Saturday, June 28, 2008

Why Los Angeles Makes People Sick. Literally.

Why does basic health care cost so much? This question plagues me, and countless others in the USA. Over the last three years, the cost of medication and tests that I have undergone has put me on the edge of bankruptcy. So, yes, I have fibromyalgia - and there is fuck-all I can do about it - but it's all the rest of what I've undergone that is wiping me out. And that's when I read this tidbit: in 2007 the total U.S. health care bill came to $2.3 trillion—more than we spent last year on food.

And what do we get for all this money? Not much. Despite claims that we have the best health care in the world, when we shine the light of reality on that claim we find this simply is not true.
By every conceivable measure, the health of Americans lags behind the health of citizens in other developed countries. Our life expectancy is shorter than that of citizens in Canada, Japan, and all but one Western European country. We rank 43rd in the world in infant-mortality rates, behind Cuba, the Czech Republic, and the United Kingdom. We are no less disabled by disease than citizens of most developed nations, and our medical care is, with few exceptions, no better at helping us survive specific diseases. For instance, the mortality rate from prostate cancer in the United Kingdom is virtually the same as it is in the United States, despite the fact that the disease is treated far less aggressively in the U.K.
But a huge factor in the rising costs is that we in the USA spend far too much on unnecessary tests. Of our total $2.3 trillion health care bill last year, a whopping $500 billion to $700 billion was spent on treatments, tests, and hospitalizations that did nothing to improve our health. And I have fallen into this trap.

And actually, that trap has a lot to do with the geography of health care. I live in Los Angeles, where everything does cost a bit more - we pay higher prices at the pump, we pay more for restaurants, we pay more for all kinds of things, including health care. Why? Because doctors and hospitals in Los Angeles tend to give their patients more tests, procedures, and surgeries, and their patients tend to spend more days in the hospital.

Now, when I don't feel well, and the doctor starts recommending and scheduling a variety of tests, I tend to become very blond and say, "uh-huh," and go along like a good girl. And then the bills start coming in. And coming in. And then I wake up and go, whoa, wait a minute. Did I really need to get tested for Vitamin D deficiency? Did I really need to get tested for a rare liver disorder that I may or may not actually have? Do I need to take those pills for this liver disorder that the expensive testing could not confirm or rule out?
Patients undergo back surgery for pain in the absence of evidence that the surgery works. They contract lethal infections while in the hospital for elective procedures. They suffer strokes when they undergo a surgery that, ironically, is intended to prevent stroke. And each year they undergo millions of tests—MRIs, CT scans, blood tests—that do little to help doctors diagnose disease.
Doctors put the blame on patients, of course, saying we demand every little pill we've seen advertised on television - and I think that is part of the issue. But in my own case, I'd been taking a lot of Tylenol for pain - this is before I was diagnosed with Fibro - and my gynecologist decided to do a ton of blood tests. She didn't ask, she just said I needed to have them all, including liver functions. No symptoms, just she decided. My liver functions were sort of whacked - she said I had numbers normally seen in a drinking alcoholic. I haven't had a drink since July 17th, 1988, so that was weird. So she started to do all kinds of research, and decided I had PBC, a rare, hereditary liver disorder and sent me to my Gastro doctor to have more tests. A liver biopsy (the 30 seconds of drug induced high were great) and the biopsy was inconclusive. And the horse pills, which are not covered by my insurance and were $100 a month.

Now, the simple answer: stop taking Tylenol, it messes up your liver.

The reality is that we have a badly broken system. This is pressing issue that will not be fixed overnight - and if McCain is elected, won't be fixed at all. But there are things we can do as individuals, and here is a checklist provided by AARP:

1. Find a doctor who communicates Most of us need a primary care doctor who can clearly explain what ails us and the possible ways to treat it. If you have a physician who does this, stick with him or her. If your current doctor tends to rush you or doesn’t explain things well, tell him or her you need more time.

