AlterNet: Health & Wellness: The Worst Health Money Can Buy

What ails the U.S. health care system and how to fix it.

One of the biggest myths about health care is that more is always better. Perhaps nowhere is this more evident than in the United States, which offers a cautionary tale for other countries seeking health care reform -- including those in Europe looking across the Atlantic for inspiration. The American people spent nearly $2.1 trillion on health care in 2006 -- more than was spent on food -- yet Americans aren't exceptionally healthy or long-lived as a result. They have shorter life expectancies than people in Western Europe, Canada and Japan and are no less hindered by disease than their counterparts in other developed countries.

In spite of all this spending, nearly 47 million Americans have no health insurance, according to the U.S. Census Bureau. And here's another irony: Although insured people often feel they receive too little medical attention, many are actually getting too much in the form of unneeded tests and treatments. This "overtreatment" is at the root of America's health care woes, according to medical journalist Shannon Brownlee, author of the upcoming book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. Brownlee contends that up to a third of health care dollars in the U.S are wasted on unnecessary care that doesn't improve people's health -- and may even endanger it.

A study of nearly a million Medicare patients (older Americans who receive government-funded health insurance) provides a compelling example of how too much care can cause harm. Medicare patients treated at hospitals that did the most tests and treatment and spent the most money were up to 6 percent more likely to die than patients at hospitals spending the least. In short, more spending, more hospitalization, more technology and more drugs do not necessarily equal better health care.

Why do doctors and hospitals provide too much care in the first place? They are stuck in a dysfunctional system driven by money. Doctors get paid for how much care they deliver -- not how well they take care of their patients. Meanwhile, hospitals are pressured to recoup the expensive investments they've made in pricey technologies and specialists. This means the more care doctors and hospitals provide, the more money they make.

Much of what doctors do is prescribe medications, some of which help save lives, like insulin for diabetics and cyclosporine for organ-transplant patients. But when it comes to medications, doctors are increasingly under the sway of drug companies. Brownlee observes that the pharmaceutical industry now foots the bill for at least 80 percent of clinical research (formerly funded by the federal government) and underwrites 90 percent of continuing medical education, wielding unprecedented influence over the content of medical journals and what doctors do and don't know about drugs.

When money drives every aspect of health care, from doctors to hospitals to the pushing of dangerous -- and often inadequately tested -- drugs, what can be done? Brownlee finds inspiration and solutions in one of the most unlikely places: the Veteran's Health Administration (VHA). A horrific shambles in the mid-1990s, the VHA has been transformed over the past decade into a model of effective, affordable and humane care. Today the agency, which cares for military veterans -- including many of America's oldest, poorest and sickest patients -- outperforms most other U.S. health-care institutions at a little more than half the cost per person. The VHA's prescription-accuracy rate is 99.9 percent and it has a lower rate of hospital-acquired infections than most other health-care institutions in the U.S.

In 1994, Kenneth W. Kizer took over the VHA as undersecretary for health. He introduced new information technology that helped lower rates of drug error and infections, while reducing unnecessary care. VHA doctors are encouraged to choose drugs carefully, based on scientific evidence rather than slick marketing, a step that has reduced costs and unneeded prescriptions. And patients report a high rate of satisfaction.

The perfect system may not exist, but the VHA story suggests that effective, affordable and compassionate health care -- publicly funded, no less -- isn't a pipe dream, but an achievable reality. Patients, policymakers and anyone concerned about the future of health care around the world would do well to read Brownlee's book.

Shannon Brownlee's book, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer (Bloomsbury), will be out in September.

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The privilege of the writ of habeas corpus shall not be suspended, unless when in cases of rebellion or invasion the public safety may require it. United State Constitution, Art. I Sec. 9 Par. 2

"Dissent is the Highest form of Patriotism" -- Howard Zinn

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"I suppose I always knew America would eventually break the planet, like some ghastly, hyperactive toddler that gets hold of a mobile phone and then smashes it repeatedly against the edge of a table". Quote from british journalist.

Wait ... you forgot to mention the attorneys and their frivolous law suits. You know, sleazy scum-bag lawyers like John Edwards.

