National health expenditures hit
$3.35 Trillion (that’s $3,350, 000,000.000.00) in
2016, which works out to an average of $10,345.00 for every man, woman and
child in the USA. Drug prices and
treatment costs continue to rise and Medicare and Medicaid programs are heading
toward insolvency . . . in-other-words, we need to rethink healthcare spending
and find ways to reduce such costs! Simply put, rising medical costs have
crippled our healthcare system and are crippling our nation!
To make matters worse, the 3.35
Trillion Dollars we spend annually on healthcare isn’t actually buying us
the best of care nor ensuring the best health. In fact, not only does the U. S.
fare worse in regard to infant mortality and life expectancy than other
developed nations, the U. S. tops the list for deaths that are preventable if
timely and appropriate treatment was properly administered. Moreover, a hospital stay or common
diagnostic tests, like MRIs, cost several times more in the U.S. than in
countries like the United Kingdom, France, Germany, or Japan.
These excessive costs place a
heavy burden on funding Medicare, Medicaid, and other public insurance
programs; on employers, who help pay for health insurance coverage for their employees;
and on the millions of U. S. households, who feel the sting in their bank
accounts, via higher taxes and lower wages.
It doesn’t take rocket science to
determine that U. S. healthcare is spiraling out of control while, for years
now, both houses of Congress have woefully launched into a tail-spin about
what’s to be done in regard to most anything!
Considering the never-ending gridlock within and between the two
majority political parties, there is little chance, a reasonable health insurance
plan agreement can be consummated that will actually stop, and more
importantly, reduce, the cost of
healthcare in America.
Even so, there are several common sense approaches or acts, absent a healthcare insurance plan,
that the United States Congress and the American President could take that
would definitely reduce healthcare costs.
A dozen ways to cut U. S. healthcare costs:
1. The federal
government should be permitted to negotiate prescription drug costs.
Big drugs buyers should be able to negotiate
prices. Thanks to Medicare, the federal government is the number one purchaser
of prescription drugs in the U.S., yet, by law, it’s unable to negotiate prices
with drug manufacturers.
The notion that
a drug company can simply name its price and buyers must buy it at that price
is bizarre and amounts to little more than outright theft from American citizens!
2. Allow U S Citizens to buy prescription medications and reduce
restriction on the purchase of medical devices from other countries such as
Canada.
Prescription
drugs and medical devices are considerably lower in cost in other
countries—Canada included. Yet, Americans are barred from buying prescription
drugs from out of country and FDA regulations on the purchase of medical
devices out of country can be challenging at best. Healthy competition would
force down drug and medical-device prices, posthaste.
3. Stop drug companies from compensating doctors who prescribe the most
expensive drugs in the marketplace.
Drug companies routinely
pay doctors cash bonuses if they use their name-brand drugs. A 2014 study found
that nearly 75% of doctors across five similar medical fields received at least
one payment from a drug company. To
think things have changed for the better in this “arena” is folly.
Genentech, Inc. who manufactures,
markets, and distributes more than 36 drugs in the United States, often pay
doctors $50,000 annually if they sign confidentiality agreements and prescribe
large amounts of Lucentis, a drug
commonly used for the treatment of blurred or no vision at the center of the
visual field, at a cost of more than $2,000.00
per dose, rather than prescribing the less-expensive Bevacizumab (Avastin) at a cost of $50.00
per dose. Both drugs are manufactured by Genentech
and are nearly identical.
4. Hearing aids should
be sold similar to the way eyeglasses are marketed.
20% of Americans suffer from some degree of hearing loss, but surprise, federal rules require that
expensive hearing aid devices be used that cost thousands of dollars each,
rather than selecting newer tech options that are priced as little as one-tenth
as much. If hearing aids were sold like
reading glasses, more Americans would be able to hear, and the costs per
hearing device would go down by as much as 90%.
5. Encourage the use
of generic medication.
Generic drugs
are copies of brand-name drugs that are safe and affordable. However drug manufacturers
often go to great lengths to keep generics out of the marketplace and keep
their own patents in place.
6. Ban prescription
drug advertising.
Other countries, including Canada, have banned
drug advertising in an attempt to prevent consumers from unwittingly seeking and or requesting inappropriate or overpriced treatments.
7. Require future
“patients” to indicate their “end-of-life” preferences via a “Living Will” when
they obtain their driver’s licenses and or during the voter registration
process.
