicitly, I gather that they are flowing not from the Capitol, but to the Capitol, and that influence is in the form of dollars. Our healthcare system has grown so powerfully wealthy, he says, that it's going to be very hard to trim the cost of doctors and the services and medicines they prescribe. 

It's almost as if there has descended on us, like a poisonous fog, a culture of money, a phrase I borrowed from Atul Gawande's famous New Yorker article, The Cost Conundrum. You should read it: 

The Cost Conundrum

Here Gawande describes the medical goings-on in the small, not-very-prosperous McAllen Texas, which had -- at the time of Gawande's writing (2009) -- the most expensive healthcare market in the country. Many healthcare markets -- such as El Paso -- were far more prosperous yet spent on medical costs only half the money spent in McAllen. With all this money spent in McAllen, one might suppose that the healthcare delivered there was superior. Not so -- in fact, Gawande reports the reverse: 

"Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care."

Why then? Gawande quotes a general surgeon: "'We all know....there is overutilization here, pure and simple.' Doctors, he said. were racking up charges with extra tests, services and procedures."  It got to the point, he said, where “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?”

Gawande contrasts all this with the practice at Mayo clinic, where doctors are not paid by procedure, but are salaried. The time they spend with patients is not a predetermined slot of 15 minutes,but is determined by the patient's need. And they regularly consult with other doctors in the practice, so that the outcome is a joint effort. Gawande writes that "No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs." 

It's no accident that in my recent posting [Good News ... Sort Of], Mayo is one of the hospitals cited for combining with others to establish CIVICA RX, a company which will produce generic medicines that the current cartel has attempted to price out of reach of many people. Intermountain Healthcare, also cited by Gawande for good practice, is another co-founder of Civica. Are they exceptions? As far back as 2009, Gawande pessimistically predicted that the Mayo Model seemed to be losing traction, whereas the McAllen model seemed to be winning.

Despite the remarkable surge in demand for Single-Payer, it may be too soon to tell which model will win. As we saw in the video above, Bernie Sanders proposes a transition plan to ease us into a full scale Single-Payer, but from my point of view, the crucial question will be whether or not Bernie or anyone else can succeed in putting price controls on Big Pharma. That is the epic struggle to come. Meanwhile, NYHA has such controls written into it, and it behooves us to push for it, publicize it, and do everything we can to hasten the day when Single-Payer will be the law -- if not of our country, then of our State.

PS: If you'd like to leave a comment -- and I hope you will -- just click on the number of comments area and share your thoughts in the "comment box" that appears.

PPS: My surgery went well, and I'm doing fine. But an amusing thing happened. I heard one nurse comment to another that the downside for working for an eye surgeon is that while before surgery, some patients mention how nice looking they are,  they hear no such remarks after surgery, when the patients can see. And on a more serious note, both doctors present said Single-Payer was "inevitable."  More on that later, perhaps.

GOOD NEWS! ... SORT OF

Today I read some very positive sounding news: The on-line journal VOX reports that "A group of hospitals is banding together to produce cheap generic drugs to fight off egregious price hikes and drug shortages. The not-for-profit venture is called Civica Rx, and the company announced itself last month. A collection of 22 hospitals in the Salt Lake City area called Intermountain Healthcare, the Mayo Clinic, the for-profit health care facilities company HCA Healthcare, and some philanthropic foundations are pulling together to form the firm."

Wonderful!  They're looking to produce drugs generic drugs that are in short supply, or whose prices have skyrocketed  -- or both. For example, IV bags, injections for sundry anemic problems, tissue numbing agents, have been reported in very short supply, not to mention drugs that treat Parkinson's disease, chemotherapy drugs, and a tablet to treat C.O.P.D.  -- chronic obstructive pulmonary disease.

All this, Vox reminds us, is happening against the backdrop of the Justice Department and 45 states being  "currently in court accusing generic drug makers of price fixing and costing Americans more than $1 billion for their medicines."  Vox goes on to say that  "We spend a lot of time on new brand-name drugs, but some of the most egregious examples of price hikes have been for generic drugs."

Amazing! No less than Jeff Bezos, chief of Amazon, had tried to go up against the behemoth of Big Pharma but had to back down, lacking the infrastructure and the complex network of customer relationships that Big Pharma has built up over the years. Yet now, these folks think they can do what Bezos couldn't? 

They have a very good chance. Part of Big Pharma's network of customer relationships was with hospitals, but a good part of the new group are themselves hospitals! They're not trying to develop any new drugs, but simply to make old ones that the drug industry, doubtless for monopolistic reasons, had allowed to get very scarce. Yes, the FDA will have to give its approval, but with the collective bona fides of  the new venture, that may not be at all impossible. The new firm will start off with 14 drugs yet to be named. "Experts," says Vox, "are cautiously optimistic." 

And you thought that Big Pharma was unassailable!  But don't start dancing quite yet. Yesterday I read of a study which proved that doctors who were given free meals were much more likely to prescribe the new, branded, proprietary drug pitched by the rep who was paying for the meal!  Researchers had already established that doctors who had been set up with speaking engagements would be far friendlier to the folks who set them up -- and the drugs they were selling -- than they otherwise would have been.

Let me tell you something: For years and years, the Health Industry has been wallowing in their own private Capitalistic heaven, enjoying obscene profits untrammeled by the regulations they would face in any other country. And do you think they are going to give all that up with out a fight? Do you think they won't pull out every trick in the book, to threaten,  lie, distort, suborn, seduce -- whatever it takes for them to hold on to their cushy situation? Ladies and Gentlemen, what we're up against here is class war.  Actually, we've been it it for a long time, but not many knew it.

But now, as the Bible says, it's time for us to "gird our loins with strength," and fight for our lives -- literally. I'm not talking pitchforks; it hasn't come to that yet, thank God. What I am talking about is linking arms, for unity is our strength. Our job is to form a unified front and show our state lawmakers that if they don't pass the New York Health Act (Single Payer for New York) we'll vote them out. Period. Many of them were very happy to vote for it when they were sure that the Republicans in the Senate would shoot it down.  But since that's now far less likely to happen, these so-called progressives may remember the money that got them elected,  and where it came from. They'll have a change of heart and reconsider, UNLESS WE HOLD THEIR FEET TO THE FIRE. What fire?  Why do you think I've been sharing these tales of  rapacious capitalists whose stupendous salaries we've been paying for with our blood -- to fuel the the fire of our outrage, our determination.  There'll be more of the same, God willing, together with some sense of what Single Payer is, and why I can think of no  other cure for the sick morass that is healthcare in our country.

Dio

PS: If you'd like to comment, (and I hope you will) simply click on the number of comments  area, and share your thoughts in the comment box that appears. Don't be afraid to teach me something -- your comments have already taught me a lot, and I love it!