Since I have nothing else to do today I thought I would cogitate on immigration, tax reform, infrastructure, entitlements, education and of course healthcare. Figure I better do it because Congress is fast approaching its summer recess which has followed on very quickly from their 4th of July recess. First things first, TTG. Of course we are spending most of our time skewering Trump and Co, which although warranted does not leap to the top of my list.

I hope healthcare is at least the second most important thing on the agenda. Just trying to understand all the pieces is setting me up for a visit to the ER with a big dose of angina. There are three moving parts. The patient, and that be you and me. The provider, consisting of the hospitals, docs, drug companies and medical device emporiums. Lastly is the money in the operation which consists of the government, insurances companies and the poor schmuck with none of the above. Each one plays a part and must be put to blame for our current state of affairs.

I find it interesting that all of the current conversation revolves around how are we going to pay for all of this? Not one word about why it cost so much? The increases can be 5-10% per annum and no one bats an eye. I will still hold out until my dying day that there is a finite amount of money we can throw at our health but people seem relatively calm about 18% of our GDP going into this trough. That is $10,000 for every man, woman and child.

We have all been given something and nobody wants that taken away or minimized. As patients we are used to service and right now. Ergo the overuse of the most expensive form of medicine, the ER. It has its place but we use it as our local doctor. Thousands of dollars? Not a problem when you are insured or even better, indigent. The hospitals even have billboards touting how short your wait time is.

Continuing on if you need a hip replacement we can get you one with no more than two week’s to a month’s wait time. The medical device company is constantly improving their product and we all want the latest and greatest. When it is done the pain is unbearable so there is a plethora of goodies to ease the agony. Then you become addicted and that creates a whole new round of treatment. Along the way you need physical therapy and followup care. And all this is until the next body part fails.

Meanwhile that non profit hospital group has to compete with the those mercenary for profits cross town so they do all they can to attract top notch practitioners. That will cost money for staff, administration and equipment. Lo and behold a relatively small metro area soon has multiple institutions that claim the best oncology, cardiac care, stroke treatment, and ob/gyn that money can buy. That redundancy causes further competition that results in redecorating birthing suites and providing valet parking to distinguish themselves.

I am capitalist at heart but the reason I believe we have gone off the rails for several decades is by making healing people a money making operation. MD’s have become specialists and by doing so you see five or six instead of the one General Practitioner or Internist. You don’t go to one hospital but several in or outpatient facilities related to your particular ailment.The hospital has an expensive MRI machine so we have to run people through it. Care is obviously better but at what cost?

Whole industries and municipal areas have grown up around this. The execs are compensated by stock options that soar as the drugs or devices they sell become an instant best seller. Take a look at the explosion in the pacemaker business when Medicare loosened its standards for care. You have a cold? You need a pacemaker. I am not singling them out because the number of unwarranted or misplaced treatments is a contagion throughout the halls of healing.

We spend almost $3.3 trillion a year and that is with a “T” on healing the sick. Almost ONE QUARTER of that is spent on just paperwork. If we went to a single payer system we could save $375 billion of that. We spend almost $350 billion a year on drugs and the only operation that bids them out is the VA. It is estimated that fraud alone costs us $275 billion across the entire healthcare spectrum with Medicare accounting for $100 billion of that.

This is a mess beyond comprehension. To think the rocket scientists in DC can come to the rescue is a fairy tale. The Dems had eight years to fix Obamacare and did nothing. The GOP has had eight years to come up with an alternative and is running around in circles. Everything is so rampant with interest groups you don’t know who is on which side.

Frankly it starts with you and me. For starters we should question the necessity of this treatment or that. If we had a copay on every test performed do you think we would want every last one or at least question them? We pay $200 billion per annum in unnecessary testing. I will call us all out on taking better care of ourselves. Eating right and getting some exercise. Don’t just show up at the clinic door after abusing your body for twenty or thirty years and say, “Heal me.”

I am pissed off. As I have said before, I will probably sneak out the door but what are we leaving our kids and grandkids with? The six topics I mentioned at the beginning of my epistle are not nice to do things but incredibly vital to our success as a nation and a world. Yet the village idiots can’t wait to take planes home on Wednesday and most of the summer off. We shrug our shoulders and say what can I do? Please tell me it is not that hopeless.

As always
Ted The Great

Factoids:

5% of the population accounts for almost 50% of the nation’s cost for healthcare. In one of the absurdities of life, healthy people spend more on healthcare in their lifetimes because they live longer than obese people or smokers.

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Medicare and its beneficiaries spent $103 billion on pharmaceuticals in 2013.The data show that 14 drugs cost the federal government over $1 billion apiece. Most of those drugs are used to treat chronic conditions that plague the elderly, including diabetes, depression, high cholesterol and blood pressure, dementia and asthma.The brand drug Nexium, used to treat heartburn, acid reflux and related stomach ailments, cost the most: $2.5 billion for 1.5 million Medicare patients, who filled 8 million prescriptions and refills. None of this was bid out.

The end of life costs are a bit of a myth when looked at in a short period of time. It is more appropriate to look at overall care which for the elderly entails sometimes many years of treatment for chronic diseases which begin to have a multiple effect. The most expensive diseases to treat per annum are:

1.HIV $25,000
2. Cancer $49,000
3. Transplant $51,000
4. Stroke $61,000
5 Hemophilia $62,000
6. Heart Attack including Cardiac Revascularization (Angioplasty with or without Stent) $72,000
7. Coronary Artery Disease $75,000
8. Neonate (premature baby) with extreme problems $101,000
9. End-Stage Renal Disease $173,000
10. Respiratory Failure on Ventilator $314,000

We are living longer and that care is one of the primary drivers of our exploding costs. My treatise is just an attempt to define things. My head is spinning with the amount of data but we have to start somewhere. Tell me where I am wrong. Let’s get the discussion going.

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