Is Our Healthcare System Either Healthy or Caring?

In 2009, during the rancorous debates in Congress, Republican Senator Richard Shelby said that “America has the best health care system the world has ever known.” America certainly has the most expensive healthcare system in the world and may even have the best emergency care system in the world, but unfortunately that advanced medical technology has not translated into better health outcomes; we lag behind in list after list of comparisons with other countries.

To its shame, the US has some 51 million people without health insurance. Another 25 million are under-insured, with coverage that meets only basic needs or has high deductibles which must be paid out of pocket before coverage kicks in. We rank poorly in terms of fairness because of the great disparity in the quality of care given to richer citizens compared to those who are poorer. The Center for Disease Control places us 30th out of 31 countries in overall infant mortality rates. In 2007 the New York Times reported that, “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care.” The Commonwealth Fund gives us high marks for preventive care like Pap smears, mammograms, blood tests and cholesterol checks, but we don’t do so well coordinating care of chronically ill patients, in protecting the safety of patients or in meeting their needs and preferences. And despite declarations by politicians, Americans hold dim views of our healthcare system. In a recent Commonwealth Fund survey of five countries, one third of American adults called for rebuilding the entire system; 13 percent feel that way in Britain and in Canada – 14 percent.

Healthcare statistics may illustrate the need to do healthcare differently, but we have not, as yet, found common ground on a solution. And unless we have some personal experience with illness, the statistics are just numbers. What do the 51 million without healthcare mean to someone who is relatively healthy and hasn’t faced the loss of a home, savings or life itself due to a chronic illness or accident? For Wendell Potter, former Vice President of corporate communications at CIGNA, one of America’s largest health insurance companies, the healthcare crisis has a face. In July of 2007 he toured a free clinic given by Rural Area Medical in rural Virginia. The British newspaper, The Guardian, described it this way: “What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements.” It may surprise many Americans that groups like Doctors Without Borders wouldn’t have to travel outside the US to find third-world conditions where healthcare is concerned. Free clinics are not only operated in rural areas, but in cities like Los Angeles, New York, Atlanta and Chicago. For Potter, they were life-changing. Haunted by the faces of the thousands that came for care, he left his successful career with CIGNA and began to speak out against the industry. In June of 2009 he testified before the US Senate Committee on Commerce, Science and Transportation. He encouraged the members to “look very closely at the role for-profit companies play in making our healthcare system both the most expensive and one of the most dysfunctional in the world.”  According to Potter, Wall Street dictates whether the average family is offered coverage, whether they keep it and how much they pay for it. The reason for-profit companies exist is to drive up the value of their stock, and to help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. In addition, they also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. And while sick people scramble for coverage, profits for health plan administrators grow. Insurers often refuse to tell customers how much of their premiums are actually paid out in claims. Potter testified that one “Houston employer discovered that its insurer was demanding a 22 percent increase in 2006 even though it had paid out only 9 percent of the employer’s premium dollars for care the year before.”

When listening to Potter, it’s even more disturbing to find who is behind all the fear-mongering and hyperbole of the health insurance debates. Hysteria over “socialized medicine” and the “government takeover of healthcare” comes from the insurance companies themselves, through the politicians whose campaigns they finance. In his book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care And Deceiving Americans, he writes, “If you are among those who believe that the U.S. has the best healthcare system in the world–despite overwhelming evidence to the contrary– it’s because my fellow spinmeisters and I succeeded brilliantly at what we were paid very well to do with your premium dollars.”

“And if you were persuaded that the health care bill President Barack Obama signed into law in March 2010 was a ‘government takeover of the health care system,’ my former colleagues and I earned every penny of our handsome salaries.”

For-profit providers of healthcare in the US serve one master – the bottom line. Dedicated to the best interests of the shareholders, they cannot serve the best interests of policyholders. Breaking the hold of the insurance system and removing the middleman from the equation would seem to make good economic sense, as we spend a whopping one-sixth of the GNP on our current system. Whether we decide, in the end, to adopt Medicare for all, opt for the VA model of socialized medicine, or embrace a form of the Kaiser system in California, one thing is clear – profits and health care do not mix.

