“Just because you are not sick doesn’t mean you are healthy.” (Unknown)
“The doctor of the future will give no medications, but will interest his patients in the care of the human form, in diet and in the causes and prevention of disease.” (Thomas Edison)
By Nancy Palermo Lietz
The current state of healthcare has many consumers frustrated and enraged. Insurance premiums are skyrocketing, yet patients are now responsible for a greater percentage of their bills. For example, in 1993, 95% of a premium covered the insured’s medical bills, by 2009 this percentage dropped to 85%, placing the burden to pay on the patient. And this burden has been great. Half of all personal bankruptcies filed in this country, in the past two years, are related indirectly to unpaid medical costs.
Health care providers haven’t fared so well either. Medscape, a Healthcare Business Firm, surveyed over 24,000 physicians in 2012 on job satisfaction. As compared to the prior year, only 54% of those surveyed would choose medicine as a career again. If you disregard the results of those less affected by changes in healthcare (Dermatologists, Radiologists, and Pathologists), the percentage dropped to 41%. Reasons cited for the dissatisfaction were declining compensations, reduction in patient contact, increasing regulation and documentation, and with Obama Care, more unnecessary accountability. In 2012, most physicians saw a decline in their compensation, some as high as 3%. The number of hours of patient contact has dropped because of increased paperwork and administrative demands. The average physician now only spends 30-40 hours a week on patient care. Physicians estimate they spend over 4 hours a week on paperwork and 5-14 hours a week on administrative demands.
More worrisome are the proposed changes in physician compensation. Under the new Obama regulations, physician compensation will now be based on patient satisfaction scores. Review of patient surveys have found the greatest dissatisfaction concentrated on long wait times and the inability to get tests and treatments they feel they need. Instead of doing what they feel is appropriate, many doctors, in order to get a good rating, will be pressed to see more patients in less time, overprescribe, and over test. In fact, a 2012 study from the University of California Davis, published in the Internal Medicine Archives has shown this to be true. The study reviewed surveys from over 50,000 respondents. During the four year study period, those patients in the “Highly Satisfied Groups” were more likely to be hospitalized, had 9% higher prescription costs and over 9% higher overall healthcare expenditures. Those in the “Highly Satisfied” group also had had higher death rates during the four-year study; 126 versus 100 participants. The higher mortality was related to overtreatment with pharmaceuticals and increased rates of procedures. Thus the proverbial doctor’s oath “First Do no Harm…” may be questioned.
Unfortunately, the nation is facing a serious shortage of physicians, anticipated to be 90,000 over the next decade. Medical schools plan to increase enrollment by 30% over the next few years but with rising dissatisfaction, it is anticipated that the quality and quantity of future applicants will be seriously affected.
So how can we change the health care crisis? Who is to blame for these issues? The answers are not quite that easy. Here are some considerations:
Insurance Corporations are profiting more than ever. Despite the threat of the Obama-care restraints and restrictions on the industry, The New York Times reported that the health insurance industry enjoyed record earnings in 2012. Their earnings beat predictions of Wall Street analysts by 30%. Profit margins or the amount left over after all salaries are paid, increased from 6.88 two years ago to 8.24 percent. United Health operation, the biggest for-profit insurers saw a 13% increase to 1.35 billion from 1.19 billion over a year ago. Stock prices soared and last year, Stephen Hensley, United’s CEO was paid over $101 million in salary and stock options, making him the highest-paid corporate executive in the United States. Looks like Obama’s “restraints” worked out well for this industry.
The profits of the insurance industry look mediocre when compared to those of the pharmaceutical industry. Profit margins for the top ten pharmaceutical companies, accounting for 60% of the world’s drug production, were up 24%. Net profits for these top global pharmaceutics topped $711 billion over the past ten years ending in 2012. Average CEOs made $18 – 24 million dollars in salary and that’s just take home spending money. Pharmaceutical companies have always touted that they have to spend more on research and development, yet in 2011 for every dollar spent on research they spent $19 dollars in promotion and advertising. Such advertising only increases costs to healthcare by increasing demand and cost of new drugs.
The profits of the Hospital Industry should also not go unnoticed. Hospitals have become their own corporations with overpaid CEOs, CFOs and managers funded by astronomical charges to patients. What makes this industry more curious is they practice within a non-profit status. There are no other non-profit institutions in this country that pay their CEOs $2- 6 million a year. We would not tolerate it, yet most non-profit hospitals are doing just this. Hospital costs in this country are easily five times the costs of other developed countries. It even costs five times more to park your car in a hospital parking garage.
Finally, we cannot point blame without taking a good hard look at ourselves. Americans are unhealthier today than ever. In fact, the statistics are staggering and disturbing. Data from the 2010 National Health and Nutrition survey showed that 2 out of 3 American adults are overweight and 1 out of 3 is obese. Thirty percent of school-age children are also considered obese. Twenty-five percent of military recruits were deemed too overweight to serve and the Defense Department is spending over a billion dollars a year on medical care for weight-related health issues. Recent indicators have suggested that these percentages have continued to increased, in all groups, an additional 5-10% since the original study began. The Robert Wood Johnson Foundation is a non-profit organization dedicated to “Improving the Health and Healthcare of all Americans”. They have looked at many aspects of our health. They have found increase waistlines have been associated with a significant increase in medical problems. The incidence of diabetes has increased ten-fold over the last decade and The Robert Wood Johnson Foundation (RWJF) predicts that half of all Americans will suffer from Diabetes by 2020. Dr. Masters, a researcher at the foundation has compared the ”toll obesity takes on the body to be similar to the effects of tobacco”. Dr. Risa Lavizzo-Mauney, president and CEO of RWJF, estimates there will be 5 million new cases of coronary artery disease and stroke and 400, 000 new cases of cancer-related to the obesity epidemic. They have also predicted, given the incidence of childhood obesity and medical illness, this current generation of children may be the first generation not to outlive their parents. These societal issues have helped fund the growing health care epidemic and those who profit from it.
Patients are now using the health care system more than ever because of their worsening medical conditions. The increase has led to an unhealthy increase in morbidity and mortality related to medical errors, unnecessary procedures, and fatal and near-fatal drug reactions. This increase has also funded the already booming pharmaceutical, hospital and insurance corporations making them wealthier than ever. Unfortunately, the increased consumption of healthcare is not making us any healthier and appears to be draining our bank accounts.
The current state of healthcare leaves consumers angry and helpless. The only way we as Americans can change the direction of corporate healthcare is to stop funding it. We must personally improve our health and the health of our families. We must become the curators of our own health and make personal changes to stop funding this system. The best revenge is good health!
As a physician, it is my personal goal during the remainder of my career to focus on the prevention of disease. I do not define prevention as ordering tests and procedures, though they may be necessary at times. I want to focus rather on helping patients improve their personal health and thus reduce their need for healthcare in the future. There are many conflicting sources and few patients get the information they need from their doctors. Most doctors do not have training in nutrition and preventative measures and even if they had the advice, they lack the time with patients to implement it. Many patients rely on health information from the internet and medical shows like Dr. Oz. This information can be confusing, costly and sometimes wrong. It is my hope that the information you will receive from my unbiased, reliable articles will help guide you toward the right path. Most medical conditions are preventable. Lifestyle changes can reduce the incidence of over 80% of the more common medical conditions. We must focus on the changes today to prevent problems tomorrow. If not today, then when? Stay tuned…