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Thursday, February 20, 2014

Health $ Care: Bless the Broken Road

"Americans on average are living longer now than ever before. A 65-year-old can expect to live an additional 19.2 years, five more than in 1960. By 2050, the number of Americans 85 and older is forecast to reach 19 million, up from 5.5 million in 2010.

"But with advanced age often comes illness. Three out of four Americans older than 65 suffer from health issues like cardiovascular disease, diabetes, cancer and chronic respiratory illnesses. Of those 71 or older, 15 percent (3.8 million people) have dementia, and that number will swell to 9.1 million by 2040, according to federally financed research by the RAND Corporation."

(Kyle Harrington. "50 May Be the New 30." February 19, 2014)  

These two paragraphs represent the new reality of aging. If you read between the lines, you can see even more serious problems that coincide with these statistics. The natural progression of getting old and developing illnesses makes more and more American seniors dependent upon the health care system to sustain their quality of life.

The evidence contends health systems in many other countries perform far better than the United States  The World Health Report 2000, Health Systems: Improving Performance, ranked the U.S. health care system 37th in the world. According to this report, countries such as Iceland, Columbia, and Chile have superior performance indicators than those of the States.

You must consider that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. This begs the question: "Why do we spend so much to get so little?"

 (WHO. Geneva. World Health Organization. September, 2009)

Look at proposals to bettering this dismal situation:

"The current proposals for U.S. health care reform focus mostly on extending insurance coverage, decreasing the growth of costs through improved efficiency, and expanding prevention and wellness programs. The policy debate has been overwhelmingly centered on the first two of these elements. Achieving universal insurance coverage in the United States would protect households against undue financial burdens at the same time that it was saving an estimated 18,000 to 44,000 lives.

"However, narrowing the gap in health outcomes between the United States and other high-income countries or even slowing its descent in the rankings would require much more than insurance expansion. Given the vast number of preventable deaths associated with smoking (465,000 per year), hypertension (395,000), obesity (216,000), physical inactivity (191,000), high blood glucose levels (190,000), high levels of low-density lipoprotein cholesterol (113,000), and other dietary risk factors, there are huge opportunities to enact policies that could make a substantial difference in health system performance — and in the population's health.

"More investments that are targeted at promoting proven strategies — including tobacco taxation and smoking-cessation programs, screening and treatment for high cholesterol and blood pressure, banning of trans fat, creating incentives for people to engage in physical activity, and subsidizing the cost of consumption of n−3 fatty acids — could dramatically reduce mortality and enhance the performance of the U.S. health care system."

(Christopher J.L. Murray, M.D., D.Phil., and Julio Frenk, M.D., Ph.D., M.P.H. "Ranking 37th -- Measuring the Performance of the U.S. Health Care System." N Engl J Med 2010; 362:98-99)

Dramatic variations exist among regions and racial or ethnic groups in the rates of death from preventable causes. The health care system needs to address these issues to effect great positive change. Yet, in reality, prevention restricts the flow of dollars into the coffers of the practitioners and the insurers who make large profits treating those with serious diseases.

This is capitalism -- profit drives the continued success of every business, and the health care system is a conglomeration of businesses that are no exception to the rule. As seniors develop illnesses and health problems related to aging, they find themselves on a fixed income with inadequate health insurance. After working and retiring with supposedly "good benefits," seniors find themselves going further and further in debt to receive American health care. This is the sad state of treating an aging population.

The answer to the initial question in this blog is... "The business of health care -- not the compassionate employees and their attempts to heal an ill, aging populace -- is broken." When those who pay enormous premiums for health insurance need the best coverage in their "golden years," the businesses of health insurance and health care do not cooperate as they should. In fact, those who pay for health coverage and health care already fund the government system for those who contribute nothing. There is absolutely no parity in this tradeoff.

Health costs are outrageous. They defy description and explanation. Have you ever tried to discover why normal checkups, simple procedures, and medicine cost so much... no, I mean why they really cost so much? The answer lies in enormous profits of back-scratching lobbyists, politicians, companies, and professionals who operate a "closed-circuit" game with your money. You will get answers such as the following:

* "It's all in the way it (your service) is coded."
* "That's the standard, required rate for procedures as controlled by the hospital."
* "Technology is expensive, but it is vital to spend this money to keep track of your health."
* "The cost of malpractice insurance alone is driving up your bill."
* "Perhaps it would help to lower your deductible."
* "You're right, that does seem odd, but it must be something 'funny' about your deductible or copay or coverage.
* "I'm afraid we can't help you, but we will refer you to a specialist who may be able to help. Of course, you will need to pay for inflated rate of the initial visit and the increased charges of specialty treatment. You are insured... aren't you?"

The bullshit has no end, no answer, but occasionally some well-versed sympathy. All of your efforts to comprehend the logic employed by the health care system result in more frustration and in no savings to your bill. In fact, the more time you spend talking to medical professionals, the more you will be charged, so it's best to keep conversations brief, and, like Peter Pan, just "believe, clap your hands, and don't let Tink die."

People have found a convenient scapegoat in Obamacare. Health reform -- better coverage for less money -- is needed. We know that. Those suffering illnesses and large payments agree. I, for one, am sick of blaming efforts to reform for the actual problem. The beast is out of control and has become the burden of the middle class. President Obama didn't create the monster nor neither does he deserve all the blame.

I am tired of the political wrangling, and I know why solutions with compromise can't be found. No politicians in Congress (or in any governmental position) are paying big money for their health care. They do not suffer the pains of expending a large percentage of their personal budget to maintain their health, so arguing about reform is just the "business" of politics that keeps them busy maintaining proper allegiance to party lines rather than solving pressing issues. News flash -- empathy largely stems from sharing the hurt of oppression. 

Older Americans, please try to stay healthy. But, when the inevitable occurs and you find yourself needing to seek proper health care, rest assured big corporations will provide all the services you can afford. Depending upon the size of your wallet, you can find like comfort and relief.

And, if you find yourself in tremendous debt, take heart. You are joining a growing fraternity of seniors who represent a new "silent" segment of slaves to the system. Soon, your dementia may provide you some relief. It doesn't really matter if you pay your health care insurers and providers now or later. I guarantee you, you can't afford the enormous bill of one long hospital stay or the payment of a long string of technical procedures. That's the "price" of growing old in America these days.

I believe it was good old Ben Franklin who said, “An ounce of prevention is worth a pound of cure.” And, the old cliche still rings true. However, one must question the use of the word worth as it applies to health care. The inflated costs of something as logical and supposedly cost effective as prevention are not covered by buying affordable insurance. Paying for prevention is rather like gambling with your health with a sure deficit in the end.

You see, without old, sick people, lots of them, the system doesn't profit nearly as much, so the best future for health care relies upon jacking up charges to receive the maximum percentage of insurance payments plus collecting the obligatory patient charges not covered by the policy. Capitalism in a non-profit system? You bet your life.

 “Everyone should have health insurance? I say everyone should have health care. I'm not selling insurance.”

--Dennis Kucinich

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