Oh ... and do I remember a post by you, Med, about how Bush was making a shambles out of the VA medical system? Hmmm ... yes, there's something tucked away behind a brain cell I think.

Vi

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Damned right I'm an equal opportunity offender, I'm a Conservative!

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The privilege of the writ of habeas corpus shall not be suspended, unless when in cases of rebellion or invasion the public safety may require it. United State Constitution, Art. I Sec. 9 Par. 2

"Dissent is the Highest form of Patriotism" -- Howard Zinn

__________________
"I suppose I always knew America would eventually break the planet, like some ghastly, hyperactive toddler that gets hold of a mobile phone and then smashes it repeatedly against the edge of a table". Quote from british journalist.

Med sez ...

"Did you know that National Guard soldiers are not entitled to VA health care. Once discharged, they are on their own."

If true, Med, this would be a travisty. Do you have a credible link? I mean, something from VA guidelines that I can read?

Vi

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Damned right I'm an equal opportunity offender, I'm a Conservative!

i can promise you that the single biggest health care problem we have in our country is greed.

are the pharmaceutical companies greedy? no, they are profit driven just like any living organism is, but they donate billions to 3rd world countries and their execs are paid nothing compared to the salaries of telecomm, auto, and other giant industry execs.

are the doctors greedy? they spent at least 4 years in college, many spend 5 or 6 to get a post-grad degree before applying to med school. they go to med school for 4-6 years and then work for less money than the average secretary for one to two years while paying for huge student loans. yes, they chose a lucrative field but it's also a field that's about people and improving lives.

who's left then?

patients, lawyers and insurance companies - but not the ones you think.

patients in the USA are spoiled, arrogant people who believe that medicine is a product. they feel like they are customers entitled to the cheapest, fastest and best of everything. unfortunately, medicine can not solve every problem and doctors are not perfect. mistakes are made, lives change or may even come to an end. as though they are returning a defective item to a store patients or their families demand big money to compensate for any medical errors, no matter how unavoidable or accidental they were.

lawyers are quick to exploit any tragic circumstance; building millions of dollars of wealth from the suffering of others. these lawyers make so much money ruining our medical system that you will often see TV ads soliciting your calls to report anything they might be able to latch onto and sue someone for. this pressure has forced doctors to be overly cautious. almost any medical complaint, such as fatigue or even tiredness, will result in an admission to the hospital for observation and an exhaustive round of expensive tests. doctors are in CYA mode 24x7!

medical liability insurance companies often headed by former trial lawyers and with a board that's always infested with lawyers, these companies lobby hard to balance the government requirements for liability insurance with the lack of tort reform. they profit from charging doctors huge fees to insure their practice and protect them from the "other" lawyers, who tend to be very close most of the time. by using the government, these companies have forced their way into the medical world and began pillaging the trust and high ethics that made American medicine the best in the world for so long.



people need to stop blaming our medical system for the current state of affairs because it's not only dishonest, it's not going to solve any of the problems we're facing. by not paying attention to the reality here we are pushing the best medicine on earth into the hands of the professional liars in D.C. and that's going to wind up hurting really bad. our government is not the solution, we are.




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"But even when you cease to be slaves, you are yet far removed from being placed on an equality with the white race."

- Abraham Lincoln, President of the United States of America, Hero to the servants of big government, Racist War Monger

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"I suppose I always knew America would eventually break the planet, like some ghastly, hyperactive toddler that gets hold of a mobile phone and then smashes it repeatedly against the edge of a table". Quote from british journalist.

I believe the US health care system is still better than Cuba's.
I think government oversight of health-care providers is proper, but providing heath care would be a nightmare. You people who complain about the government now, just imagine the problems and red tape if the government was in charge of all your health care. And for you security minded paranoids, hows another government database on all its residents sound?

Regarding government-run anything: how have your experiences been?

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Of course, everything I say about using or growing weed is hypothetical...

If you saw the film "sicko" you would see the US are barbarians when it comes to health care .... here profit outweights life .... in the country with universal health care the welfare of the patient comes first .... you don't have to choose between eating and getting your meds in those country or worry about how to pay for any kind of medical proceedure .... People in those countries live longer than Americans ... in those countries people don't die because they can't afford a medical proceedure .....

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