25% of medical
costs for Medicare recipients alone are incurred within the last year of a
patient’s life. Many, if not most, of these pricey decisions result when grief-stricken
family members who, in the absence of specific written instructions or a “Living
Will” from their loved ones, require they be kept alive even if they are not responsive
and have no possibility of regaining their health.
Frankly, in this
way, a comatose patient who is terminal is granted the opportunity to choose
whether to pursue treatment at all costs; in turn, saving their loved ones the
heavy burden and anguish of having to make the choice for them. Such situations are always a difficult moral
dilemma for the “non-patient”, but doing nothing in such cases only insures
that useless medical costs will spiral out of control.
8. Expedite or encourage the use of “telemedicine” by way of the
telephone, the internet, wireless devices, and et cetera to assist in the
maintenance of good health.
America’s
healthcare structure is built around outdated systems. Typically, doctors only
get paid if they see patients in person. Phone and internet consultations are discouraged;
the use of devices that monitor vital signs and alert healthcare providers to
changes in a patients “condition” are also often discouraged because of
liability and privacy laws. The one shining star of exception is Medicare,
which will pay for telemedicine services but only for those patients in rural
areas.
It’s long past time
for a more cost efficient approach — amendment the laws so as to allow the benefit
of newer technologies and require in-patient or in person visits only when
necessary. The use of telemedicine could
be the single greatest development that will reduce cost and access to health
care in the years to come.
9. Limit drug-price increases and stop the
drug company monopoly of price-gouging.
Some drug companies are actually making an effort to reel in prices.
Still, many patients struggle to pay for medications because drug companies have
free rein when setting prescription drug prices. One only need look at a 2015 report from the Kaiser Family Foundation, to recognize
the significance of overpriced medications; the report found that 33% of
patients who take four or more doctor prescribed medications do not fill a
particular prescription, cut pills in half, and or skip doses altogether in an
effort to save money — a short term fix for reducing medical costs, perhaps,
however such actions “fly in the face”
of the more sensible approach of preventative healthcare efforts; a proven measure
for the reduction of long term medical costs.
10. Impose
Coordinated Care Requirements for patients.
Costs for patients
really skyrocket when the care they receive is poorly coordinated: In such an
environment, patients may undergo the same lab tests multiple times, have the
wrong combination of medications administered, and get serious conditions misdiagnosed.
The lack of
coordination between the primary care provider to a recommended specialist; followed
by a move in and out of the hospital, and transition from the hospital to home healthcare
or to a long-term care facility, all,
with little or no communication between providers is far too common. Such chaos leads to unreasonably high costs
coupled with inadequate care for patients.
And too, it is
has been estimated that the United States spends up to 33% of its health care
dollars on medical services and lab tests that do absolutely nothing to improve
the health of a patient—some of which may even be detrimental to good health. Such “excess care” is most often a byproduct
of poor care coordination. For example, when a patient has an MRI in his
doctor’s office; then another, shortly thereafter, during a related hospital
stay.
11. Decrease
treatment Costs and stop the duplication of Lab Work.
In America, Doctor’s
office visits, lab tests, hospital stays, medical procedures, and prescription
drugs are much higher than in most other high-income countries. For example,
the average cost for a single day in a U.S. hospital is a whopping $4,287.00;
in France, it’s $853.00. The full price for a routine birth is nearly $10,000.00
in the United States; in the United Kingdom, the average cost is $2,641. Knee replacement surgery??? Far beyond an average of $25,000.00 in the U.
S. — more than twice the typical cost in Switzerland. Wait; it’s even worse, U. S. prices for identical services vary
significantly between providers, even within the same county or city of a given
state.
Poor medical
procedures are also a driving factor in high medical costs. Every year,
thousands of patients are treated for health complications that should not have
arisen in the first place; a typical example is a serious infection picked-up during
hospitalization.
Overtreatment is
also problematic: Choosing surgery, when medication or a less-invasive treatment
would be equally effective, is just one example. Admittedly such actions are learned behaviors
stemming from the thousands of tort cases filed against the medical community
every year—an unhappy circumstance that has long been in need of Congressional
“fine-tuning”—not eliminating!
Before you
decide messing with potential medical Malpractice and you right to pursue just
compensation for careless acts is off limits, keep in mind that in the United
States the average jury award tops a Million Bucks and is trending upward at an
average of 85,000 cases each year . . . a circumstances that results in every
type of medical facility and medical provider opting to purchase malpractice
insurance, including Primary Care & Specialist Doctors, Nurses, Anesthesiologists,
Physical Therapists, Paramedics, Hospitals, and the list goes on—each (the judgment awards & the malpractice insurance premiums),
of which ultimately adds to America’s healthcare costs.
