THE RISING COSTS OF HEALTH CARE EXPLAINED
By Cleaves M. Bennett, M.D. FACP
May 22, 2009
I have been a doctor for 50 years. I am a just retired Prof of Medicine from UCLA. I have created a non-profit 501-c3 corporation No More Medicines, Inc. We have a website, nomoremedicines.com. Our mission is to reveal and explain the reasons for skyrocketing healthcare costs, so that some sort of realistic corrective actions can be taken. Okay I admit, that’s a very tall order.
When I started in Medicine there were few meds for high blood pressure and cholesterol, and type 2 diabetes was called "maturity onset diabetes" because we only saw it in patients >50 years old. The American diet and Big Pharma have changed all that. When I started in Medicine, McDonalds was new, a hamburger was 25 cents and you could hold it in one hand. Fries were 15 cents. “Supersize Me” had not been invented yet. Most people still ate “slow” food. You could only eat Pizza if/when you visited Rome. In 2009, the newest McDonald’s offering is a burger with 4 patties - one for each chamber of your heart! Kid’s meals at many restaurants meet or exceed 1000 calories. Baskin Robbins’s Large Heath Bar Shake has 2310 calories, 266 g sugar and 108 gm fat. You know what they call that Heath Bar Shake? Your Last Meal!
In the last 50 years the rise of the fast food industry, the appearance of huge grocery stores selling large amounts of prepared foods (so working moms can feed their families), and the upward creep of serving sizes at all restaurants (a favorite marketing ploy is “all you can eat”) has “fueled” (pardon the pun) the pandemic of diabesity. There are now teens with diabetes who will be on kidney dialysis in their 30s. There are now children with “diabesity” who will need dialysis in their teens. Life expectancy on dialysis is only a few years. There are not nearly enough dialysis centers to meet the demand now. Transplantation is an option for only a lucky few. Transplantation causes you to be sick in a different way. The cost of your care does not go down very much. Sadly most patients reject the transplanted organ and end up back on dialysis.
disease risk factors are showing up at earlier ages. Pediatricians are
now recommending “statins” for 8 year olds and up who have
high cholesterol. There are a lot more of those kids than you would
imagine. The average teenager has pre-hypertension (120/80 – 140/90).
Unless you get health religion, pre-hypertension always progresses to
the real thing. This “echo boomer” generation will not live
as long as their parents.
David Walker (former head of the GAO) has been on a nationwide tour crying “Hey you guys, the sky really is falling!” The US can not afford providing all the needed Health Care for old people and poor people right now. Nor can we afford Health Care that the government is obligated to provide over the next 20 years. Medicare and Medicaid seemed like a good idea back in the 60’’s when “diabesity” had not been invented yet. And when there were a lot fewer sick old people qualifying for the latest and most expensive medical therapies.
Here is the explanation our budgetary woes. We have this whole new way of practicing medicine, involving decades of regular MD visits for expensive but relatively ineffective preventive measures (red pills, blue pills, green pills and more pills) followed by years to decades of high tech, ruinously expensive rescue care with a cadre of specialists. So how in the world did we get into this mess?
1 - Almost everyone gets high blood pressure. Defined as >140/90, 90% of Americans get there before they die. Defined as >120/80 (the newest cut-off) it is close to 100%. Most of those folks have high cholesterol and many have diabetes too. This combo is called the Metabolic Syndrome. You do not want to end up in a nursing home with the Metabolic Syndrome: bed sores, blindness, amputations, heart, lung and kidney failure. Most feared of all: “losing it” upstairs… senile dementia.
2 - As a consequence, 10s of millions of Americans, starting in their 20s, 30s and 40s are going to their doctor regularly, not because they are sick yet, but because they have various “risk factors” for getting sick. They have to get stuck for blood tests and stand in line to fill several very expensive prescriptions which health “insurance” may or may not pay for – every 6 months for the rest of their lives. Unless… we’ll talk about that in a minute.
3 - The same unhealthy diets and lifestyles that cause the above problems can lead to insomnia, anxiety, restless legs, heartburn, ED, ADD, IBS, etc. That adds many more doctor visits. To encourage everyone to visit their doctors regularly, there are DTC ads on TV explaining which pills to take for which symptoms. These ads always end with “Ask your doctor….”. Marketing works. Lipitor (one of 6 statins) annual sales are $12 billion. “Soap operas” got their name because all their ads were for Tide, Rinso and Cheer, etc. Now these daytime serial dramas should all be called “prescription drug operas.” Check it out, I did. You’ll be amazed. My new nickname for Big Pharma is “the Somali Pirates of the Health Care Industry.
