Archive for March, 2016

Healthcare’s Endemic Problem, Part One

March 17, 2016

The American health care system is touted as the best in the world.  This is a lie.  Certainly it has the resources and the potential to be the best, but the current system, on many levels, prevents this from being the case.  The system is broken, spoiled, fermenting from within, and drunk on its own excess.  Unfortunately, what Congress is presently debating, on both sides of the isle, is merely how best to fund the acquisition of more spoiled grapes when the issue should be: How can we dispose of the rotten and yet retain the good?  In its present, fermented state, the more money we give to health care, the more gluttonous it becomes.

The problem with health care is not how to fund it, or even who should receive it; the problem is what we are funding.  For what we are funding is a system bloated with excess; a system that relies upon its own failure and the employment of misallocated and superfluous billable procedures.

Of course we will not hear the American Medical Association (AMA) or Big Pharma divulge this problem, at least not publicly.  But behind those double doors where “Staff Only” is permitted, these issues of failure, overutilization and misallocation are well-known facts.  The industry relies upon them.  Overutilization and misallocation are so common that if they were to cease, the fiscal foundation of the entire health care industry would crumble.  Therefore, rather than expose this very real problem, the health care industry uses its bully pulpit to cover it up; even to tout the excess as necessity and thus they cry out for even more money.  Sadly, Congress listens.

A fairly recent article in The New England Journal Of Medicine (NEJM), stated, “It has been clear for some time that the primary hurdle to enacting health care reform is figuring out how to pay for it.”[i]  It is this argument upon which the government’s the Affordable Care Act is based.  I take issue with this argument, for it assumes a false premise.  It is based upon the presupposition that the vast amount of health care services currently provided have intrinsic value.  But this presupposition is without support, as noted by the renowned (or infamous depending upon your profession) Robert Mendelsohn, MD, who warned Americans years ago that they did not need “ninety percent or more of Modern Medicine.”[ii]

Until he published this opinion Dr. Mendelsohn had been a well-respected member of the medical community, filling many prestigious roles beyond his pediatric practice.  He had been chairman of the Medical Licensing Committee of Illinois, an instructor at Northwestern University Medical College, an associate professor of pediatrics and community health and preventive medicine at the University of Illinois College of Medicine, president of the National Health Federation, and national director of Project Head Start’s Medical Consultation Service.  Of course, even with these creditials, once he criticized the system, he was immediatelly ostracized.

I do, however, agree with another observation in the NEJM article, “great savings could be achievable in two areas: administrative costs and unnecessary care.”[iii]  Where I differ is the nature and volume of the administrative costs and unnecessary care that could be purged.  The article’s focus is limited to extreme clinical misallocation and fraud, which is estimated at $830 billion (30%) and another $500 billion (20%) in administrative costs.  I, on the other hand, focus on the routine, ubiquitous excess that drives the current medical system, that which constitutes its financial backbone, the 90% of unnecessary care Dr. Mendelsohn discussed.  Using these figures, controlling this waste could realize a savings of perhaps $2.5 trillion in clinical costs and another $2.3 trillion in administrative costs. If orchestrated effectively, the savings generated by eliminating this waste would be such that health care cost for the entire nation would be but a small fraction of its current expenditure.  From this premise, it is clear that true health care reform must take place at the clinical level, not the fiscal.  Reforming insurance policies and tax codes will only further exacerbate the problem of overutilization and fraud which are consuming our fiscal resources faster than we can produce them.

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[i]. RA Levine, “Fiscal responsibility and health care reform,” The New England Journal Of Medicine, Vol. 361, Issue 11 (Sep 10, 2009) 1533-4406.

[ii]. Robert S Mendelsohn, Confessions of a Medical Heretic (Chicago, IL: Contemporary Books; 1979), xiii.

[iii]. RA Levine.

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My Love-Hate Relationship With Healthcare

March 8, 2016

As a seasoned clinical respiratory therapist and clinical manager with an advanced degree in health care management, I have developed a love-hate relationship with allopathic medicine.

The Bright Side

I love the advanced technologies and medical interventions that can change and literally save lives.  Many times, I have been part of an emergent health care team employing such advanced technologies and medical interventions in various life-threatening situations.  I have witnessed seemingly miraculous recoveries—people virtually coming back to life when none of us thought it possible, or at the very least, probable.

