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   From: pautrey23x@gmail.com   
      
   U. S. Health Care Gets Bad Grades   
      
   Posted by: Linda Carbonell on September 6, 2012.   
   This is not the week for me to be writing about the state of health   
   care in America. We are now three weeks into trying to get a diagnosis   
   for my husband.   
      
   The Institute of Medicine, a division of the National Academy of   
   Sciences, is an independent organization that advises the government.   
   They have issued a new report on waste and fraud in the health care   
   system. According to their best estimate, the system loses $750   
   billion a year, 30% of our $2.5 trillion health care spending. For   
   that $2.5 trillion, twice what the next most expensive nation pays per   
   person, we are ranked 37th in health care delivery.   
      
   The principle causes of the loss are unneeded care, incredibly   
   complicated paperwork, fraud and general waste. The report states,   
   “Health care in America presents a fundamental paradox. The past 50   
   years have seen an explosion in biomedical knowledge, dramatic   
   innovation in therapies and surgical procedures and management of   
   conditions that previously were fatal. Yet, American health care is   
   falling short on basic dimensions of quality, outcomes, costs and   
   equity.”   
      
   How much is $750 billion? It’s more than the Pentagon’s yearly budget.   
   It is more than the disputed amount that will be cut from Medicare by   
   either Obamacare or the Ryan budget plan over the next ten years.   
   Obviously, it is not all government money. It is money spent by   
   government through Medicare and Medicaid, money spent by health   
   insurance companies, money we spend out of pocket for our health care.   
      
   How do we over-spend that much? Let me count the ways….   
      
   Malpractice paranoia: Doctors and even nurses are so scared of being   
   sued they order extra tests, order extra procedures, order extra   
   appliances just to make sure they have covered their asses. I included   
   nurses in here because nurses are now being required to carry   
   malpractice insurance, not just doctors. Nurses used to be covered   
   under the doctor’s office policy or a hospital or nursing facility’s   
   policy.   
      
   Lack of accountability: On the other hand, there is not an adequate   
   system for dealing with inadequate physicians. Unless something goes   
   critically wrong, the best a patient can do is write a letter to the   
   state’s medical board. In most cases, you might just as well ship a   
   letter into a black hole. There is no system of professional review   
   for doctors. I once spent three days in the hospital undergoing a raft   
   of tests for a possible heart attack. On the fourth morning, the   
   cardiologist finally showed up at my bedside. He started explaining   
   what the tests had found when he was interrupted by his assistant. She   
   pointed out that he hadn’t properly reviewed the emergency room notes   
   that said I had come in immediately, at the first pains. He had   
   ordered all those tests based on his assumption that I had hung around   
   my house ignoring the symptoms for a few hours. That assumption   
   completely changed the meaning of those first EKGs in the ER.   
      
   Designer drugs: No, not that kind of designer drugs, what are known in   
   the pharma world as “combo” drugs. Case in point was a “new”   
   medication my primary care doctor was advised to prescribe. It   
   consisted of two meds I was already taking and a dose of potassium.   
   Before filling it, I asked by pharmacist to get a quote for me on the   
   new combo, my existing meds and the over-the-counter supplement. The   
   combo cost $5 more per 30 days than my existing meds and the   
   potassium. I asked the pharmacist to call my doctor and get the   
   prescription changed. The second case is “tweaked” drugs. Prilosec and   
   Nexium come to mind. When Prilosec went off-patent and could be   
   purchased in generic, the manufacturer unveiled Nexium. A tiny tweak   
   in the formula gave the manufacturer a new, patented name-brand drug   
   to push at doctors. It was barely more effective than the original.   
      
   Billing hocus-pocus: After that little maybe-a-heart attack, I opened   
   the statement from my insurance company and went into shock. There   
   were five surgical procedures listed on it. I called the company and   
   had it explained to me. They were all for the cardiac catheterization   
   I’d had done. The doctor’s office had billed it in segments – cutting   
   the incision, inserting the catheter, guiding the catheter, watching   
   the TV monitor and removing the catheter. Five separate billings   
   increased the amount of money the doctor was paid for the procedure.   
   She also separately billed for giving me a shot of local anesthesia   
   and for filing the report with her partner, that other cardiologist.   
   What I considered a single procedure was billable as seven.   
      
   Excessive bureaucracy: In a decent sized doctor’s office you will find   
   one person who just handles the paperwork. He or she must contact   
   insurance companies for pre-approvals, determine co-pays, file reports   
   if there are other doctors involved in a patient’s care, and that’s   
   just the stuff I know of from my side of the sliding glass window. And   
   all that is before it goes to the billing person who has to keep track   
   of dozens of addresses and fax numbers and electronic mailboxes for   
   sending bills to insurance companies. There might also be a third   
   person to transcribe the nurses’ and doctor’s notes onto electronic   
   records. Just the complexity of dealing with so many diverse insurance   
   companies and insurance plans is enough to give a secretary an ulcer.   
      
   The uninsured: The first problem with the uninsured is that when they   
   default on their medical bills, those bills get added to the bills of   
   people with insurance. Uncollected accounts receivable get spread over   
   the formula for figuring out how much to charge others. The second   
   problem is the people who don’t seek medical care. You know all those   
   tests we are supposed to have on a regular basis, pap smears, breast   
   exams, colonoscopies, blood tests? Well, if you don’t have insurance   
   or if your deductible or co-pay are too high, you put those things   
   off. People over 50 are most prone to do this, thinking that they will   
   hold out until they qualify for Medicare. So things that could be   
   treated easily if found early become chronic diseases that cost more   
   to treat. Things that could have been treated if found early become   
   death sentences.   
      
   Redundancy of services: Let’s say you live in a city of a half   
   million. How many of the latest imaging device does your city need?   
   Should every hospital have one? In Canada, there is a panel that makes   
   that decision based on the number of cases of whatever the device   
      
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