45 Million Uninsured: Why Does Health Care Cost So Much?

By Loyd Eskildson

Almost everybody already knows that American health care costs about double that of other developed nations, that about 45 million Americans lack health insurance, and that health care costs are the leading cause of bankruptcy in America. Thus, Washington's efforts at 'reforming' health care by expanding insurance coverage and banning the insurance industry from not covering those with pre-existing conditions, etc. Little discussion, however, has addressed the question of "Why does American health care cost so much?" Do doctors provide too much treatment (possibly to avoid malpractice lawsuits), are we too fat, too indolent, and/or too old? Do we have too many high-tech gadgets? Is it our administrative overhead costs, insurance company profits, . . .?
 
How can we solve our health care problem if we don't even understand the causes?
 
Comparing what insurance companies pay for health care vs. uninsured citizens paying posted prices provides a major clue. My personal experience has been that insurance companies pay much, much less than the uninsured - so much less, in fact, that many Americans wouldn't even bother thinking about health insurance if they could just pay those insurance company rates. Maybe health care high 'costs' are simply a means to artificially create demand for health insurance?
 
But there's another possible explanation as well. Again, my own observations tell me there's an enormous amount of 'non-value added' expense in health care associated with staff sitting around idle, walking back and forth, looking for data, calling each other, etc. Maybe we just need Toyota engineers to redesign our hospitals (they've already directly or indirectly drastically simplified most of our factory and warehouse operations)?
 
Then along comes Ezra Klein in his 11/02/09 blog on the Washington Post in which he provides charts supplied by Kaiser Permanente CEO George Halvorson showing that "American health care costs so much more than health care in any other country because we pay so much more for each unit of care.  As Halvorson explained, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent!" So it's the doctors and hospitals that are the problem!" See these charts, originated from the International Federation of Health Plans.
 
Personally, I think it may be all of the above. Regardless, it's time to stop redesigning health care and instead go back to first determining exactly what is causing the problem we're trying to fix.

Loyd Eskildson is retired from a life of computer programming, teaching economics and finance, education and health care administration, and cross-country truck driving.  He's now a reviewer for Basil & Spice.

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H1N1 Vaccinations: Public Health Officials Unwilling To Speak Out

Davis Liu, M.D.--

Can Doctors Provide Rational Care or Cave In? H1N1 Experience with Public Health Indicates the Latter

As the country discusses providing everyone with health insurance, an even more important conversation is how to slow the rise of healthcare costs. Many studies and research point to the ability of doctors to remove waste by not performing unnecessary tests or procedures and not prescribing the latest medications which are proven to be no better than generic versions. There is a belief that much of this additional cost is due to the fee for service reimbursement system where doctors get paid more to do more.

For example, spending 30 minutes on nutritional counseling, weight loss, and exercise for one patient with hypertension doesn't pay as much as prescribing blood pressure medication for three patients in 10 minutes. In the fee for service environment, volume is key, not necessarily providing the right care or the most rational care. A recent Newsweek opinion piece by an emergency doctor showed how he evaluated a patient appropriately for a recent head injury, discussed the plan with the family, and arranged follow-up with the pediatrician all without getting a CT scan of the head. Result? Patient did fine. No radiation exposure to the brain. No additional cost to the healthcare system, insurer, or family. Everyone benefited.

While the example isn't rare, it also isn't common. Some 30 percent of tests or procedures performed in this country have been suggested to be unnecessary and added no value to improving patients' quality of life or outcomes.

In other words, if we removed the fee for service reimbursement system, then doctors would prescribe only the right care. Not too much or too little, but just right.

Or would they?

Recent articles should make us think twice. The H1N1 virus which has been demonstrated to affect those under age 25 years old and pregnant women disproportionately than the general population now has a vaccine available, albeit in short supply. This limited supply has been given to individuals not deemed at high-risk for adverse outcomes by CDC.