Years ago, I participated in the mechanical ventilation of a patient, who for several weeks had been virtually on the verge of death—showing no signs of cognitive function, which was confirmed by multiple unpromising EEGs suggesting irreversible brain damage.  Then (and this is not typical), when all hope was gone and everyone knew it was way past time to pull the plug, a glimmer of consciousness appeared.  Slowly, day by day, we watched his life return.  First, his eyes began to make contact with ours.  After a week or so, his eyes began to follow us as we walked about the room.  Within a couple of weeks his eyes began to respond to our questions.  Then his head began to move, and one day, he mumbled a few words.  Soon he was talking.  Eventually, he walked out the door.

A few years before that I participated in the nearly hour-long CPR of a 12 year-old girl, whom, it was believed, had an allergic reaction to anesthesia.  After exhausting every possible option without results, her condition continued to deteriorate until her heart simply would not beat at all, not even erratically.  At last, we were mere seconds away from giving up; the discussion to cease our efforts had already begun, when suddenly her heart began to beat with a regular rhythm.  She has since grown into a beautiful young lady.

More than twenty years ago, I managed the ventilation of a middle-aged man ravaged by disseminated intravascular coagulation (DIC); it was to a degree that none of us had ever seen, consuming every limb and much of his torso.  We all knew he could not survive.  Days turned into weeks and somehow he was still hanging on.  Then he started getting better, the DIC reversing.  But after several days of promise he suddenly took another turn for the worse.  Again the DIC started to spread, though not as extensively as it had the first time.  Once again his condition looked dire; and then, after several days, the DIC began to reverse again.  He was eventually discharged, minus one leg.  I watched him hobble to the car on his new crutches.

Many medical procedures and medications are all but miraculous; and, as one who administers some of these services, it is an honor to be part of them.  I love that part of medicine.  I also love the genuine compassion and personal sacrifice on the part of the caregivers.  Most doctors, nurses and therapists of various disciplines, enter the medical field with a true desire to help, to make a difference in society.  Through the years, I have watched many of them weep (I have wept) when faced with the realization that nothing more could be done for their patient, and death was imminent.

I have heard physicians chastise uninsured patients for neglecting their office visit simply because they had no money to pay for the service.  They would assure the patient that their health was more important than the ability to pay.  I knew one physician who paid the cable bills for several of his nursing home patients because they could not afford it themselves.  I love that part of medicine, the human part, the empathy, the concern, the desire to make a difference.

The Dark Side

But there is also a part of medicine that I hate.  It is the dark side.  It is ever before us but seldom discussed; and it runs deeper, far deeper, than the benevolent bright side.  It is the white collar criminal element, endemic, even intrinsic to the system.  Without this element the current system (even under the Affordable Care Act) would simply implode.

I hate the misinformation, the widespread misallocation of resources and the fraud upon which the system is structured.  But this is only one aspect of this convoluted system, for it is broken at virtually every level.  In the following pages I attempt to peel back these layers and expose this system for what it is.  Some harsh things are said about the system, and consequently, about physicians; but I want the reader to understand this is not so much a condemnation of physicians as it is of the system of which they (and all of us really) have necessarily become a part.

As for the hint of sarcasm and cynicism strewn across these pages, it is not without cause.  From both a professional and a personal vantage point, through the years I have developed a very healthy sense of skepticism toward the dogma of allopathic medicine (western medicine).  For both your personal wellbeing and your financial stability, I would advise you to do the same.  Barring a relatively few and some nearly miraculous procedures, the majority of services provided by allopathic medicine are anything but honorable, or even necessary for that matter.  Not that particular services or procedures are themselves without value, but their superfluous and careless use, whereby they are employed without sufficient cause are, indeed, without value.  Not only does this create additional expenditures, it fills the patient with false hope and misinformation.

