How much is $2 trillion? If you could get it in cash, in single dollar bills, you would have enough of them to circle the earth eight times when they were laid end-to-end. The figure represents about 15% of our gross domestic product (GDP). The GDP is the total market value of the goods and services produced by the US economy each year. It includes all final goods and services—that is, those that are produced by the economic resources located in that nation. So $2 trillion is about 1/6 of everything everyone makes in the US for a year. It is also our health care bill. Our $2 trillion health care bill is more than the entire economies of all but four nations in the world. We spend more on health care than most of the rest of the countries in the world spend on everything else! And the price is going to go up.
When politicians debate about health care, the debate centers around whether the government should pay the bill or we should be responsible for our own health care costs—not why it is so freakin’ much. According to a report released in September, 2006 by the Commonwealth Fund, a non-profit, non-partisan organization, American health care only scored 66 points out of a possible 100 and lagged far behind the rest of the industrialized world. It received low grades on efficiency, access to care and in outcomes. Not only that, most industrialized nations only spend about 10% of their GDP on health care.
Insurance administrative costs in the U.S. were more than three times the rate in countries with integrated payment systems. Nearly one-third of Americans under the age of 65 have trouble paying their medical bills. Unfortunately, the increased spending does not result in better care. The US rated 15th out of 19 nations with regard to preventable deaths. About 115 per 100,000 people die who would have survived if timely and appropriate medical care was administered. France scored high in this category, with only 75 deaths per 100,000.
The US ranks last in infant mortality, with 7 deaths per 1,000 births. The top three countries have 2.7 deaths per 1,000 births—less than half our number. We are at the bottom of the list in life expectancy. American children miss more school for illness than the children from the other industrialized nations. Fewer than half of American adults receive the recommended screening tests appropriate for their age and sex. Preventable hospital admissions for chronically ill patients (eg; those with asthma or diabetes) were twice as high compared to the nations at the top of the list.
The bottom line is that we do not get very much for our money. One thing that would slash costs is if we started to learn more about natural health care. We spend $3 billion on drugs for reflux, $3 billion on drugs for ADD and about $90 billion per year for chronic pain, which is the most costly health problem in America. As Senator Everett Dirksen said, “A billion here and a billion there—and pretty soon you are talking about real money.” Natural health care has effective and inexpensive, and can help slash these costs.
Real Health Care Reform
Health care reform has been on everyone’s mind. A couple of years ago we had a great national debate and passed a law that has been dubbed “health care reform” by people who liked it, Obamacare by people who didn’t. The problem is, the law had nothing to do with reforming health care–just how we pay for it. Whether the money comes from private insurance or from the government, healthcare still costs around $2.7 trillion—a figure that represents about 1/6 of our GDP. If it were its own economy, it would be the 4th largest economy in the world. Americans spend more on health care than the entire economies of all but 3 nations in the world.
Even if we get the government to pay the bill—it still will cost us. Who do you think will pay the taxes to cover this expense? Cost is cost, whether you pay higher insurance premiums or higher taxes. There are a number of reasons for the magnitude of our health expense. We pay higher administrative costs than most Western nations. We also spend a lot of money at the end of life—we tend to use the ICU as hospice.
Healthcare in America is expensive and it is getting hard for many to afford it. General Motors spends more on worker healthcare than it does on steel for a new automobile. About 15% of all Americans cannot afford health insurance and about 23% of the working population is uninsured.
What is worse is that we do not get very much for our money. According to an article published in the Washington Post (May 5, 2004), Americans can expect the correct diagnosis and treatment less than 60% of the time. The United States is 18th in infant mortality and 21st in longevity among the nations of the world. According to the Journal of the American Medical Association ( 2000; 284(4):483-5), 225,000 Americans die each year from iatrogenic (doctor-caused) causes, making it the third most common cause of death in this country.
What many of us don’t realize is that healthcare is a business, and treatments have much to do with marketing and profitability. Drug companies are enjoying enormous profits in this environment. Let’s just take one drug company, Pfizer, in 2002 shareholders had $9.2 billion in after-tax earnings (a 28% profit). Almost two-thirds of Americans currently use medicines, 49% use prescription drugs, and 30% use nonprescription medications. About 32 million Americans are taking three or more medications daily.
There is some fallout from this reliance on drugs. According to the Journal of the American Medical Association (1998; 279:1200-5), administration of drugs in hospitals leads to adverse effects in more than 2.2 million patients and results in about 100,000 deaths per year.
Perhaps we need a new paradigm. Natural health care focuses on improving the body’s infrastructure and improving health. This approach is safer and less expensive than manipulating symptoms with drugs; we should try to get to the cause of health problems. Not to say that drugs should never be used, but they should be used cautiously and wisely.
Healthcare is a business
If you were to ask anyone what the goal of health care is, they would probably answer that the goal is to get sick people better. It makes sense. What other purpose can our health care system have other than to get sick people better? Actually it is a little more complicated than that, and there is a little caveat. The goal of our health care system is to get sick people better in a profitable and patentable manner.
