Corporate medicine exploits doctors and nurses

Danielle Ofri, a physician at Bellevue Hospital and New York University writes that “corporate medicine has milked just about all the ‘efficiency’ it can out of the system. With mergers and streamlining it has pushed the productivity numbers about as far as they can go. But one resource that seems endless—and free—is the professional ethic of medical staff members.” What she’s saying is that most doctors and nurses are committed to doing the right thing for their patients and that the system takes advantage of them. Demands on them keep escalating “without a commensurate expansion of time and resources,” yet they continue uphold their professional ethics—sometimes at great personal cost—and try not to stint and caring for their patients. The nurse doesn’t take a lunch break; the doctor squeezes in the extra patients; evenings and weekends are dedicated to catching up with medical records, and so forth.

Here’s what’s happening:

• Primary care doctors spend nearly two hours entering information into the computer for every hour of direct patient care.
• Patients are sicker than in the past: more chronic conditions; more illnesses to treat; more medications to handle.
• Burnout levels among doctors are at new highs and increasing; doctors and nurses commit suicide at higher rates than in almost any profession.
• There are now roughly 10 administrators for every doctor. (From 1975 to 2010 the number of health care administrators increased 3,200 percent).

What are those administrators doing? I suppose a lot of them are entering the codes used by insurance companies. She doesn’t say, but they don’t sound like they do much good for the medical staff.

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

Forget testing for vitamin D

We need vitamin D because it increases our intestinal absorption of calcium, magnesium, and phosphorus and makes our bones strong. We get most of the vitamin through a synthesis that occurs on our skin. The synthesis is a complicated process involving a chemical that resides in our skin combined with exposure to the sun (ultraviolet light). (Vitamin D is found in only a few foods, such as egg yolks, oily fish and milk fortified with vitamin D.) Because many people have little exposure to sunlight, especially those living in northern areas in the winter, some investigators became concerned that large swaths of the population were not getting enough of the vitamin.

In 2007, one influential doctor published a paper asserting that blood levels of vitamin D below 29 nanograms per milliliter of blood leads to an increased risk of cancer, autoimmune disease, diabetes, schizophrenia, depression, poor lung capacity and wheezing. (He’s also published books.) Word got around and soon “there was a vitamin D bandwagon,” in the words of Mayo Clinic doctor. Doctors began incorporating vitamin D tests into the general evaluation of patients. Commercial labs immediately began describing levels of 20 to 30 nanograms as insufficient (and many continue to do so). The number of blood tests for vitamin D among Medicare beneficiaries increased 83-fold from 2000 to 2010. Among those with commercial insurance, testing rates rose 2.5-fold from 2009 to 2014.

In the meantime, a number of scientists performed multiple studies to verify the doctor’s claim, which turned out not to be true. After conducting many trials with thousands of test subjects, scientists found that those who took vitamin D supplements were no better off than those who took placebos. After reviewing the studies, the Institute of Medicine prepared a report stating that there’s no benefit for healthy people to have blood levels above 20 nanograms of vitamin D per milliliter of blood. After becoming convinced that the tests weren’t necessary, one doctor tried to discourage her patients from being tested. But, she said, “people were used to vitamin D monitoring, like with cholesterol. They wanted to know what their number is.”

There’s no reason to be tested for vitamin D, even if you live in Maine. It’s just another unnecessary test.

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

Why we fell behind in health care

We (the U.S.) devote much more of our economic resources to health care than any other nation, yet our health care outcomes aren’t better for it. In 1980, this wasn’t the case. At that time we were spending about the same as other countries and our life expectancy was also about the same. But by the mid-2000’s we were spending more than other countries and were at the bottom of the life-expectancy pack. What happened?

According to the experts, the oil price shocks of the 1970's hurt economic growth, straining countries’ ability to afford health care. At the same time, high inflation contributed to growth in health care spending. Unlike other countries that had constraints in place to control spending, constraints in the U.S. were negligible. It all goes downhill from there.

