Oh Canada!

We spend about twice what Canada does on health care administration. In fact, we rank number one in the world! No surprise, I guess. About 30 percent of our health care dollars goes for administration:  

• Out of the $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes for administrative costs.
• For every 10 physicians providing care, almost seven additional people are engaged in billing-related activities.
• Physicians spend about three hours per week dealing with billing-related matters; for each doctor a further 19 hours per week are spent by medical support workers (in doctors’ offices).
• Administrative costs amount to $68,000 per year per physician.

In the U.S., administrative costs are high because of the complexity of our health care system. Most importantly, our health care providers must deal with a multiplicity of payers, including various public health programs plus a host of private insurers, each with its own set of procedures. In Canada, with its tax-funded single-payer system, medical practices spend a fourth of what we do on dealing with payers. (Canadians can buy private insurance for certain services such as dental or home care.)

A particularly big headache for medical practices in the U.S. comes from generating bills and collecting payments. Among other things, our providers must chase down patients for the portions of their bills not covered by insurance. Studies show that, for bills exceeding $200, only 67 percent are paid within a year. As the patients’ out-of-pocket payments increase, providers devote more resources to collecting it.

Single-payer anyone?

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Steer clear of new medical devices

I recently watched a new Netflix documentary called "The Bleeding Edge," which tells horror stories about medical devices. Here are some of the devices it discussed:

• Hip and knee replacements containing cobalt (metal on metal). The cobalt makes its way into patients’ bloodstreams. Not only does it damage the tissues around the implant, it affects patients' brains and causes dementia, tremors, blindness, and other neurological problems.
• Essure, a metal contraceptive device that’s inserted into the fallopian tubes. Many thousands of women have been made seriously ill, probably for their lifetimes. There’s no fix: when trying to remove it, the device breaks apart and pieces are left in their bodies.
• A surgical mesh used to repair pelvic floor problems, such as incontinence. When used as a sort of sling around the bladder and vaginal area, the mesh shrinks, degrades, perforates nearby organs, and other horrors. Like Essure, it is nearly impossible to remove the entire mesh.
• The DaVinci robotic surgical instrument. It has caused plenty of botched surgeries, including burns, tears, organ punctures, internal bleeding and infection and has damaged blood vessels, bowels, bladders, vaginal cuffs, urinary tracts, kidneys and other tissues.

Manufacturers can get these (and many others) quickly to market because of the FDA's fast-track process—known as a 510(k), which exempts products from full review if they are "substantially equivalent" to ones already on the market. It does not require submitting clinical data demonstrating safety and effectiveness There’s plenty of politics and money involved.

As far as I can tell, the only way to be sure a device is safe is if it has a substantial track record and has been used on thousands of patients without adverse effects. Older is better.

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Got milk?

In the old days, kids drank milk. We drank it with our meals. Schools supplied little cartons for lunch. It’s what we served our kids at mealtime. Fruit juice was something that you only drank at breakfast—usually orange juice.

That all began to change sometime around the late fifties and early sixties when an influential scientist, Ancel Keys, using what has now been debunked as erroneous “science,” determined that saturated fat was bad for you. The government and nutritionists bought into this notion and encouraged everyone to stop eating fat, including milk, which contains butter fat. Not only that, the government created a food pyramid in which carbohydrates, such as bread, formed the base of the pyramid, telling us that we should eat 6 to 11 servings a day. Because of the fear of fat, mothers switched from giving their kids milk to giving them juice. We now know that the government’s food pyramid was all wrong—that carbohydrates (sugar!) is linked to diabetes, obesity, and heart disease.

Nevertheless, the effect of Key’s influence lingers on and is easy to spot. You rarely see kids drinking milk. Mothers give their kids juice boxes, as do nursery schools. Even government programs designed to provide healthy food for children include juices in their offerings. Studies show that more than half of preschool age children (ages 2 to 5) drink juice regularly, and that they consume on average 10 ounces a day.

Fruit juice is nothing more than a sugary beverage. One 12-ounce glass of orange juice contains 10 teaspoons of sugar, which is roughly the amount in a can of coke. There’s no evidence that shows that fruit juice improves health. Plus it contributes to tooth decay in children. A pediatric dentist reports that he “routinely treats children, as young as 14 months, their upper front teeth destroyed, often beyond repair, by sleeping with or carrying around bottles of juice (among other sugary drinks.) Juice is soda without the bubbles.”

I doubt that milk drinking will ever come back into vogue. Well, I guess you can't go wrong with water.

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When bacteria go rogue

This is part two of my staph infection saga, written at week six. (See last week’s post for an introduction.) The “rogue” in the title refers to the fact that my normally benign skin bacteria turned against me. It is very creepy when bacteria appear to be eating your flesh. It’s especially creepy if you Google images of flesh-eating bacteria.

Week five. Week six is similar, minus raw area.

   What started as a tiny break in the skin on my finger grew day by day until I had a raw, stinging, pea-sized wound. The antibiotic ointment the doctor prescribed had no effect. The wound kept growing. After about two weeks of religiously applying the ointment, I quit. It seemed to make matters worse. All I could do was compulsively stare at it to see if my immune system would come to the rescue. It did, but it's been an extremely slow process. I was used to wounds healing in a couple of days.

I told myself I’d seek further treatment if the wound exceeded the
size of the original “blister.” It never did. To look at it, my wound doesn’t seem like any big deal. But it could be. I know of someone whose finger infection required IV antibiotic treatment 24/7, administered with a device strapped to his body. If the antibiotics don’t do the trick, his finger will be amputated.

This little trauma of mine makes me appreciate the forces at work keeping our bodies in balance, especially considering the thousands of bacteria and other organisms we naturally carry around with us. One false move…

I am now very curious about the bacteria that live on my skin and have sent a sample to The American Gut Project (UC San Diego), which will analyze it and tell me what kinds of bacteria I have. It’ll be a few months before I get the results back. I’ll let you know.

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