The Cost of Healthcare in the U.S.

Everyone knows  that the cost of medical care in the U.S. is very high.   We buy insurance to help pay the cost which we may not otherwise be able to afford.   Some of us can't afford the insurance so we go without.  The Organization for Economic Cooperation and Development is a group that keeps track of the costs and other issues in medical care.  The statistics mentioned in this blog are from them via PBS. Most Americans believe and many politicians will tell you that we have the best health care system in the world.  The reality is that we pay much more than anyone else and our outcomes are often not as good.

 Health care costs in the U.S. are $2.6 trillion a year.  This is 17.6% of GDP.  Let's compare some numbers.  The average per person, per year cost of health care in the U.S. is $8,233.  That is two and a half times the OECD average cost of $3,268.   We spend more in all categories.  We spend $900 per person per year just on  administrative costs.  By comparison France spends $300.  We have been slow to embrace technology and cut down on waste.

Hospital services cost 85% more in the U.S.  The average hospital stay costs $18,000.  The average cost of a hospital stay for OECD countries is one third at $6200.  These counties have strong regulation to set prices that hospitals can charge.   The quality of care is comparable and universities still attract the best students to medicine.   In the U.S. the prices for certain procedures are much higher resulting in higher incomes for physicians.  U.S. physicians also use more expensive diagnostic procedures.  Studies have shown that one-fourth to one-third of all hospital patients suffer harm from adverse events that occur during their stays. Sixty-five per cent of these adverse events are due to failures in communication.

In the U.S. we have fewer practicing physicians.  We have 2.4 per 1000  people as opposed to 3.1 average in OECD countries.  The U.S. uses a "fee for service" system that charges for each visit, procedure, and test.  The more doctors do,  the more money they make.  The pay depends on insurance.  So it comes down to if your insurance will pay for something whether you need it or not.   OECD countries use a "common fee" schedule by which doctors and health services are paid similar rates for most patients.  If certain costs exceed what is budgeted, they are flexible in lowering the fees they will pay in that area.  There are few methods for controlling rising costs in private insurance in the U.S.  They pass the increase along to patients rather than asking providers to contain costs. 

The U.S. is known for over-testing and over-treating.   Tests are subject to the doctor's opinion as to whether they are desirable or not.  The reasons sighted for this over-kill are: 1. fear of litigation; 2. more pay for more service regardless of necessity;  3. patients ask for more tests and services regardless of need  with insurance that will pay all or most of the extra.  Despite this extra testing and services the U.S. life expectancy is 78.2 years compared to the average OECD country expectancy of 79.5 years.  

To be fair the U.S. leads the world in health care research and cancer treatment .  On the other hand we very much need stronger policies in tackling poor health lifestyles.   As a nation we are getting older with more chronic diseases and obesity. 

Well, I thought about that ... and here's what I think.   First of all, we have to take control and responsibility for our own health and health care.   We need to remember that the health care system is there to help us, not control us.   With more and more large corporations and practices  we need to remember that they focus on bottom line.  We need to focus on and decide what is best for us.  They can provide the medical knowledge and experience to make decisions, but they are our decisions. 

Here's what you can do:  1. Pay attention; 2. Ask questions; 3. Never assume that any doctor or hospital is error free.   Be a list maker.  Write it down.  Keep track of what you are taking and doing and why.  Write down your questions for your nurse or doctor.   Work towards the healthiest lifestyle you can.   There is also a book you may want to consider.  "The Patient's Checklist:  10 Simple Hospital Checklists to Keep You Safe, Sane, and Organized" by Elizabeth Bailey.

Be well!                                

Habemus papam !

With the words "Habenus papam !"(We have a pope !) Roman Catholics were introduced to their new leader, the 266th Roman Pontiff.  He is 76 year old Cardinal Jorge Bergoglio, Archbishop of Buenos Aries.   He will be known as Pope Francis.  Bergoglio is the Buenos Aries born son of middle class Italian immigrants.   He is the first Latin American born pope, the first Jesuit, and the first to choose the name "Francis".

He has a reputation for humility having denied himself  luxuries previous Buenos Aries cardinals enjoyed.  He lived in a one room apartment in Buenos Aries, often cooked his own meals, and took the bus to get around town.   He is also described as loving with a special love for the poor and  marginalized.  He is also spiritual and capable.     He considers social outreach, rather than doctrinal battles, to be the essential business of the Church.   As a cardinal he worked to repair the reputation of  the church which was losing many followers by failing to speak out openly to challenge Argentina's murderous 1976 - 83 dictatorship.