Our Healthcare Headache – Part 2

“Out of control government spending!” “Fiscal irresponsibility!” “Extravagant government expenditures!” We hear it every day – the droning of pundits and politicians on the national budget: the weight of the deficit is crushing us and we must tighten our belts! No matter which side of the political fence you sit on, we can probably agree that spending in the US is out of control. We are less likely to agree on what to do about it.

Depending upon one’s world view, “entitlements” like Medicare and Medicaid are budget busters to be slashed, while military expenditures and low tax rates for corporations and the wealthy are sacred cows, not to be touched. Spending on the national level is the same as in any household – a matter of priorities. But for the sake of argument, let’s consider cutting Medicare to solve our budget problems. What would that mean exactly? Something called the Sustainable Growth Rate (SGR) is set go into effect at the end of the year. It is a $62 billion “doc fix” that would be paid for by “changes that squeeze Medicare and Medicaid payments to hospitals and doctors and expand the use of generic drugs in federal health programs,” according to The New York Times. Congress has been delaying putting it into effect since it was proposed in 2001 for obvious reasons. If doctors suddenly had to eat a substantial part of the cost of treating Medicare patients, they might drop those patients. When the SGR does go into effect, doctors across the board will see a 21.1% drop in reimbursement rates – an enormous amount. Many doctors can’t afford to treat patients for so little compensation, especially primary-care doctors, who are already financially strapped. Other proposed cuts would reduce inpatient repayments, hospital readmission subsidies, nursing, imaging, medical education, pharmacy and home health services. Even if unintentional, these cuts will have a trickle-down effect which will result in reduction in services for the elderly and disabled.

“I just want to assure [you] we’re not talking about cutting Medicare benefits.” President Obama said this to a town hall audience in Portsmouth, New Hampshire. A “myth that we’ve been hearing about is this notion that somehow we’re going to be cutting your Medicare benefits,” Obama said on Aug. 11, 2009. “We are not.” Well, perhaps not directly. But a person on Medicare who can’t find a doctor to treat him will, in effect, experience a cut in benefits. And any patient who relapses and is refused readmission to a hospital will experience a similar cut. Cuts in services for the elderly may raise no eyebrows in some circles. But people who need medical care and can’t go to a doctor don’t just fade away. They go to emergency rooms for treatment, instead. Getting treated in an emergency room is 3-4 times more expensive than a trip to the doctor’s office, according to the California Health Care Foundation. When hospitals provide emergency care, they absorb millions in uncompensated costs. They must recover that money and someone has to pay for it. People with insurance pay a hidden tax, in the form of higher insurance premiums, higher deductibles, co-pays and out-of-pocket expenses. What’s more, when millions of people use emergency rooms as their only means of healthcare, they don’t receive preventative care for things like weight reduction and smoking cessation. That adds billions to the back end of the healthcare budget for treatment of chronic disease. Health outcomes in the US are already lower than that of other developed countries; cuts to Medicare aren’t going to fix that, nor will they help to balance the budget by cutting overall healthcare costs.

Public discussion about our healthcare system has been reduced to one of dollars and cents. Little is heard about the ethics of the system. What does the system of healthcare delivery in this country say about us?  A report released in 2000 by the World Health Organization said that any healthcare system defined as both good and fair would include the following: 1.) overall good health (e.g. low infant mortality and high life-expectancy) 2.) a fair distribution of good health across population groups 3.) a high level of overall responsiveness 4.) a fair distribution of responsiveness across population groups and 5.) a fair distribution of financing health care (the cost of financing health care is fairly distributed based on ability to pay so that everyone is equally protected from the financial costs of illness). By this definition the US healthcare system is neither good nor fair. It is also, by far, the costliest system of healthcare delivery in the world.

When Medicare was first proposed in 1965, it was to be the first step in providing accessible, affordable healthcare to all Americans. Yet America has never been able to enact universal government health coverage. That’s why today the U.S. is the world’s only industrial democracy with compulsory health insurance for only its elderly. Even in that the system fails our seniors; the program excludes long-term care, dental care and coverage of the catastrophic expenses of chronic illness. Coverage for prescription drugs is inadequate at best. And despite all of this, concerns about the deficit, rather than expanding access and improving care are fueling the calls for reform. Does a country as wealthy as ours have a moral obligation to meet the health care needs of its citizens?  Even if you disagree with that principle, most of us would agree that our current system of Medicare for the elderly and for-profit insurance for everyone else costs too much and delivers too little. And like that old car that we tinker with endlessly but still doesn’t run very well – it’s time to trade it in for something new.

