“Monday Musings” for Monday August 25, 2014
Volume IV, No. 33/133
The High Cost of Medical Care In America
By Assad Meymandi, MD, PhD, DLFAPA*
The cost of medical care in America is the highest in the entire world, both industrial and underdeveloped nations. We spend nearly 18% of the gross domestic product (GDP) on health care. European countries, such as France, Great Britain, Sweden, Norway and Germany, as well as other advanced nations such as Singapore and Japan, spend about 4 to 7%. And frankly we do not have a whole lot to show for the excess cost. Granted that we have lengthened average life span, but Japanese live longer than Americans because of their diet and the nation’s commitment to prevention and primary care. Reasons for the overblown profligacy in America’s health care are many.
Obesity, gluttony and epidemic of diabetes Type II with its unwelcome consequences of cardiovascular and kidney disease and musculoskeletal pain, sedentary lifestyle are among them. But let us not forget the unwelcome and greedy alliance of the healthcare and pharmaceutical industries. Only last week we learned that the lead scientists, writing papers in medical journals, were indeed sponsored by the drug makers. The purity of research ought to be beyond ethical reproach and it is not. The late President Eisenhower once in the late 1950s warned against the military-industrial complex. The nation must be warned against the medical-pharmaceutical complex. It is ominous. It is of great concern that American Medical Association has now declared obesity as a disease. Also, many articles are appearing in research medical journals stating the paradigm of restricting caloric intake to lose weight is no longer tenable. They propose complex and often unintelligible theories that link obesity to genomic factors beyond patient control. To these researchers I submit: look at the hundreds of thousands of displaced Yazidis, Syrians and Kurds with no food and water. You will not see one obese child or adult. The heart wrenching videos of atrocities in the Middle East provide eloquent testimony for direct correlation between caloric intake/output and obesity. In the years I have travelled to Middle East and African countries, only the well healed administrators and well fed bureaucrats are obese. The starving populations of Somalia, Ethiopia, Syria, Iraqi, Yemeni, are for most part undernourished and thin. In the more affluent Middle East nations such as Kuwait, Abu Dhabi, Qatar, and Saudi Arabia, there is more incidence of public obesity. AMA should review its position on this subject, and not give excuse to the gluttonous and the irresponsible.
Some drugs are more expensive than platinum, six to seven dollars a pill or capsule. The hospital charges are exorbitant. As a result, the fees for Medicare Part B that pays for the doctor’s services are cut drastically to the point that doctors cannot afford to take Medicare patients. But the most expensive cost is our system of imposing a middle man between the doctor (provider) and the patient (consumer). These entities known as insurance companies, Health Maintenance Organizations (HMOs) etc., are the major culprits driving up health care cost. Their commitment is to the bottom line and not to patient care. We have several CEOs of these companies who amassed 2007 compensation in the billions, and are now either behind bars or on their way to prison. Physicians and not business people ought to be in the health care driver’s seat
We need to come to some understanding that the middle man is the culprit and instead of our politicians screaming the plight of uninsured and underinsured, they ought to offer thoughtful designs that provide universal health care for our citizens and decrease the political and financial influence of the insurance companies and the third party operators.
Using the emergency room for primary care, such as sore throat, common cold, cuts and bruises, and routine medical care for asthma, cardiovascular diseases such as regulating hypertension, congestive heart failure and diabetes is very expensive. Having a medical home and a designated primary care doctor is most effective in reducing the cost of medical care. Using the hospital emergency room, on the other hand, is the most expensive way to get medical care.
Patient protection and the Affordable Care Act or Obamacare is now the law of land. To understand the bill, I started to read it last year, and somewhere around page 2000 I quit. It is a cumbersome and often unintelligible piece of legislation. It has more than 11, 588,500 words. Faithful readers of this space recall that there are 593,493 words in the 39 books of the Old Testament, and 181,253 words in the 27 books of the New Testament, total for the entre Holy Book 774,746 words. For further comparison, there are 884,647 words in the collected 118,406 lines of William Shakespeare (makes one wonder if Shakespeare knew more words than God!). Well, Obamacare has more than 12 times as many words of the Holy Book and Shakespeare’s work. Having read 2000 plus pages of Obamacare has not been helpful to my health or to my soul. I wish I had spent the time re-reading the Holy Book or the collected work of Shakespeare instead of spending the time on Obamacare. Nonetheless, there are some positives in Obamacare, chief among them is insuring patient who have pre-existing disease. Obamacare promises to reduce the cost of medical care. This remains to be seen.
Finally, we need to have a thoughtful, universal and comprehensive solution to eliminate frivolous law suits and design tort reform that is fair and just to the injured patients and the physicians. This important matter has not been adequately addressed.
*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.