Having carefully considered the many troublesome layers to America’s health care system, I believe I have the answer to this dilemma.  The solution does not reshape the system but replaces it all together.  And I do mean altogether, the clinical as well as the fiscal elements.  However, I truly doubt those legislators with the power to fix this debacle seriously want to know the cure.  The cure is not a matter of resources but a matter of clinical reform—a reform that must initiated via legislation. It would be controversial legislation for it would affect one of Capitol Hill’s greatest lobbying groups: the pharmaceutical industry and its plethora of dealers—AKA, medical doctors.  Therefore, I suspect the cure is not welcome.

Furthermore, this work indicts the American medical establishment for its conscious and unethical neglect of promoting health; and, even worse, for actively engaging in the destruction of the same, by ignoring and even opposing proven natural therapies while promoting useless, yet profitable, medications that it might advance its own self-serving agenda of self-preservation.  Although many physicians at the clinical level might be excused for unwittingly disseminating misinformation, the medical establishment which knowingly advances this misinformation cannot; and be not deceived, this medical establishment is a very real and elite society of powerful movers and shakers within, or closely tied to, the pharmaceutical industry, which is the driving force behind our health care system.

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Congress Has No Desire To Fix Our Broken Healthcare System

March 8, 2016

America’s health care system is broken and nothing Congress has done, is doing, plans to do, or has even debated, will fix it.  The fervent arguments from either side of the isle are fallacious; for neither address the crux of the matter.  It is not who should have access to health care, or even how to pay for it; the issue of concern must be the health system itself, which is grossly bloated with misallocated resources and fraudulent services.  So that (and I say this without hyperbole) the vast majority of dollars spent on health care pay for an unimaginable volume of absolutely unwarranted doctor’s office visits, medical tests, hospitalizations, and medications that accomplish little more than to fill the coffers of service providers.

The health care system is not merely riddled with overutilization, misallocation, and fraud, but these form the framework upon which the entire system is built.  These are the foundation of the medical economy.  If taxpayers knew the extent of superfluous, gratuitous and fraudulent health care procedures and services I am certain they would force politicians to fix it.  It is so bad that if politicians truly understood the degree of waste and fraud, they might even be tempted to fix it themselves.

I submit that the health care system itself is sick, terminally ill. Like an irreparable myopathic heart, hopelessly destroyed by disease, no amount of money can cure this sick system.  More personnel cannot cure it.  Better trained clinicians cannot cure it.  It needs to be replaced.  It must be cut away and a new system put in its place.  Herein, I suggest a viable replacement, a new system that would provide necessary health care to all.  But it will take an act of Congress, for many laws concerning medical service providers and reimbursement for medical services must be changed.  The current medical system will fight it to the bitter end. So too will the medical malpractice trial lawyers, for the cash cow from which both of them suck will be removed.

One day, in my frustration at a couple of physicians admitting more patients to the hospital (unnecessarily so) and writing useless medical orders for unwarranted services,  I said, “If we would only admit truly sick patients to the hospital, and only provide the services that were necessary, the whole country could have affordable health care.”

One of them responded, “I know, but everybody wants their money: the doctors, the hospitals, the pharmacies; everybody wants to make money.  We have to do this to keep the system going.”  They both chuckled, brushing it off as if it were merely a game they played.

With more than four decades of clinical and managerial experience in the medical system, I am speaking out, blowing the whistle, and biting the hand that feeds me.  Not that I haven’t spoken out before.  Indeed, I’ve been speaking out for decades, writing articles, doing radio shows and even writing a previous book on the topic.  But in light of the newly passed legislation of the Affordable Care Act, I felt I had to speak up yet again because this monstrosity of a mess is merely going to increase the already bloated system of misallocated and fraudulent medical service.  I hope someone listens.

Hopefully, at the very least, these blogs will cast enough light on the severity of this fixable problem to get people thinking and talking about it.  Reader’s Digest often publishes an article entitled something like, “Twenty Things some profession Will Not Tell You;” and they have published one about physicians.  But they left out the most important one, which virtually every physician knows but will absolutely not tell the public.  “If they provided only that medical care which is necessary and beneficial, the total cost of quality health care in America would be a very small fraction of the current exorbitant cost.”  The problem is that such a practice would put most of them out of business.  It is the current high volume of unwarranted, superfluous medical services (provided largely to the minority of the population) that keeps their practices thriving.  The foundation of America’s healthcare system is rooted in this sanctioned waste fraud and systemic abuse.

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