Health care is, after all, a business. The people involved with it are in it to make a living. Many have noble intentions and want to Serve and want to play a part in improving the human condition, but ultimately they still have to pay their bills.
Since health care is such a necessary commodity, we have created rules to help ensure that people have access to it. Those rule tend to play havoc with the business end of health care. For instance, in a life threatening situation, a hospital has to offer you services regardless of your ability to pay. If you show up in an emergency room with chest pain, shortness of breath and pain down the arm, you would be admitted and given treatment. If you cannot pay, the hospital takes that as a loss. Hospitals care for patients on Medicaid and Medicare
What if you had a factory that made widgets and it cost you $10 to produce, and normally you sell them for $20. Let’s say that when people need a widget, they absolutely have to have one. If the government decided that you had to give free widgets to some people. Furthermore they decided that the government would buy widgets for some of the other people, but in order to keep costs down, you were required to sell your widgets to the government for $7 to some people and for $11 to senior citizens. You need to stay in business, so when people who can afford to pay want a widget, you sell them from $40 to $110.
It gets even more complicated. In health care a third party often pays for the widgets. The third party may decide that $20 is too much for a widget, but it will pay $15. Sometimes the third party decides that the customer didn’t really need a widget and does not pay you at all. When someone does pay for a widget, you would have to make up for all of these losses.
Why do you think hospitals bill $40 for aspirin? I had a patient who needed lumbar x-rays. X-ray film costs about $1 per sheet, and a lumbar series uses five sheets of film. The hospital may have $20,000 to $50,000 tied up in equipment. There are labor costs for the doctor to read the film and for the tech to take the film. Still, $200 is about what a lumbar series should cost. My patient was paying cash and it cost him $800. I called to complain and the administrator on the other end of the line calmly explained that that was what they billed insurance companies, because they never collected their entire fee anyway (the insurance probably paid the $200), and that they lost money on Medicare and Medicaid.
This is not to say that we should not offer care to those who cannot pay, but we do need to realize the real cost of doing so. This is not event the main emphasis of this book. I just thought it was important for people to begin to think of medicine as a business. Insurance companies are businesses. When you cut into the profits of a business, they have to make up for it in other ways. What we are calling health care reform is really just an exercise in deciding which pocket the money is going to come out of. While some savings can be had through administrative and procedural changes, what we are calling health care reform does not do very much for cost containment.
What is the goal of our health care system?
For some reason when we think of our health care system we think of an organization full of Dr. Marcus Welbys, dedicated and coming up with the absolute best therapy available. While the system is full of doctors, nurses, physical therapists and other practitioners who are intelligent and absolutely dedicated, the information they are working with has been given to them by entities that exist primarily for profit. The goal of our health system is to care for people in a patentable and profitable manner.
Drug companies
In my world, the natural health care world, drug companies are considered evil, at least in the opinion of most of the people I know professionally. They are heading a huge conspiracy to keep us sick and to make billions of dollars doing it. I am pretty sure that these companies are not headed up by Lex Luthor-like characters bent on world domination.
The do, however, exist to make a profit. They want to address health problems in a patentable and profitable manner. Take a problem like ADD or ADHD, for instance. They create drugs like Ritalin, which address the problem, but more importantly, bring in about $3 billion per year.
Like any business, they want to market their products, stifle competition, and increase their influence and profits. Like any business, they purchase advertising, they hire sales people and they get their message out to both doctors and lay people. They advertise to lay people on television and in other media, mostly to get the patients to ask the doctors for the product. Doctors are especially important, because the product does not get sold if the doctor does not recommend it; so a lot of the drug companies’ marketing is directed at doctors.
Drug companies spend a LOT of money to influence doctors. Drug companies endow medical schools, sponsor post-graduate education, and advertise in medical journals. They hire doctors to help influence other doctors. This is not particularly evil, it just makes good business sense. The problem is that the marketing efforts of the drug companies are so efficient and so pervasive that they have near absolute influence over how doctors think of health care.
If I am making $3 billion on a drug that addresses ADHD and I am spending thousands, if not millions of dollars advertising in medical journals, how happy am I going to be if one of those journals publishes a study that says B vitamins and essential fatty acids help children with ADHD? It is bad for my business. Occasional studies get through, usually small ones, but the attitude of the drug company influenced medical system is, “My, isn’t that amusing. We will have to look into that one day.” The occasional study does not have much influence because the drug company has a huge influence over the doctor from cradle to grave. They give the doctor information in medical school, at seminars, in the journals and just to top things off, they hire the hottest women on the planet to personally visit the doctor and give samples of the products.
So when you take your child to the doctor and say, “I heard that B vitamins may help his ADHD,” or “Should I be giving him less sugar?” The doctor is likely to says something like, “The studies are inconclusive, but I have this great new product. Let me give you some samples.” This ends up costing us a fortune, because we are spending $3 billion on pills instead of focusing on nutritional status and exercise.
