Since sickcare is fiscally and demographically unsustainable, it will eventually be replaced by something that is sustainable. Our only choice is to either let the current system collapse and then start pondering sustainable alternatives, or begin an honest discussion of sustainable alternatives before sickcare implodes in insolvency.
In the spirit of openly discussing a variety of sustainable, systemic healthcare options, we present this essay by correspondent “Ishabaka” M.D. on how to cut our current (18% of GDP) healthcare spending by 50%. Ishabaka received training in Canada, so he has direct knowledge of the Canadian system from the inside. Having spent decades as a primary-care and emergency room physician in the U.S., he also has deep knowledge of the U.S. sickcare system from the point of view of a care provider to under-served (i.e. uninsured) Americans.
Here is Ishabaka’s essay: Some time ago I told you how I could cut health care costs in half and provide every American with the healthcare they need (not necessarily the healthcare they want!). Here goes. Some of my points might seem drastic, but we are facing a drastic problem.
1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE.
2. Like Canada, this will cover all doctor’s office, E.R., clinic, hospital etc. visits. Unlike Canada (the biggest mistake Canada made), there WILL BE co-pays for routine office visits and visits to the E.R. that are NOT serious emergencies. Here is why Canada’s no co-pay system is wrong. A family physician friend of mine in London, Ontario had a family in her practice. The little girl got an ear ache, with a low-grade fever on a Saturday. The mother took her to an E.R. and got an antibiotic prescription.
On Sunday the girl was feeling better with no fever, but the mother took her to a walk in clinic “Just to make sure everything was all right”. The doctor said “Yes”. On Monday the mother took her daughter, who was now feeling fine, to my friend’s practice “Just to make sure the other doctors knew what they were doing”. The ear infection was cured. That was two totally unnecessarily visits the Canadian tax payers paid for, and the first visit should have been to the walk-in clinic, which is much cheaper than the E.R.
Co-pays have to be meaningful – not too much to dissuade patients from necessary care, but enough to make them think. That should apply to all aspects of healthcare. Let me give you another example – right now, where I live, a basic ambulance ride (no drugs or treatments) is about $500. I have had a patient come in by ambulance for a TOOTHACHE. The paramedics should be able to say “No” and not worry about being sued.
3. Like Britain, every person will choose a primary care provider, who will provide their primary care. Referral to a specialist will require a request for consultation from the primary care doctor. In the U.S., there are no restrictions on seeing specialists who charge twice as much or more than a primary care doctor. I saw a guy who went to an ear nose and throat doctor to have his ear wax cleaned – a procedure any nurse can do!
4. Immediate tort reform. Not quite sure of the details, but I estimate that probably 50% of the tests done in the U.S. are to C.Y.A. against malpractice suits, and are medically unnecessary. What would probably be best would be a no-fault system. You are injured by the health care system, you are compensated a REASONABLE amount for your injuries, regardless of who was or wasn’t at fault. You aren’t really injured, you get nothing. This could be handled by arbitration panels which would take the lawyers out of the system. Right now, it takes on average $50,000 to defend a doctor against a frivolous lawsuit – the doctor wins, but still $50,000 is down the drain. On the other hand I was involved in a suit where a patient died due to real negligence on the part of two doctors and the family lost the lawsuit and got nothing. This would cut malpractice premiums by at least 1/2 and drastically reduce the amount of testing.
5. We spend WAY TOO MUCH money on end of life care. We have to get together as a society and decide what we will and will not provide for end of life patients, and that doesn’t just mean cancer patients, it also applies to end of life heart failure patients, emphysema patients, etc. For example, a reputable study in The New England Journal of Medicineshowed 0% survival from treatment of cardiac arrest on kidney failure patients on dialysis. Zero. I have had to do numerous “codes” on kidney failure patients on dialysis – they all died. A code costs thousands of dollars.
The first code I ever ran was on a 38 year-old accountant having an acute heart attack. In the old days (1960’s) I would have simply pronounced him dead. He lived, and was FINE, no brain damage from loss of oxygen, walked out of the hospital a week later and went back to work. That was money well spent. We don’t have infinite money. We need to get the most bang for the buck. The $90,000 chemo drug that extended terminal prostate cancer patients’ lives by 6 months should NOT have been paid for by taxpayers’ money. Patients who want it should have to pay for it themselves.
