The evidence that our healthcare system is the most expensive and the least effective among developed nations keeps piling up to an extent that is irrefutable! Fixing this dire problem could relieve the pressure on family and governmental budgets. It should be a leading national priority.
A recent survey from the Commonwealth Fund shows that many Americans, even if they have health insurance, have inadequate coverage that leads to care that is delayed or omitted altogether. Many of us are accumulating significant medical debt. Delayed or omitted care is worsening basic health problems like high blood pressure and diabetes that are easy to address. Only 44% of Americans with high blood pressure have it controlled to under 140/90. A much smaller number of patients with diabetes have their pressure, sugar, and cholesterol controlled at the same time. Poorly controlled hypertension and diabetes lead to much more difficult and more expensive problems like heart failure and chronic kidney disease. Those patients with heart failure and chronic kidney disease become disabled and only then do we cover their care. We could keep workers healthy for pennies on the dollar. They would be paying taxes instead of becoming dependent on others. It is backwards and upside down. It is self-defeating.
These problems with affording our very expensive healthcare system are pervasive. Nearly sixty percent of Americans said medical needs consume 10% or more of the family budget. For low-income families it is 25%. Fully half of working-age Americans find it very or somewhat difficult to afford their healthcare costs. Forty percent delay or skip needed health care or buying medication because they couldn’t afford it. Over half of working-age adults who delayed or skipped care because of costs said their condition worsened as a result. One-third of working-age Americans reported having medical or dental debt they were paying off over time. Just over a third of Americans with medical or dental debt delayed or avoided getting needed health care. This debt has had a huge impact on their lives generally. Of course, they are worried and anxious about it. Many have cut back on basic necessities like food, heat, and rent. Over a third have exhausted their savings. One in four work at more than one job. One in five have delayed buying a home, moving, or getting more education. They are trapped by debt and medical costs. Huge numbers of us struggle under a healthcare system that does not serve us.
It seems most Americans believe that we save taxpayer money by not providing care. If we don’t provide care, it does not cost anything. That is completely wrong. We alone—of all developed nations—do not provide healthcare coverage for everyone. Healthcare for chronic illnesses is like water or electricity services. All families need it. If these families don’t get healthcare to prevent the complications of chronic diseases, then caring for these complications is many times more expensive. Some countries, like Germany, provide health insurance through employers like we do—but all other developed countries cover everyone. I think that is one big reason their care costs from one half to one quarter of ours. We don’t cover our people in the early stages of their disease. By not addressing these problems early, we allow our people to progress to disability and complications like chronic kidney disease and heart failure. Then we pay for their disability and healthcare. We cover everyone eventually and then we pay a much higher price. I guess Winston Churchill was right: “Americans will always do the right thing, only after they have tried everything else.”
These burdens are greatest in those of us who are least able to deal with them. In the county where I practiced for many years, there were four dialysis centers. About 90% of those being dialysed in those centers were poor black people who had not received adequate treatment for their diabetes and high blood pressure.
Everyone in healthcare talks about patient-centered care but it is a bad joke. Patient-centered care is virtually non-existent. Our care system is designed to meet the needs of large hospitals systems, drug companies, device companies, and provider groups. Our failures are a severe burden to half the country. It is impossible to defend the indefensible. High medical costs are part of the reason so many Americans no longer trust their institutions. Every one of us can help move our health system to one that is much more patient-centered. Make your family and friends aware of these facts. Let’s do something. Contact me if you want to be part of the push for real change in healthcare. We can have better health at lower cost soon. More on that in the next post.
I attended an annual dinner of a medical organization, which operates clinics. I basically did not eat, for I fast after 6 PM. So only water for me, and a few leaves of lettuce in this case. But I watched with mounting disgust at the dishes that were served. And I asked my contact, how can you have an annual dinner for this organization like this and serve the kind of foods that GIVE people heart attacks? I mean what is wrong with us, is we are in an unwell system and a codependent system. We need to go back to Freud and understand secondary gain - the perverse gain from the victim position. https://www.academia.edu/88292557/Wilful_Ignorance_of_Secondary_Gain The assumption that people want to be well, is a faulty assumption that drives healthcare costs to infinity.
The only good news I see in medicine, is that we have better and better tools to support taking responsibility. One area is with a cardiometabolic test that provides near 90-100% accuracy of diagnosis and prognosis, with the emphasis on the latter. It can also provide valuable feedback for making lifestyle changes. I have literally seen cases that start out looking like when do we need to put in a stent, to a complete return to health, with the patient adding decades to their life expectancy. https://hippocratessays.com/restarting-wfpb-jumpstarts/
In short, the options are growing, but the fix is not primarily the healthcare system, it is the doctor-patient relationship, and the patient's willingness and interest to take care of their own health. We have lost that to the pharmaceutical industry, who have trained us carefully to always look for drugs first, which generally speaking suppresses symptoms, and allows chronic diseases to fester, and then when you retire, the bills come due, just when you have to learn to live on a fixed income. All unnecessary, but patients are unwilling to do dangerous things like healthy nutrition, healthy sleep, exercise, relaxation, meditation and prayer and so on. Lifestyle changes. We resist them exactly because we are often our own worst enemies, and until we are willing to step up to the plate and begin to want to work on healing that inner conflict and our self-destructive tendencies, nothing will ever change.
How very true: "Everyone in healthcare talks about patient-centered care but it is a bad joke. Patient-centered care is virtually non-existent. Our care system is designed to meet the needs of large hospitals systems, drug companies, device companies, and provider groups."