What Shall We Take for Our Healthcare Headache?

Do you know anyone with health insurance headaches? Or maybe the question should be: do you know anyone who DOESN’T have health insurance headaches? With over 100 separate health insurance companies operating under different sets of rules, we have created a bloated, unwieldy and unnecessarily expensive delivery system for healthcare that promises problems for anyone using it, provider and consumer alike.

Pharmacists have been hit hard by our for-profit, 3rd party system. Pharmacy blogs and online articles abound with stories of inefficiencies that make a hell out of every ten-hour shift. But most importantly, the system endangers the health of the people it purports to serve. I read one account of a pharmacist whose staff spent a total of seven hours on the phone trying to get approval for two simple prescriptions. Another pharmacist made this comment on a blog recently: “To get a claim processed, we had to bill one insurance policy, get a rejection, bill a second insurance policy, get a rejection, THEN bill a government-funded insurance with several override codes to get the claim to go through. There were only myself, one tech and one pharmacist who knew how to get this to go through without problem every time.” Another blog comment tells the following tale: “I recently had someone bring in a prescription for an expensive antibiotic and it rejected stating that the insurance does not cover it. I called and spoke to someone who was obviously in a foreign call center. They told me that another similar drug was the “preferred” drug for this patient’s plan. We called the doctor and got it changed to the “preferred” drug. We then tried to run it again and it rejected for the same reason. I called the insurance back and the rep I spoke to this time simply stated that the first rep I spoke with was wrong and that neither of these drugs are covered.” I had a scare myself some years back when I was told that the $900.00/month drug I take to stay alive would no longer be covered by insurance. Repeated pleas to my HMO renal social worker got me nowhere. It was a pharmacist who finally took the time to straighten the mess out and restore my coverage. God bless him.

Pharmacists will be the first ones to tell you they are capable of doing much more than counting pills – they are the experts on the drugs we consume. In most cases they know a lot more about your prescription that the person who wrote it for you. They should be spending their time educating providers about the best medications to prescribe and counseling patients about how to take those meds safely and effectively. Pharmacists are talking about expanding their role and setting up specialty clinics to advise patients with HIV, diabetes, heart ailments, cancer and other diseases. They should be free to concentrate on high-value activities, such as drug dosing, adherence, and medication adjustment. Instead, they’re using their valuable time and skills to argue and coax insurance companies into doing what they supposedly already exist to do – provide medical care to the insured.

Here are some hard truths: with our private medical insurance system we spend more per capita on health care than any other country in the world, over twice as much as most other developed countries. Yet some 47 million people in this country are without health care and, according to the CIA World Factbook, rank #36 in life expectancy, just above Slovenia. Slovenia?! Where quality of healthcare is concerned, the Commonwealth Fund Commission’s National Scorecard on U.S. Health System Performance gives us 66 out of 100 points across 37 indicators of performance. Scores on efficiency are particularly low. No wonder that in 2007 we spent an astonishing 2.2 trillion dollars on healthcare costs. Medical News Today, an online compendium of medical health news, says, “America is the country where people spend the most on healthcare and live the shortest amount of time, when compared to Western Europe, Japan, Australia and Canada – that is, the rest of the developed world.” For the first time in American history, the life expectancy of American children is less than that of their parents. In short, people from other countries enjoy a much higher level of general health than the best privately insured Americans.

Our healthcare system is administered by insurance companies whose loyalty is to shareholders and to the bottom line. They make profits by denying care to patients and every day nurses, physicians and pharmacists go to war against them to procure equipment, tests, medicines and care for their patients. Obama’s healthcare reforms may right a few of the wrongs in the system but don’t address the essential problem; the US healthcare delivery system is made up of insurance companies that profit off the rotten luck of their customers. This is the third rail Congress members don’t want to touch and the companies lie to us about. And until we oblige them to come clean about not just the economics, but also the ethics of such a system, there will continue to be some bad days ahead for the rest of us.

