Wednesday, January 23, 2008

Reining in health care costs

Lots of talk is going on about health care today: access for all, controlling costs, improving care, addressing preventative care, not exempting people for pre-existing conditions, and lots more. Working in the health care industry, involved with DIRECT patient care, I see the waste and inequities of the current system every day I step into the hospital to care for my patients. So why aren't the people who are involved with the day-to-day care of patients being asked for their input on how to help health care become more of what all of us want it to be and how to make it more affordable?

Since no one has asked me, I'm going to throw out some of my suggestions. First, stop the pharmaceutical companies from advertising the latest, greatest new drug to treat problems you didn't know you had or didn't know that existed! Last year, the pharmaceutical companies spent $30 billion on research and development --- but spent over $60 billion on advertising those drugs you never knew you needed! And is it any wonder that they spent so much on advertising? The ads are flashy and glitzy, and hardly a commercial break happens without at least one or two of those plush ads graces our television screens. You, as the medical consumer, DO NOT need to be exposed to the "sucker-you-in" ads that prompt you to ask you doctor about this latest and newest drug to treat a problem you didn't know you had. Half as much money as is currently spent can be better spent on educating and informing physicians about those drugs ... and letting THEM decide which of their patients will most benefit from the new drug. This is the way it has happened for years prior to the previous 10 years or so that pharmaceutical companies started flooding our airwaves with "Viva Viagra" or "sleep like a butterfly with Ambien" type ads. And it worked VERY well. It can and will work just as well again.

Second, start paying for preventative care! It costs a LOT less to prevent a disease or condition (especially chronic health conditions) than it costs for long-term treatment of these diseases and conditions. For example, many (if not all) health care plans will NOT pay for smoking cessation products (Chantix, nicotine patches, nicotine gum, nicotine inhalers, nicotine lozenges, etc.). Instead, the insurance companies then are faced with the lengthy and expensive proposition of paying to treat patients suffering from chronic obstructive pulmonary disease, emphysema, chronic bronchitis, and asthmatic bronchitis (among other lung conditions) from years of patients smoking. Even paying for multiple rounds of smoking cessation products would be infinitely cheaper than paying for 20 to 40 years of treatment of a chronic condition that finds some patients making two to 12 or more hospital visits annually, many of which require a week or more of hospitalization. The current state of affairs makes absolutely no sense, especially since these insurance companies are so focused on the bottom line profit.

Third, restrict the wages of the CEO's of for-profit hospital administrators (heh ... any health care administrator, for that matter), pharmaceutical companies, and anyone else charged with providing the care/tools/equipment that provide for the general health and welfare of the medical consumers. What person needs $20 - $40 - $60 - $100 million salary (including incentives) to live on? This is just pure, unadulterated gluttony and greed. And that gluttony and greed is being paid for by the blood and well-being of the average medical consumer. It is blatantly obvious (to me, at least) that health care costs are grossly inflated and could easily be brought under control (or assisted) by eliminating these obscenely high salaries.

Fourth, make coverage for ALL a reality. We are the ONLY industrialized country in the world without universal access to health care for our citizens. While we, as a country, lead much of the world in the quality of our health care, it it out of reach for roughly 1/4 of our citizens. And that coverage for those who are either under-insured or non-insured is passed on to those who are covered by higher costs for those who do have coverage. WE END UP PAYING FOR THOSE WHO CANNOT AFFORD IT through higher health care costs. The costs of the care for those who cannot afford it get passed on to the rest of us who can afford it and who do pay for it. Personally, I don't care what method or model they choose to follow -- Great Britain, Canada, Cuba, France, Germany, Japan -- take your pick of any of those listed or pick your own -- just get it done! How can we be competitive, as a country, in a world market when we cannot or will not even take care of one of our most precious resources: the backs of the working people that make us competitive!

Finally, does it REALLY cost $4 or more for a Tylenol? If it's provided by the hospital pharmacy, the answer is YES. But what would be wrong with allowing a patient to provide his own bottle of Tylenol, ibuprofen, aspirin, or any other over-the-counter medication? Undoubtedly, the cost can be cut and the patient can actively contribute to the lowering of his/her own health care costs. The patient or their family members can bring their own OTC medications in, and the nurse or med-tech can administer it to the patient per the physician's orders (to insure compliance with the doctor's orders).

These are only the tip of the iceberg for ideas I have for helping bring health care costs under control and to make health care accessible to everyone. There are lots more ideas for how to accomplish this. But in this, an election year, health care is on the minds of most voters and candidates. And those of us involved most intimately with providing that patient care need to speak up and offer suggestions for how to improve things. After all, who better knows what needs to be fixed and how to fix it?

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