4 - The staggering and ever rising costs of taking care of all these folks has made health insurance unaffordable not just to 50 million Americans but to most employers and even States as well. Health insurance for Americans is unaffordable for the same reason that flood insurance is unaffordable in New Orleans and hurricane insurance is unaffordable in Jamaica and the Florida Keys. Too many people need to use it too often.
5 - If we took as poor care of our cars as we do our bodies, auto insurance would be unaffordable too. People want “pre-existing conditions” to be covered by newly purchased health insurance. Do you think you could buy fire insurance from State Farm if the fire engines were already on the way to your house? Duh! (That’s not “insurance”. That’s “you’re related to the president of State Farm” if you can pull that one off.)
6 - Despite taking multiple pills for multiple risk factors and symptoms, most Americans end up admitted to the hospital in their 50’s, 60’s and 70’s with all the same problems the pills were supposed to prevent. Now they can qualify for rescue care. Rescue care in 2009 is really expensive!
7 - Prime example: Bill Clinton, who has had health insurance and the best doctors, ended up having a heart attack before he turned 60. What do you think his hospital stay cost the taxpayers? Tim Russert (Meet the Press) died at age 58 despite all his pills and regular “good doctoring”. By dying suddenly at work he saved his insurance company a bundle.
8 - The latest, high tech rescue care appears frequently on the nightly news. Docs can clean out heart arteries by manipulating robot arms via closed circuit TV from another city! You’re too ugly, you can get a face transplant! The newest/highest tech rescue care: stem cell implants. Bush is out, Obama’s in, and it’s a new day for unwanted fertilized eggs. As shown on ABC World News recently, scientists have destroyed all the muscle in a rat’s heart, and then replaced all the muscle with stem cells, causing the rat heart to start beating again normally. (That is indeed good news for ex-Vice President Dick Cheney.)
9 - Bottom line: decades of regular “preventive medical care” leading to years of “rescue medical care” is “catapulting” us into bankruptcy. David Walker has stated that the Medicare Problem is 5x worse than the Social Security problem and will explode in our faces decades sooner. The date he has projected is 2018. The Medicare Part D (drug benefit) brings the date a year or two sooner. That will certainly bring the troops home from Iraq.
10 - It gets worse. Many doctors don’t accept new Medicare, Medicaid and SCHIP patients because the reimbursement rate is too low. (I still find it hard to believe that doctors would refuse to care for old people and poor people and underprivileged kids because of money issues, but that is our brave new world in 2009.) The proposed new health insurance for the 50 million poor and uninsured is not likely to pay any more generously than Medicare. Well I guess poor people could always catch a slow boat with Michael Moore to Cuba, where doctors are good and healthcare is free.
What’s to be done? We have to get the food industry to help us out. For starters, every place that sells prepared food (both restaurants and deli’s) must have Heart Healthy® items identified. Let’s eliminate all trans-fats in the food supply, an idea whose time has come. (The only safe use of trans-fats is to wax the floors!) Let’s ban “all you can eat,” one of the worst ideas the food industry ever came up with. Put a weight limit on people who can be admitted to restaurants and grocery stores. (imbed scales in the floor at all entrances) No ordering fast food by phone unless you have been certified by your doctor. Charge care-givers who continue to feed people who are too obese to get out of bed with felonious life endangerment. Close the drive by windows at all fast food restaurants. Come on now, that’s a no brainer! Once you’ve gotten out of your car, gone inside and placed your order, you can’t get your food until you (and everyone in the car) have walked around the block at least two times. You all will wear GPS bracelets to monitor compliance.
So what do we do if they say no? The tree hugging earth-firsters who go around smashing new Hummers on car lots might be convinced that near universal diabesity will ruin the planet and kill us all sooner than global warming. They could go from city to city, infecting all the non-compliant grocers and restaurants with Anthrax. That might work. Or slip some of that super radioactive element polonium-210 (remember Alexander Litvinenko) into the feed of the entire nation’s livestock. That might work. Burning down most of the big grocery stores only contributes to global warming which will p… off Al Gore, so we don’t want to do that.
You understand? We are a nation in trouble, big trouble. Procrastination is not an option. Desperate times require desperate measures. (Ok, insert your own favorite “doomsday” cliché here) You have some ideas, write your Congress person. Email the Mayor. Twitter the Governor. Make a video that gets on U Tube. We are all in this mess together and there are not nearly enough lifeboats. Maybe Paris Hilton could be our spokesperson. Hey, she’s skinny, and if she’s good enough for John McCain, she’s good enough for me. We need constant press constantly, and not necessarily all good.
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There are just too many teens walking around schools now-a-days, with needles that are not for crack or smack, but for their twice daily insulin shots.
� 2009 - Cleaves M. Bennett, M.D. - All Rights Reserved