Baby, Where Have You Been All My Life?

Several months ago I visited my doctor. After reviewing my blood test results he said, “Oh, your vitamin D levels are low. I would recommend a supplement.” That was it. No information on how much to take or what could happen if I didn’t take it. And I knew so little about vitamin D that I didn’t think to ask. I didn’t do much about my vitamin D deficiency for a while. I relegated it to one of those things I’d “get to in time.” Some weeks later I happened to catch one of those physician radio programs. He was discussing vitamin D and I was about to have a revelation.

It turns out that nearly 60% of the US population is deficient in vitamin D. And should you suspect radio show doctors of quackery, this statistic is backed up by a study published in the March, 2010 issue of the Journal of Clinical Endocrinology and Metabolism. It found that not only is 59 percent of the population vitamin D deficient, but nearly 25 percent of the study subjects were found to have extremely low levels of vitamin D. The causal link between vitamin D deficiency and rickets is unquestioned and evidence-based studies have also shown it to be associated with osteoporosis. But now there are newly appreciated associations with other diseases, including tuberculosis, psoriasis, multiple sclerosis, inflammatory bowel disease, type-1 diabetes, high blood pressure, increased heart failure, muscle myopathy and some types of cancer. According to Grassroots Health, a public health promotion organization, the incidence of these diseases could be reduced by 20%-50% or more if we radically reduced vitamin D deficiency by simply taking more of it.

If vitamin D’s role in all the diseases mentioned about isn’t enough, new research at the University of Copenhagen has revealed that vitamin D activates the immune system by arming T-cells to fight off infections. Without the vitamin the T-cells remain dormant, offering little or no protection against invading microorganisms and viruses. So if you’re facing the winter flu season in a state of vitamin D deficiency, you’re defenseless against seasonal flu. Here’s something to remember: virtually all the people who died from H1N1 influenza were chronically deficient in vitamin D. With no immune system protection they were easy targets for the swine flu.

Unfortunately, health care professionals have largely ignored the problem. The powerful National Academy of Sciences controls many researchers’ grants and oversees the Institute of Medicine’s Food and Nutrition Board (FNB). In 1997, the FNB set vitamin D recommendations to 200, 400 and 600 units, depending on age – advice which seems woefully inadequate in light of the country’s 59% deficiency. The FNB went on to say that 2000 units a day might be toxic and reinforced a near hysterical fear in physicians that vitamin D is highly toxic. Dr. Reinhold Vieth, a prominent vitamin D researcher in Canada, countered the FNB in a 1999 paper in which he suggested that potential toxicity of vitamin D may start at 10,000 units a day but is probably closer to 40,000 units a day. Dr. Robert Heaney of Creighton University reported in 2003 that humans in fact use between 3000 and 5000 units a day, amounts physicians traditionally think are toxic. Dr. Heaney wrote that the FNB recommendations fall into a zone between irrelevance and inadequacy. What gives?

If vitamin D deficiency is the root cause behind so many degenerative diseases, then correcting this deficiency across the population could have implications for our for-profit healthcare industry. Vitamin D supplementation is cheap and effective. A bill introduced to the U.S. Senate, the Dietary Supplement Safety Act of 2010 (S. 3002), was an attempt to allow arbitrary banning of nutritional supplements, like vitamin D, by the FDA and to make it easier to argue for the justification of banning them altogether. It didn’t pass but that doesn’t mean it won’t come around for consideration again later. Something like it is already in effect in Europe, the European Union Food Supplements Directive.

You don’t have to be a cynic or subscribe to conspiracy theories to understand that the US pharmaceutical industry spends billions developing and advertising drugs to combat diseases like MS, diabetes and cancer. They lobby Congress and they fund drug research. It stands to reason they would want to marginalize or discredit arguments for simpler, cheaper, safer alternatives. To put it bluntly, there is no profit in them. The bad news about all of this is that it’s up to the individual to ferret out the clues to the healing properties of good nutrition and effective nutritional supplements. The good news is that alternative information and products, so far, are not hard to find.

  • Vitamin D truly is the center of the universe. ~ Dr. Russell Chesney, professor and chairman of pediatrics at the University of Tennessee Health Science Center in Memphis