Hospitals to blame for high costs of health care

According to a professor at Yale’s School of Public Health, hospital prices are responsible for the high costs of health care, including the 320 percent increase in insurance premiums over the last 25 years. (Premiums for a family health plan can exceed $27,000 a year.) Prices at hospitals have grown three times as fast as inflation and twice as fast as prescription drugs and doctor visits.

In the U.S., hospitals earn $29,000 on average for hip replacements that are covered by private insurance and $16,000 for those covered by Medicare. In Germany, where 90 percent of the population is covered by a public system of nonprofit insurers, hospitals receive $9,400 for a hip replacement.

The reason for excessively high hospital costs is the hospitals’ “accumulation of market power, which brings them more bargaining heft when they negotiate prices with insurers.” Their market power is a result of mergers: Since 2000, more than 1,300 out of 5,000 hospitals have merged. When hospitals that were once competitors merge, prices go up. Now, 21 percent of hospitals are effectively monopolies.

Because hospitals are the largest or second-largest employer in many counties in America and spend more than $100 million on lobbying, politicians who represent places with dominant hospital systems are not eager to fight with these institutions. Moreover, chronic underfunding of the Federal Trade Commission inhibits their ability to regulate the hospital monopolies. According to the professor, the costs of  fighting hospital mergers “would potentially exceed the agency’s entire budget for antitrust enforcement across all sectors of the economy.”

The professor says we should push back on mergers and “scrutinize an industry in which 25 years of price increases have left care unaffordable.” Pushing back and scrutinizing don’t strike me as very powerful weapons.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Actinic keratoses and more

Actinic keratoses are rough patches on the skin. I have zillions of them. They’re caused by long-term sun exposure (ultra-violet light). Thirty percent of Medicare beneficiaries have been diagnosed with actinic keratoses. Dermatologists freeze them off with squirts of liquid nitrogen—a rather painful treatment. I’ve occasionally had that procedure, but mostly I give it a pass. I’ve got way too many.

Actinic keratoses are usually described as pre-cancerous. But, as one scientist noted, research has shown that there is less than a 1 in 1,000 chance of it progressing to skin cancer. What’s more, even if you have one removed, it will probably reappear. (This has happened to me.) It’s a chronic condition.

The last time I went to a dermatologist (a new one) I told him not to freeze my actinic keratoses. He was clearly annoyed with me—and I with him. (He was new. My previous dermatologist had retired.)

Removal of actinic keratoses is one of several treatments that investigators are now saying are probably unnecessary for old people. Colonoscopies are not recommended for people aged 75 and older. The drug levothyroxine for “subclinical hypothyroidism”—borderline underactive thyroid gland—has been found to have “no apparent benefit” for old people and can harm. Mammograms are not recommended for women over 75. Neither are PSA (prostate cancer) tests for men over 70.

I guess you could consider avoiding these tests and treatments as advantages to being old. Big deal.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

“Natural rejuvenation”

Natural rejuvenation—reversing cellular damage—is one of the newest developments in longevity research. Scientists have learned to trigger it in the lab. For example, they’ve taken skin cells from 90-year-olds and restored them to youth in a petri dish. They’ve rejuvenated diseased mice, returning their gray hair to black and strengthening their muscles.

Scientists discovered that rejuvenation happens naturally at conception. At first, the fertilized egg inherits all of the DNA damage that the parents had accumulated over the years. But after two weeks, the embryo’s cells have reverted to a pristine condition. Researchers are attempting to mimic this process.

To do this they’re attempting to reset cells’ epigenetic markers—the tiny clusters of molecules that sit on our DNA and give it instructions about which genes to turn on and off. Over time, some of these epigenetic molecules go awry, such as by attaching where they shouldn’t or losing their tight connection to the DNA, making it harder for our cells to read their instructions. The rejuvenation process attempts to reset the epigenetic code and restore its function.

This past March, Life Biosciences, Inc., began the first safety trials to test rejuvenation therapy on 18 people with glaucoma. In these trials, they’re delivering “reprogramming factors” to reverse the disease. The results are not yet in.

In the meantime, at a longevity science conference, the scientists agreed that, for now, there’s only one scientifically certified approach to extending human life: vigorous exercise and a healthy diet. Too bad. It’s so tedious.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The self-serve blood test

It looks like private enterprise is getting into the lab testing business, making it possible for you to bypass your doctor to get a blood test (and others). In researching this topic, I came across a Forbes Health site that rates 11 such companies. Here’s a quote from the site:

You Might Feel Fine—But What’s Happening Inside?
Fatigue. Weight gain. Brain fog. These subtle symptoms are often dismissed or attributed to stress. However, they could be early warning signs of deeper issues, such as nutrient deficiencies, hormone imbalances, inflammation, or even the onset of chronic disease. The problem? Most people are unaware, as they do not test their blood regularly enough.

On reading this, my initial thought was “Good heavens! It’s a scare tactic to generate business!”

One company, called Function, was not listed in the Forbes list (I don’t know why). But it was the focus of a New York Times article. For $365 a year, Function offers more than 160 lab tests—far beyond what is typically included in an annual workup. (If you test that many markers, a few of them will be abnormal in a person who’s healthy.)

Function customers receive a summary created by AI and reviewed by a clinician. The summary includes the test results, how to interpret them, and what steps to take next. The company does not accept insurance. The blood draws themselves are performed at Quest Diagnostics locations.  

The bloodwork that you’d typically get from your doctor mostly screens for common conditions that have well-established treatments, such as diabetes and anemia. Depending on your history or symptoms, you might also be tested for additional biomarkers.

Looking at 100 to 1000 biomarkers—as offered by these companies—sounds like a fishing expedition, leading to unnecessary follow-ups, treatments, and anxiety. I’ll skip it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.