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