While the issue might be that some public county clinics received more vaccine than others (a systems or distribution problem), the bigger question is whether public county officials and doctors are willing to have honest and frank discussions about a person's need for the vaccine. Unlike doctors in the fee for service environment, these providers don't get paid more to do more. Since compensation isn't an issue, then can they talk through the fear that people have and provide the appropriate care?

Answer? Unfortunately no. Public health officials don't want to be the police and determine who should justifiably get the vaccine and who should be turned away.

In other words, if people want it, then they will get it. If public health officials can't say no appropriately, then can we expect much better for doctors in the future? Even if the fee for service reimbursement structure is removed, unclear if that will ever happen, will doctors provide rational care and advice or cave in when patients demand prescriptions based on television ads or care recommended by celebrities?

As I received my vaccine at a flu clinic, there were nurses asking each individual in line what vaccine did they want. The nurses appropriately advised those not in the high-risk groups that they would only receive the seasonal flu vaccine and not the H1N1 vaccine. There were no fights, outbursts, or fear. Patients understood that they were getting the right care. Not too much and not too little, but just right.

If America is going to solve the affordability issue of healthcare, then doctors will need to lead the way.

Based on the public clinic officials' performance, I'm even less optimistic about the medical profession's ability as a whole. While I have great confidence in my fellow medical school alumni from the University of Connecticut School of Medicine, the colleagues I work with at the Permanente Medical Group as well as the many medical bloggers I've encountered , have real concern about many doctors nationwide and specifically on their ability to provide rational care and not to cave in and take the easy way out when making decisions about medical care.

What does this ultimately mean? Without doctors leading the way, the only choice left is government run healthcare. If doctors can't say "No" based on scientific and medical evidence, then Uncle Sam will say "No." Don't say I didn't warn you.

Davis Liu, MD, is a respected family physician, a healthcare educator and writer, and the author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System. He is a practicing board-certified family physician with the Permanente Medical Group in Northern California since 2000. Dr. Liu received his medical degree from the University of Connecticut School of Medicine, and graduated summa cum laude and Phi Beta Kappa from the Wharton School of Business at the University of Pennsylvania. He completed his residency training at the Glendale Adventist Family Practice Residency Program.

 Until healthcare reform improves the American healthcare system, he feels individuals today need to have the vital information necessary to ensure that they are doing the right things so that they and their families Stay Healthy, Live Longer, and Spend Wisely.You'll find the author online at www.davisliumd.com

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48% Of Health Care In U.S. Already Paid For By Uncle Sam

Infomercial Icon Bares His Soul for Health Care

For better or worse, infomercial stalwart Matthew Lesko, whose late night TV ads have driven many an insomniac to the medicine cabinet, has decided to tone down his shtick.

Why?

“Health Care reform is nothing to joke about,” says Lesko, the founder of Information USA and author of Michael Leskonumerous books on free government services and programs for the common man. “The price of medicine in this country is sick. The price of health insurance is ridiculous. Most people can’t afford it, and neither can employers – something has to give.”

The typically manic author is amazingly subdued. He’s serious.

For years, Lesko has been evangelizing the availability of cost-offsets and prescription-assistance programs for people who can’t afford needed medications, and directed many toward special programs where they can get free or inexpensive treatment. 

Nonetheless, he says most individuals are either choosing to do without or are limiting their medical care to the barest of necessities.  Studies show that 25% of people who don’t have coverage are covered by an existing health care program but don’t apply, because they don’t know about it.

“Anyone concerned about health care should visit and at least find out for themselves what is available for free from the government,” he says. What is amazing is that 46% of health care in this country is already paid for by Uncle Sam.  Until the health care system is overhauled, if and when, this is the best that is available for people with medical problems and little money.” 

“From diabetics to cancer patients,  patients are making sacrifices to buy medications that they need to save their lives. This is nothing to laugh about in a country where drug companies routinely spend several million dollars on 60-second television ads for erectile dysfunction.”

On Lesko’s www.myamericanbenefits.com  website, he comprehensively lists health care assistance programs and services, contact names and qualifications for applicants.