2. Coordinate your own care Talk to your primary care doctor about making sure he or she sees copies of your medical records from all your various doctors. Somebody besides you needs to know what all your physicians are doing—including all procedures, tests, and drugs they’ve prescribed. This is especially important if you are on multiple drugs or have a chronic condition, such as diabetes or an autoimmune disorder, that requires visits to multiple specialists.

3. Get the right specialist If you or a loved one is facing a serious illness, find yourself a palliative-care doctor. Physicians trained in this specialty have a particular expertise in the control of pain. They are also trained to coordinate the care among your various doctors.

4. Find out what difference a test or procedure makes Ask your doctor what he or she expects to learn from the test and whether the results will make a difference in your treatment.

5. Weigh the benefits and risks If a physician recommends a surgical procedure, ask what will happen if you decide not to do it—or if there is a less-invasive treatment option.

Cross posted at The Sirens Chronicles


Randal Graves said...

"Heh heh, just don't get sick."

- George

It sure does seem like every system the body politic has is broken: education, health care, food, transportation. None of them on their own are all that sexy of a topic, but they're all interrelated.

I don't even want to think about all the shit that won't get done if that creepy lunatic gets in.

Agi said...

Just this year my wife had jaw surgery, my mom had a benign tumor removed from her brain and my dad had cancerous tumors removed from his liver. Thankfully, we all have health insurance. I can't begin to imagine what it's like for people who are uninsured to go through similar circumstances. No one should have to lose their home to pay for medical bills.

Anonymous said...

But a huge factor in the rising costs is that we in the USA spend far too much on unnecessary tests.

I would add the staggering cost of 'busy-work' generated by the HMO/PPO industry in figuring out how to deny coverage. There is a tremendous amount of waste in the administration of health care.

DrDon said...

This is one of your best posts Diva, and a subject I'm rabid about. People in the U.S. have been sold a bill of goods by the folks who have a vested interest in the status quo. We keep hearing scary stories bout how bad universal health care would be but as you correctly point out, what do we get with our phenomenal private health system? Mediocre health care and a consistent ranking in the middle of all industrialized countries. We don't live longer, have 40 million uninsured, and can't afford medication but somehow this system is best than national health care? This is pure bullshit peddled by the health care industry, insurance companies, pharmaceutical shops, and the politicians in their pockets.

Another thing that drives up costs, and it's not pleasant to say this, is that about 80% of health care dollars are spend on the last 2 years of life. This just makes no sense. While no one wants to see a loved one pass away, spending such vast amounts of money simply to extend life for a year or so is foolish. And these treatments tend to be some of the most expensive.

It's a tough problem that, like most problems in America, won't be addressed until there's a crisis.

an average patriot said...

I did a story on this because a girlfriend with Diabetes got me thinking! Just remember California is the direct benefactor of China's massive pollution. and that is the very beginning

Fran said...

Apparently my last post went to the ether.
Anyway.... I posted earlier @ Sirens.
But wanted to add this-- you ain't seen nothin' yet till you get a glimpse of elder care & care facilities.
Medicare has zero zip nada for dental care, so you are on your own there.
Care Facilities are sooo expensive & it just goes up as the level of care increases.
My Mom pays $7100 a month for Memory care. Add another $500 montly, for meds Medicare does not cover. I almost fell off the chair when they said this price does NOT include laundry services. You could either pay by the pound, or make your own arrangements.

The trick is to get into a long term care facility before the $$ runs out.

Utah Savage said...

This is a great post Diva. I DID go bankrupt because of health care costs. I'm three years out from that, and once again the medical bills are rising. I'm with you completely on the enormity of this problem.

PS. While you are doing brilliant work, I am trying to explain the workings of a swamp cooler to you at my place.

DivaJood said...

Kids, I was at the office today, and could not respond to a soul.

Randal, the topics are all interrelated, and each one emphasizes the differences between the "overpriviledged uber rich" and the real world.

Agi, I am insured and my coverage doesn't begin to address everything that's gone on with me the last couple of years. But it would have been worse without insurance.

