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The healthcare reform bill wants to assure all Americans can afford health care but it is not a fix for the system in general. We need to understand fully the drivers of rising costs in our healthcare system. Americans tend to blame these rising costs on everything but themselves; it is time we face the fact that we are a very unhealthy society. In order to repair our failing system, we have to look at how our habits contribute to the problem. It is easy to criticize the healthcare reform bill and point fingers but that does not help develop solutions. Sobering Facts about Health Care Costs "Expenditures in the United States on health care surpassed $2.2 trillion in 2007, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. In 2007, U.S. health care spending was about $7,421 per resident and accounted for 16.2% of the nation's Gross Domestic Product (GDP); this is among the highest of all industrialized countries". (An, Saloner, Tisdale, and Ranji, 2009). The Effects of Chronic Diseases: An Ounce of Prevention According to An, et al, "...chronic diseases, such as diabetes and cardiovascular disease, has risen dramatically; both of these chronic conditions are known to be correlated with obesity, smoking, and diet, and are very expensive to treat over long periods of time." (2009). We are a generally unhealthy society that places a tremendous burden on the healthcare system. Our goals, if we want to start repairing the system and decrease costs, should be on prevention and education. I have had patients with heart and lung diseases suffer exacerbations every other month resulting in longer hospital stays until their death. Despite the patient education nurses provide, some patients continue to practice bad habits that worsens their chronic disease. Patients post laryngeal cancer with tracheostomies who continue to smoke through the hole in their throats! I have cared for men with hypertension who discontinue their medications because they "feel better" eventually requiring open-heart surgery or developing co-morbidities (such as kidney disease with dialysis). Patients who refuse to follow their prescribed low cholesterol diets that end up with coronary artery disease leading to expensive bypass surgery. These actions are drivers of the rising costs of health care; no reform bill can eliminate this human factor. Many Americans have a choice of not being obese by adhering to a healthy lifestyle of proper diet and exercise. Obesity is at the center of many chronic diseases that places a burden on the health care system. Our love for fast foods continues to undermine health care concerns about the increasing incidence of obesity in our children. We are raising unhealthy children yet refuse to actively campaign for healthier foods in our schools. American children are also transfixed in front of a game system instead of physical activity and exercise. The healthcare reform bill will not change American's habits that lead to obesity and other chronic diseases. The system will continue to be overburden with the rising costs of caring for these people. New and Costly Prescription Drugs Again, Americans have some blame in the fact that we are bombarded with antibiotic resistant infections, which, requires drug companies to produce new drugs to combat these bacteria. Many times, especially when the culprit is a virus, Americans insist the doctor place them on an antibiotic. Super-bugs are developing faster than drug companies can produce new antibiotics. People who fail to complete their antibiotic therapy also assist super bug development. According to Moroney, "Several studies by Lichtenberg, et al. found that the replacement of drugs developed more than 15 years ago with newer, "priority" drugs recently approved (within the last 5.5 years) by the FDA reduce non-drug medical costs by as much as the cost of the new drug." (2003). Another problem is the current trend of suing drug companies for the side effects that are listed within the literature. Lawyers have abundant advertisements for customers who have suffered such adverse effects. Every drug has side effects but not everyone suffers from them. The question is '"Should the unfortunate ones have a right to sue?" Sometimes public demand for quick cures force the Food and Drug Administration (FDA) to rush a medication or vaccination to the market before all side effects are known. That is why, if you look at the accompanying literature, there is a number to the FDA to report new adverse effects. Some effects are beneficial to others; I remember in the early 80s when Minoxidil made female patients very hairy, it eventually became a drug used for male baldness. I was on a medication that lawyers advertised for class action respondents because it was believed to have caused diabetes in some patients. The fact was that the medication's side effect was weight gain; I gained 50 pounds and developed diabetes. The solution for me was simple, stop the medication (only under my doctor's supervision), and lose the weight. I no longer suffer from diabetes; I did not participate in the lawsuit. When drug companies have to contend with multiple lawsuits, the cost of prescription drugs are passed to the customers. Defensive Medicine Sometimes, a doctor will order a test or procedure only because the patient persists, knowing it is not necessary. Cardiac and Gastroenterology are common areas where this may occur. Patients with chest pain may have classic or atypical signs and symptoms of a heart attack; a trained physician can discern between the two. If a patient persists, they can undergo extensive (and expensive) testing, ending with a prescription for an antacid. According to Moroney, "many physicians suggest that the threat of litigation forces them to practice defensive medicine-prescribing unnecessary tests and treatments largely to protect themselves from possible adverse outcomes from doing too little. In addition to productivity pressures, providers are also facing increasing malpractice insurance premiums that have forced some to consider leaving the profession altogether". (2003). Some literature blames the internet for increasing patient demands for new technology, treatments, procedures, etc. The public's demand for the newest drugs (often encouraged through direct consumer marketing or TV ads) and the latest diagnostic technology also help increase health care costs. Patients would be admitted to hospitals just to have special tests done in a timely manner. Physicians would keep patients in hospitals so long; they would actually get sick, especially with hospital-acquired infections. We had ICU patients who had to stay an extra one to two days because there were no available beds; the backlash was a hold on further operations. American's Bad Habits In addition to poor eating habits and obesity, Americans continue to drink excessive amounts of alcohol and smoke tobacco. These two habits lead to many chronic illnesses that place extra burdens on our health care system, even after all Americans are covered under any healthcare reform bill. Perhaps taxing industries that contribute to the poor health of our society can help fund the bill. Another major problem is noncompliance. Patients who do not follow their medical regime usually end up hospitalized for longer days resulting in higher treatment costs each time. Sometimes we call them "train wrecks", those with multiple medical problems. They have a tendency to be demanding, blaming their woes on everyone except themselves. Noncompliance includes failure to follow a prescribed diet, not taking medications correctly, and continuing to practice habits that worsen chronic conditions, i.e. smoking. Our Aging Society "Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector. However, experts agree that aging of the population contributes minimally to the high growth rate of health care spending." (An, et al). Moroney states, "an aging population will require expanded services for such specialties as cardiology and orthopedics; ...91% of cardiology patients and 75% of orthopedic patients are over 45 ... Solutions Needed There are many other reasons our health care system is in trouble. The signing of a reform bill is only the beginning but it will not force compliance among the American people. We should stop pointing fingers and blaming others and take an interest in our own health. Proposed solutions range from increasing the quality and efficiency of medical personnel, increasing information technology with computerized medical records, a fee based payment system, and more government regulations. None of these solutions will work if Americans continue unhealthy practices, noncompliance, and a lack of preventative measures. Only then can we begin to repair our health care system. References An, Jane, Saloner, R., Tisdale, R., Ranji, U. The Kaiser Family Foundation (2009, July). U.S. Health Care Costs. http://kaiseredu.com/USHealthcarecosts/backgroundbrief.asp Moroney, S.D. (2003, Feb.). National Institute of Health Policy. Understanding Health Care Cost Drivers. http://www.NIHP.org/mbc1_healthcare_cost_drivers.pdf |
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