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RTI: 150 Malaria Control Scientists To Meet In Zanzibar

RTI International Hosts Pan African Malaria Vector Control Conference in Zanzibar

ZANZIBAR, Tanzania—About 150 of the leading malaria control scientists and national malaria program managers from more than 18 African countries are gathering in Zanzibar this week to share their collective knowledge and experience at a conference hosted by RTI International.

Conference attendees will discuss the latest science on vector control and best practices for using Victoria F. Hayneseffective malaria control interventions, including indoor residual spraying, to reduce malaria's impact on morbidity and mortality.

Best practices and lessons learned will be published in conference proceedings and then distributed widely among organizations engaged in malaria control efforts.

"During the past several years, the world has witnessed tremendous progress in the fight against malaria, as governments, foundations and others have begun to fund and implement a cohesive malaria control strategy," said RTI President and CEO Victoria Haynes, Ph.D. "These efforts have provided the financial and technical resources vital to reducing malaria-related illness and death."

RTI is the lead implementing partner for the U.S. Agency for International Development's Indoor Residual Spraying program, one element of the U.S. President's Malaria Initiative. This program and many others will be discussed during the conference.

Since 2005, this USAID-sponsored effort has treated 21 million homes in 16 nations, protecting more than 128 million people from malaria-carrying mosquitoes. Other organizations attending the conference have equally impressive program successes to share.

Despite recent success, Haynes said continued investment and innovation are required to sustain this initiative and to develop new interventions needed to keep pace with threats such as the one posed by drug- and insecticide-resistant strains of malaria.

"Through our cooperation and collaboration at events such as this conference, I am confident we can continue to make progress in this noble effort," she said.

About RTI International

RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,800 provides research and technical expertise to governments and businesses in more than 40 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory and chemistry services. For more information, visit www.rti.org.

©2009 RTI International. RTI International is a trade name of Research Triangle Institute.

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2016: Number Of Older Workers To Increase More Than 80%

Older Workers Spend Less on Necessities and Health Care

COLUMBIA, Mo. – More older Americans are choosing to continue to work or are returning to the labor force. The number of workers age 65 and older is predicted to increase by more than 80 percent by 2016. In an ongoing study, University of Missouri researchers are examining the financial motivations of older working Americans. New results reveal that older workers spend less money on necessities, including housing and food, and health care than older non-workers.   

Deanna Sharpe, Associate Professor of Personal Financial Planning at MU.“The recent increase of older adults in the work force has raised some interesting questions that previous studies haven’t answered – are older people working to meet financial needs, and are workers spending differently than non-workers?” said Deanna Sharpe, associate professor of personal financial planning (PFP) in the MU College of Human Environmental Sciences. “In this study, we found that older workers aren’t necessarily working because they have to, and their spending patterns are very different compared to those of non-workers.”

Using data from the 2005 Consumer Expenditure Interview Survey, MU researchers compared the financial budgets and expenditures of people ages 55-74 in working and retired households. They found that older workers spent more on transportation, eating out, education and insurance, while non-workers spent more on health care, cash contributions, food and housing. Older workers also had lower out-of-pocket costs for health expenses.

“Older workers spend less on necessities, including  food and housing, which implies they aren’t working out of need,” Sharpe said. “They also are spending less on health care, which may indicate that workers are somewhat healthier than non-workers.”

Current downturns in the financial market could force older workers to remain in the labor market to finance retirement, Sharpe says. The researchers will continue to study the impact of the changing economy. Sharpe predicts that adults from the Baby Boom generation will face increased responsibility for their financial futures as employers shift from defined benefit to defined contribution plans.      

The study, “Spending Patterns of Older Workers,” won the AARP Public Policy Institute Financial Service and Older Consumer Best Paper Award at the 2009 Joint Conference of the American Council on Consumer Interests/American Agricultural Economic Association. Tansel Yilmazer, assistant professor in PFP, co-authored the study.

 University of Missouri News Bureau

CDC: Those Aged 65 And Up Least Affected By H1N1