Kvatch, in reality, the paperwork and beurocratic mess accounts for only about 3% of the rising costs. Go figure.

drdon, This is pure bullshit peddled by the health care industry, insurance companies, pharmaceutical shops, and the politicians in their pockets. You are absolutely right - and a culture in America which places doctors as some kind of higher being. My grandmother used to say "Dactahs. They don know nuthing." I believe she was mistaken. They, along with Big Pharma, know how to fleece the unsuspecting.

Jim, pollution is a factor in the increase of auto-immune disorders, I am quite convinced of it.

Fran, I saw your comment at Sirens, but haven't had a moment til now to respond. Saturdays, when I work, suck big time. Long term care facilities are terrifying. I have long term care insurance, but wonder if this is another boondoggle. As for dental, well, sister, the dental insurance directs you to "factories" that insist you have all kinds of work done that you didn't need before when all you wanted was a simple teeth cleaning and polish.

Utah, I am five years out from a BK due to health care costs, was doing well, and then boom, here I am again. If we wind up with McCain as President, there is no way on earth this will be addressed, this crisis in health care.

enigma4ever said...

Great post on a truly crappy subject that is beyond senseless....close to 50 million without insurance ( 47 million was the 2004 figure...) and 25 UNDERINSURED.....gee that should really sum it up HOW many are really suffering...if mcInsane gets eleceted ( by hook or crook) I seriously am thinking of working in a 3rd world country- because I know I will and would get better healthcare....

I am a nurse..I work partime..make too much to qualify for the FREE clinic ( I make 2000 too much a year...)....I have been a nurse for over 20 years...and taken care of hundreds ( or more) and I can not even take care of myself.....this is dangerous...I should just go ahead and buy a cemetary plot...that would be the best buy for my money.....

great post...thank you for being brave enough to talke about it....

Pagan Sphinx said...

As I wrote in a post recently, my mother, who lives in Lisbon Portugal, had gastic cancer surgery, all of which cost her under 100 Euros in copays. Granted, her primary care doctor is a hack and failed to diagnose her with cancer, whereas any idiot could have figured it out by using the internet. Their primary care physicians are not well trained and the state pays them shit.

One notable difference between my mother's treatment and what would be standard here is that the surgical team didn't prescribe radiation or chemo. From everything I've heard, regardless of the patient's age, that is standard post-cancer surgery treatment, regardless of whether they think they got it all or not. I believe she would be sick and dead by now, had they zapped her or chemmed her up. The U.S. is very aggressive with the radiation and chemo and one has to fight to NOT get it.

These fancy and ever-improved machines and expensive chemical drugs are pushed on hospitals to stay competitive. To justify their use, it has to become "standard". That's just what I think. But I'm no doctor and I'm very suspicious of the U.S. medical system.

DivaJood said...

Enigma, we have a system that is badly broken. The ONLY thing that prevents us from fixing it is greed. Years ago, some people we knew through my daughter's school were in England, and involved in a terrible car accident. The father had severe internal injuries and multiple fractures. The primary emergency care he received was incredibly good and immediate. He was in hospital in London for about six weeks before he was flown back to the USA in a full body cast for a six month stay in a Rehabilitation hospital. The care in England cost him nothing. I don't even want to mention what the six months in the USA hospital cost, or the flight home.

Pagan, These fancy and ever-improved machines and expensive chemical drugs are pushed on hospitals to stay competitive. This is absolutely true. And to justify the cost, the USA medical system pushes them on patients. I have seen Pharmaceutical reps come into doctors offices without appointments and get seen before patients who have been waiting. I'm happy your mother did not have to be subjected to our system!

robin andrea said...

I am so glad you posted on this topic, divajood. It's one of the most important issues facing our country today. If McCain is elected we will not see any improvement at all. When Obama announced that Elizabeth Edward was on his health care team, I breathed a sigh of relief. I know she is definitely on our side. We need single-payer now. Nothing less. It would have one of the most civilizing effects on our society.

DivaJood said...

Robin, I keep remembering the post about your mom smuggling Meds in from Canada. We are reduced to "criminal behavior" when indeed it is the Medical Business who are the criminals.