6. We have GOT to get the gold-bricks off disability and workmen’s comp. If we did, we could put the truly disabled and injured-on-the-job folks in suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind boggling to see how many gold-bricks there are. I really liked the system in Ontario, Canada. Any primary care doctor could certify a patient as disabled or off work for up to two months. After that, the patients had to be seen by a panel of specialists paid by the government. They had NO INCENTIVE to either certify the patients as disabled/unable to work or not. To make these specialists truly independent they should be salaried – and the government CANNOT fire them except for the reasons that would cause them to lose their licence (sex with a patient, drug addiction, etc.).
7. All advertising immediately banned. We go back to the 70’s. No doctor, hospital, clinic, drug company, can advertise to patients. Period.
8. All new drugs have to be compared to existing drugs (if there is a similar existing drug). ONLY if they prove superior to existing drugs should the FDA approve them. Every time a new drug is invented, all the other pharma companies copy it, change a molecule or two, and then study it compared to PLACEBO. We end up with 20 drugs that do the same thing. It’s ridiculous.
9. Get rid of fraud and abuse – for real. This means doctors AND patients. You get caught committing health care fraud you pay in fines THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial – fraudsters MUST be made to do time. Everybody’s charges get audited by an independent panel. You charge for patients you didn’t see, or wheelchairs you never provided to patients – you go to jail. It must be recognised that nobody is perfect, mistakes happen. A doctor accidentally charges for a patient they didn’t see once in five years is not fraud – it’s a mistake. In the same way, patients caught “doctor shopping” for narcotics and selling them pay three times what they made and go to jail for a year. Same for patients selling blood pressure pills (this is a big racket for Medicaid patients) – doctors are usually suspicious of healthy looking patients seeking narcotics, but see a Medicaid patient who is on expensive blood pressure pills, says they ran out and can’t contact their doctor – they will usually get a prescription. You can make a nice income on welfare doing this.
10. Eliminate health insurance companies, except for people who want to buy extraordinary coverage like for the $90,000 prostate cancer drugs. Do like we did in Ontario – fee for service with the fees paid by taxpayers via a Department of Health, the fees negotiated annually by either state or national medical associations.
11. Electronic medical records THAT WORK. Right now we are in the “pre-internet” era of EMR. There are a thousand different ones, they are very expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH OTHER. I worked for a long time in an ER in Florida in an area where elderly people from the north came to winter. They would get sick all the time and come in not knowing their allergies, meds, or medical history. It was a nightmare. If I hear “I’m on a little white pill for blood pressure” one more time I may scream!
With a national standard EMR I could find everything I needed to know with a few mouse clicks. It will be a disaster if this info is stolen or hacked, so the punishment must be severe – 10 YEARS in prison WITHOUT PAROLE, and a hefty fine. No excuses. Set up something with Interpol and the UN so this applies to all countries. And, since EMRs would benefit patients, doctors, and the entire country, doctors and hospitals pay half, the government pays the other half.
12. Get rid of the bad docs/nurses/hospitals/ etc. I’ll just speak for the docs here – there are two kinds of bad docs – ones who are bad usually due to lack of knowledge or drugs/alcohol but WANT to be good, and those who are bad and don’t care. The second ones are immediately banned from healthcare for life. The first group gets extensive education/rehab, whatever they need. Then close monitoring. In my experience, most of them will turn out to be good docs. A few won’t, and get banned from healthcare for life.
13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats. We know they are poisonous. Again, minimum one year prison for the CEO and board of directors of any company that violates this law, whether it’s a mum and pop shop or Kellogs or McDonalds.
That’s it, except for a few tweaks. 50 per cent cheaper, everyone gets what they need. Thank you, Ishabaka. Here is a story Ishabaka sent recently that highlights the consequences of fast-food on human health: This is an article from the July 2, 2012 issue of Circulation, the journal of The American Heart Association. It shows how frequency of eating fast food per week increases the risk of heart attack – up to 80% if eaten four or more times per week! This is a highly respected medical journal, not some crackpot website. Western-Style Fast Food Intake and Cardio-Metabolic Risk in an Eastern (Asian) Country.
Conclusion: “Western-style fast food intake is associated with increased risk of developing type 2 diabetes and of chronic heart disease (CHD) mortality in an eastern (Asian) population.”
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