12. Eliminate For-profit Healthcare Insurance Marketers
The true
forerunner to modern health insurance began in Texas in 1929 when educator,
Justin Ford Kimball, created the Blue
Cross Hospital Insurance Plan, which was originally a benefit for teachers
at Baylor University (BU). To participate, a teacher on the BU
staff payed a near-by Texas hospital 50¢
a month . . . in doing do so, no further cost to give birth to children was
charged to “Blue Cross” members by that
particular hospital. In reality that program was pre-payment and not insurance,
although some participants probably never gave birth to children.
The original
idea behind purchasing health insurance was to avoid the high cost of healthcare
by pooling clients' payments, via a health insurance carrier, to make treatment
more affordable for the “insured”— such healthcare costs being paid from the aforementioned
“payment pool”. In the insurers fantasy
world such a plan works best when the insured maintains good health and
therefore has no need for healthcare treatment.
A less attractive, yet potentially effective path is when the number of
insured who require healthcare treatment remains low enough so as to not
bankrupt the “payment pool” generated by the membership, however, to have a
chance to be effective, healthcare costs must remain stable.
Trouble is, for
dozens of reasons, America’s healthcare costs are far from stable and we often
mistakenly place all the blame for rising healthcare costs upon the shoulders
of for-profit healthcare insurance company carriers. Chances are, to learn that their profits are
very modest when compared with other industries is not simply a big surprise it’s more likely a huge
surprise! The truth is that health
insurance providers not only typically pay their CEOs competitively, their
profit margins average a very modest 3.3%, which is very low when compared with
other industries. For example, the banking and real estate industries have
profit margins that top 20%, and major drug manufacturer’s average profit
margins of just under 22%.
The 5 major
health insurance providers, of about 35 doing business in the United States,
reaped historically large profits in the first quarter of 2017. Aetna,
Anthem, Cigna, Humana, and the UnitedHealth
Group, amassed in net earnings, a total of 4 and a half Billion Dollars ($4.5 Billion) during the first
quarter of 2017 alone. One of the five, Aetna, actually lost money because the
insurer (Aetna) had to pay Humana
a Billion Dollar “break-up fee”
after their merger failed; otherwise it too would have been in the black by a
hearty 619 Million Dollars ($1,000,000,000.00 [billion]—$381,000,000.00 [million] = $619,000,000.00
[million]).
Sooo, how is it that when burdened
with such a low margin of profit, the top 5 U. S. healthcare insurance carriers
(not to mention the “un-named” 30 additional providers),
do so well financially — as can be easily determined by viewing the graph
displayed above? Well, consider this: Aetna
has over 39 million members, Anthem is
collecting from 38 million members and UnitedHealth
has nearly 70 million members who pay health insurance premiums.
In other words, the clear path to
a healthcare insurance carriers’ success is obviously volumes of business
opportunities, and very large volumes at that!
Trouble is, costs have risen so
dramatically in every sector during the past several years that allowing the for-profit healthcare insurance industry
to continue to thrive, simply is not a viable option. Simply
stated—your Health Care is far too important to allow “middle-man” earnings!
When combined, the above
described healthcare cost “fixes” helps clarify why our nation’s high level of
spending fails to match the quality of health care every American should be
entitled to. The good news, there’s more
that can be added to this list of 12.
In regard to the battle to control health care spending, the stakes are
high. The more the government devotes to health costs, the less it has
available for investing in jobs, education, infrastructure, and other pressing
societal needs.
Businesses—large and small alike—are
saddled with health insurance premiums that continue to break record after
record in cost surges, many small employers simply cannot provide health
coverage and raise wages for their workers. And too, large firms in many
industries must deal with with crippling obligations to thousands of retirees who
have been promised well-earned health benefits.
In any event, we have learned from experience that more spending does
not translate into better care or an improved health care system. It’s sure to
be an uphill battle to cut costs and make the difficult changes needed for the
formation a healthcare system that works for us all; but if we step-up to the
challenge, it’s within our grasp. That
doesn’t mean the problem will be easily fixed. Not even close — it will be hard!
Sources:
https://www.healthcaretownhall.com/?tag=milliman-medical-index#sthash.bMgbLEjl.dpbs
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