• Other countries put limits on health care spending whereas we rely on market forces. Because of this, prices for health care goods and services are much higher in the US. What’s more, when we have periods of rapid growth, health care markups also grow rapidly.
• In the U.S., medical facilities become ensnared in a “medical arms race,” in which they compete by investing in the latest technologies, which, by the way, don’t necessarily translate into better outcomes.
• The US has higher health care administrative costs than other wealthy countries. It’s because we have so many insurers, each requiring different billing documentation.
•  The U.S. spends less on those at the bottom of the economic ladder, even though the most efficient way to improve overall health is to focus on that population. In 1980 we spent 11 percent of our GDP on social programs, excluding health care, while members of the European Union spent an average of about 15 percent. In 2011 the gap had widened to 16 percent versus 22 percent. 

Ideas anyone?

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

Medicare for all

In one hospital, Medicare pays $17,000 for a knee replacement. The same hospital can get $37,000 for the same surgery on a patient with private insurance. The RAND corporation recently gathered information on about a third of the hospitals in the US and studied four million insurance claims. Overall, prices for hospital care average 2-1/2 times more for private insurers than for Medicare.

This study is the first to reveal such disparities on a large scale. Hospital rates are normally closely held secrets between insurers and hospitals. Businesses that contract with insurance companies have no idea what their insurers are paying hospitals. But because the costs are so steep, many businesses off-load more of the expense onto their employees through higher premiums and deductibles. The expense of paying for employees’ health care has depressed wages and entrepreneurship. One textile manufacturer moved more than 1,000 jobs out of the country because it couldn’t afford to pay for insurance for its workers. This is becoming increasingly common.

What’s more, the trend toward consolidation among hospitals have spurred higher costs. They become more powerful systems that can demand ever-higher prices. Many are flush with money. In Colorado, which has the biggest disparity, hospitals are building new facilities and buying physician practices, even though their existing hospitals are only two-thirds full.

The health care industry makes up 18 percent of the nation’s economy and is one of the nation’s largest employers. In fact, it’s the biggest employer in at least a dozen states. Medicare for all (or some form of that) would cost jobs—maybe two million of them. But as one Stanford physician-economist says, the first casualties of a Medicare for all program would be the “intermediaries that add to cost, not quality.” These would include the armies of administrators, coders, billers and claims negotiators. Plus there would be far less need for drug and device sales representatives who ply their trade office to office and hospital to hospital. Few people would mourn the end of $35 million annual compensation packages for insurance executives or the downsizing of companies that have raised insulin prices to 10 times what they are in Canada.

As the president of Physicians for a National Health Program says, “you don’t need insurance companies for Medicare for all. You need hospitals.” The point of a health care system is to treat patients, not to buttress the economy.  

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

I’m still fuming

The other day I read a case study about a woman who was being treated for ulcerative colitis. She was prescribed sulfasalazine (a combination of a sulfa drug and aspirin). She got desperately ill: very high fever and rash, so she went to the hospital and was put into intensive care. They did blood work and whatnot and discovered that she had bone marrow suppression, meaning a decrease in production of red and white blood cells. They were pretty sure she had leukemia, but it turned out she was allergic to sulfasalazine.

The reason I’m still fuming is that a couple of years ago my husband was being treated for colitis (not the ulcerative kind) and was prescribed a drug called budesonide (he didn’t think sulfasalazine was working). A few days after taking the drug, his extremities became painful and very weak. He could hardly move. He didn’t stop taking the drug until he could get ahold of the doc, who said to stop it, but didn’t say it was causing his symptoms. To try to figure out what was causing his symptoms he went to his GP, his gastroenterologist, a neurologist, and a rheumatologist. They all had different theories. He had a colonoscopy plus a muscle biopsy. The results showed nothing.

All along I’d been saying his symptoms were caused by the budesonide. But no one paid any attention to me, of course. (Although when I spouted my theory to the neurosurgeon who did the biopsy, she said, “It’s the reason I don’t take pills” and walked off.)  I even found an FDA-related “adverse effects” web site in which people reported the same effects from budesonide as my husband’s. I recommend that you look at it.

It took my husband about a year to recover. By the way, he takes sulfasalazine to control his colitis and I’m still fuming.

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