In choosing the name "Francis"  he brings to mind 13th century Francis of Assisi who loved the poor and saw his calling as trying to rebuild the Chuirch in a time of turmoil.  A well respected blog that follows Vatican affairs called "Whispers in the Loggia" has this to say, "By choosing the name (Francis) of the founder of his community's traditional rivals, the 266th Roman Pontiff has signaled three things:  his desire to be a force of unity in a polarized fold, a heart for the poor, and his intent to "repair" God's house, which has fallen into ruins (that is to rebuild the Church).

Well, I thought about that......and here's what I think.  God Bless Pope Francis.  I think this time we got it right.  He will be the one to lead the Church in the 21st century.  May he have a long and glorious pontificate.

Sequestration Schmequestration

You can't pick up the paper or turn on the news today without hearing about "Sequestration".  Sequestration is a series of across the board budget cuts tied to the expiration of the nation's temporary budget and temporary debt ceiling.  The cuts will total $1.2 trillion over a ten year period.  The cuts would be split 50-50 between the defense department and domestic discretionary spending.   It was created as a way to force Congress to take action to reduce the spending deficit.  At the time the law was passed Congress never thought we would get to the point of sequestration.  We have known sequestration was imminent for the past year.

So here we are at the deadline, and our elected leaders are incapable or unwilling to take the necessary steps to balance the budget.   Anywhere they cut funding someone is going to be unhappy, and they are just unwilling to man up to that.  So they do nothing, the economy suffers,  and they point fingers at each other.

In the meantime February unemployment  dropped to 7.7%, the lowest since December of 2008.  The Dow Jones Industrial Average has been at record highs.  Now keep in mind that 70% of the U.S. economy is dependent on consumer spending.   It appears the economy is showing some real signs of recovery and our Congress deals us another wound by allowing these cuts to take place.  Private forecasters predict that economic growth  this year will slow 0.5 percentage points.

Well, I thought about that and .............. I think we have a government that is reluctant to govern.   We elect politicians who tell us what their research says we want to hear.  Once elected they do what they want or what they think will get them reelected when the time comes.   They cry wolf at anything that may happen, so we will be agreeable to what they want.  They will select cuts that will be visible and painful to make sure we will submit.

We need statesmen and not politicians.  We need men and women who will make the difficult choices.  We need to be informed and involved in our democratic process.  I've found that in life we have to take responsibility for our destiny.  We cannot leave it to another.

Poll says 70% of Floridians favor Medical Marijuana

In a poll taken for "People United for Medical Marijuana" (PUFMM)  regarding an amendment to legalize the use of  medical marijuana in Florida 70% of Floridians back the amendment, while 24% are opposed.   PUFMM would like to put the amendment on the 2014 ballot.   It is going to be an uphill battle.  It will take 683,149 valid signatures from Florida voters.   They currently have about 100,000 signatures all of which are not valid.   In the meantime Florida State Senator Jeff Clemens has  introduced a medical marijuana bill.  He has a co-sponsor for the bill in the Florida House.   Under his bill patients with medical need would be allow to possess 4 ounces of  marijuana and grow up to 8 plants. Senator Clemens first introduced a medical marijuana bill in 2010 which was quickly defeated.  Will he be more sucessful this time?  He anticipates a 6-8 year struggle.   The state of California  has legal medical marijuana for some time, however Prosposition 19  to legalize recreational use was narrowly defeated receiving 46.2% of the vote despite widespread support.  

Currently 12 states have medical marijuana laws:  Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington.  Maryland has a law authorizing medical marijuana use, but does not allow patients to grow the plants.

Well, I thought about that  .......... and I think that medical marijuana may very well be an idea whose time has come.   We are not in virgin territory here.  Twelve states have already allowed medical marijuana.   The fabric of our society has not disintegrated.  Opponents will tell you that we have medicines that  can do the same things as marijuana.  Yet there are patients  who will tell their doctors that they do not get the same relief from pills as from marijuana.

Under the federal Controlled Substance Act marijuana is considered a Schedule 1 drug, along with heroin, LSD, and Ecstacy.  They hold that marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the U.S. , and has a lack of acceepted safety for use under medical supervision.    You can decide whether you  agree with that assessment.

The body of research concerning the medicinal use of marijuana is extensive.   Research has shown that the cannabinoids in marijuana help reduce anxiety and slow the development of certain cancers.   Marijuana has been shown to decrease nausea and increase appetite.  For glaucoma patients marijuana helps lower intraocular pressure.  Some types of  pain such as peripheral neuropathy respond better to marijuana than conventional  pain relievers.

I think we should carefully consider whether to allow the use of this substance that may help to relieve pain and suffering.  If not,  we may want to ban alcohol  for the pain and destruction it creates, although we tried that once before.  How about banning sugar.  Maybe we can stamp out obesity and diabetes.  What do you think?