> Deborah Harrell <[EMAIL PROTECTED]> wrote:
> > Bryon Daly <[EMAIL PROTECTED]> wrote:
> > Debbi, what do you think is the cause for
> healthcare to be so
> > expensive? Is it the lawsuits and insurance?
> > Salaries? Drug costs?
> > The inherent nature of health care? Something
> else entirely?
> >
> > Is there any way that that problem could be
> > addressed as part of
> > making healthcare more available to everyone?
> I have to scoot, so will answer more later - but the
> expense of healthcare is multifactorial; I do think
> that a national healthcare plan could be offered
> without breaking the bank, but as Dan(I think) first
> put it, for Toyota rather than Cadillac care. I
> called it healthcare rationing.
Please see also Gary D's recent post on the Kerry
healthplan (thread 'Dislikes about...'). Dan M and
Dee (and a couple of others IIRC) have commented on
health costs in the past - I don't recall the threads
or months, but they were relevent posts.
Disclaimer: this is my opinion only, so I'm not
hunting for sites to back up my points -- but I do
think they're valid. Several have posted about drug
company profit margins, with sites/figures, in the
not-too-distant past.
Contributing to excessive costs of healthcare in the
USA:
1) Bad lifestyle choices like smoking, drinking too
much alcohol, and being sedentary. While you cannot
change your genes, you _can_ modify your risk of
developing many of the chronic serious illnesses such
as diabetes, hypertension, heart disease and even
asthma. The most dramatic example I know of this is
that of the Mexican vs. Arizona Pima Native Americans,
which has been posted previously; basically the
Mexican Pimans do a lot of physical labor, eat a
relatively low-fat diet, and have very little
diabetes/obesity/heart disease, while their Arizonan
kinsmen live a sedentary life with a high-fat diet =>
~50% rate of diabetes with all the consequences of
that disease (heart disease, kidney failure,
blindness, etc.).
2) Lack of effective education about lifestyle
choices, and the apparent preference for 'fixing the
barn doors after the cows have run onto the highway'
rather than 'checking and repairing the barn doors
before the hinges rust/chains break/boards rot/handles
break.'
3) Lack of low-cost clinics for basic care =>
inappropriate use of emergency facilities for what
ought to be handled in a non-emergent and preventive
manner (rather than
'after-it-has-progressed-to-a-much-worse-condition').
4) Frivolous lawsuits which cost not only in
themselves, but in doctors'/nurses' time and health,
and promote if not demand inappropriate use of
tests/procedures in the effort to avoid being sued.
(Example: patient with what, after a good history and
physical, is clearly a tension headache, but gets a
head CT or MRI to rule out brain tumor. What _should_
happen is that the patient is treated for muscle
tension headache, and returns reasonably soon
thereafter for follow-up; if the headaches have not
responded to therapy, further work-up is warranted.)
Malpractice coverage for certain specialties is
completely untenable (I'm recalling ~$100,000 [*not* a
typo!]/yr for OB in Florida several years ago; BobZ
could comment on radiologists' coverage; anesthesia is
also quite high IIRC).
5) Lack of time to see patients properly; an annual
GYN exam *cannot* be done correctly in 15 minutes!!!
(Which is the time I was told I 'ought to be able to
push it through' at one HMO...<snarl>) A proper
interview takes time; a proper physical exam takes
time; missing what could have been diagnosed and
treated preventively can be dreadfully expensive in
time, money, and function or life. When your vet
spends more time with your pet at its annual check-up
than your doc does at yours, something is *very*
wrong.
6) Use of the latest drug to roll off the line instead
of basing your prescribing on what is effective, safe,
_and_ cost effective; this requires well-designed
studies, and the best include the actual endpoints of
therapy rather than surrogate-endpoints only. While
lowering cholesterol reduces heart/artery disease in
theory, the actual endpoint should be MIs/mortality,
and IMO ought to be mortality at at least one year
(rather than the 3 or 6 months some studies use);
frex use of the cheaper statin Baycol (cerivistatin)
did lower cholesterol effectively, but had unexpected
increased mortality/severe side effects (it isn't used
anymore). Both physicians and patients are guilty
here - the former more so, as we're supposed to check
study results and not depend on the drug rep's spiel
(!sp!). For pushing the latest drug and misleading the
public about which drug is best, I indict the
pharmaceutical industry ("Ask your doctor if Nexium is
right for you!"). As for the nonsense about whether
drugs from Canada or GB are safe -- <makes very rude
noise>. (Now I wouldn't trust those from China or
Mexico at this time, as their surveillence is poor,
and adulterated medications and even infant formula
have been well-documented.)
7) Salaries - hmm, well, I don't think that most
nurses make too much for the work they do, nor primary
care docs (except for those who boast about seeing 60+
patients a day...cattle callers <lip curl>). Certain
sub/specialties (frex dermatologists) make more than
they ought, IMO, but I'll admit that as an internist
I'm not exactly impartial. Pediatricians and
geriatricians, especially those with a lot of
Medicaid/Medicare patients, make too little for what
they do.
8) Fraud - unfortunately this is I think large and
underexamined; both from unscrupulous docs falsely
claiming to treat patients (or worse*, 'treating' for
non-existent conditions), and from people claiming to
be disabled/injured when they are in fact quite
healthy. *A recent case here in Denver involved _root
canal_ and replacement of baby teeth in several
preschool-aged children at a 'Medicaid dental clinic'
- I think the jerk wasn't even licensed here, and he
and his partner have similar clinics in AZ and TN,
IIRC. Those poor children were strapped down in
papoose boards for hours, while unnecessary and
painful procedures were performed on them!
Cutting corners in medicine almost always winds up
costing more in the long run (remember "drive-through
deliveries?"); because of the fallible nature of
humans, redundancy is a "must-have" in the system, and
that means properly trained professionals at all
levels. The finest heart surgeon in the world will
have bad outcomes if the tech didn't sterilize the
instruments properly, and the cleaning personnel
didn't do a full scrub-down of the OR after the
previous surgery.
Debbi
There Can Be No Weak Links Maru
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