Way to go Texas

I’ve been quiet recently for no other reason than I’m mid-move from Austin Texas to Louisville Colorado. I don’t think Texas will miss me, or care if I’m gone, but I can’t help but be glad to turn my back on the what must be some of the most vindictive, small minded, and regressive politicians I’ve ever come across.

11380987_867608403331615_1505800615_n[1]It kind of doesn’t matter where you stand on the abortion issue, I’m pro-choice. However, when you look at the time, effort, money and all the laws, regulations that Texas has pursued in their attempt to de-fund Planned Parenthood, it is nothing less than a scandal. Worse though are the indirect consequences, the way womens health has just become an acceptable casualty in the battle, little more than mere shrapnel.

While the Texas politico’s have gone after Planned Parenthood, what they’ve actually achieved is the large scale closing of family planning clinics around the state. Of the 82 clinics that have closed, only a third were Planned Parenthood. Those clinics didn’t perform abortions, they were not there just to encourage women to have sex outside of marriage, they provided obstetrical care, gynecological care, and Pap smears.

For those that remain open, there are often massive distances to travel, and long waits, less than a quarter of those that should be seen, are being seen for subsidized preventive health care treatment. That would barely meet the World Health Organization requirements for a third-world country. Welcome to Texas.

Wade Goodwyn has a good report on NPR on the state of affairs in Texas, from George W. Bush childhood home of Midland, far west Texas. The most depressing thing Goodwyn says in his report is:

Texas is becoming the model for other conservative states that would like to defund all family planning clinics associated with abortion providers.

http://www.npr.org/player/embed/464728393/464744500

Out of control drugs

For-profit hospitals appear to be better players in this price-gouging game,” says Bai, an assistant professor of accounting at Washington & Lee University. “They represent only 30 percent of hospitals in the U.S., but account for 98 percent of the 50 hospitals with highest markups.

Of the many things wrong with the US Medical system, and there are a great many, not least it is the most expensive in the world, are the prices of ancillary parts of the healthcare system.

I’ve just been catching up on my bills, one of which was a visit to a chiropracter. A single visit, with a company provided insurance, my out of pocket cost was $485. Yes, it’s complicated, it involves deductibles, co-pays etc. and of course since it’s my only healthcare visit so far this year, I got essentially nothing from insurance. You then start to question what you got for $485. 10-mins with the specialist; 15-mins electrical stimulation; and about the same ultrasound. Sigh.

I have a mild form of psoriasis which randomly appears(stress?) on my right elbow, left thumb and a couple of other areas. It’s really no big deal, I use maybe two or three small tubes of Fluocinonide per year; in a couple of days and it’s gone. I went to get a replacement tube of cream from CVS recently. It’s a prescription cream, which comes with its own problems. The pharmacist gave me the cream and announced they’d changed providers and the price was now $8. No big deal to me, I can afford it. I paid and left.

Out in the car, I stopped and thought about it. I’d just been stung with 62.5% price hike. Seriously same active ingredient, same size tube; different generic brand. And there you have it, you have no control, no choice, no free market, it’s effectively too difficult to shop around because it’s prescription only. Yet, strangely you can buy it online for pets, it’s about the same price, meaning again, my drug insurance is effectively worthless.

The problem in America is that there is no effective control for the price of drugs. This report by Johns Hopkins Bloomberg School of Public Health report, highlights how this is commonly exploited, let alone specific deliberate abuse.

The 50 hospitals, they found, charged an average of more than 10 times the Medicare-allowed costs. They also found that the typical United States hospital charges were on average 3.4 times the Medicare-allowable cost in 2012. In other words, when the hospital incurs $100 of Medicare-allowable costs, the hospital charges $340. In one of the top 50 hospitals, that means a $1,000 charge.

Of the 50 hospitals with the highest price markups, 49 are for-profit hospitals and 46 are owned by for-profit health systems. One for-profit health system, Community Health Systems Inc., operates 25 of the 50 hospitals. Hospital Corp. of America operates more than one-quarter of them. While they are located in many states, 20 of the hospitals are in Florida.

For-profit hospitals appear to be better players in this price-gouging game,” says Bai, an assistant professor of accounting at Washington & Lee University. “They represent only 30 percent of hospitals in the U.S., but account for 98 percent of the 50 hospitals with highest markups.

We all pay the price for this abuse. It’s nonsense to think that a single payer, public healthcare system would cost anymore. If we had it, there would be drug price control. Those against price control often argue that would stifle innovation and invention of new drugs, they role out the enormous cost of bringing out new drugs and using the profit of successful drugs to underwrite research, and failures during the process.

This is simply invalid. Anyone who thinks that humans won’t become involved because they are prepared to standby and watch their fellow citizens die, is just plain wrong. While medical innovations have progressed dramatically over the previous century, the last 20 years specifically have resulted in monumental advancements that substantially increased medical care standards and improved overall global health, but most of those advances didn’t actually come from the actual drugs(*), but from a better understand about the human body, how diseases spread and much about healthcare. The real ripoff in drug use is both at source, manufacturers, and those that sell the drugs.

Lets hope the next President take drug pricing as a priority.

* Not withstanding massive public health crisis drugs, like HIV, Ebola et al. These serve as exactly as an example of the invention that will still come.

Healthcare – Points mean Prizes!

Back on April 6th I wrote a blog called “Healthcare Stupidity“. In a work email today it contained the following:

It may surprise you, but prices for medical services can differ depending on where you go. For example, identical cholesterol tests can run between $10 and $270 and an MRI can range from $300 to $3,000. Need a minor outpatient procedure? Searching in Castlight could save you hundreds. With Castlight, you can compare costs for doctors and medical services before you make an appointment.

Earn more points! Sign up, perform a search and review your medical plan in Castlight by June 30 for a chance to win 10,000 WOWPoints on e-Deals (valued at $100)*! For rules and more details please visit Castlight Rewards Sweepstakes.

Speechless, you can’t make this stuff up. As Bruce Forsyth used to say, Points mean prizes, play your card right!

Watch the video, If you are one of my US Friends… It will dispel any notion you have of the British being intelligent and articulate, much like the US Healthcare system it seems.

TEXAS Two Face

Between the Maher, Stewart and Colbert TV shows you can get some of the most biting commentary on the real America. Bill Mahers latest blog takes on Texas as a “free market paradise” and a “We’ll stay out of your hair.” kinda place, makes some very interesting points.

The contradiction between the business claims and attorney Abbotts current fight with the EPA which is at odds with the record of safety history and environmental impact; and alongside that, the rugged individualism and freedom, with what has been enacted this year over Womens health.

All thats wrong with US Healthcare

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This article in Saturdays Wall Street journal was mostly about healthcare industry stocks, but what blew me away was the chart that was included. I’ve long felt the US Healthcare system aka “industry” was not only too expensive, you can’t have a balanced discussion about it, people immediately get very defensive.

Once you’ve been treated a few times it becomes obvious that insurance is used as a blanket to cover

  • a vast array of unnecessary services, loads of extra tests, samples, examples, scans and xrays. Often because upfront you’ve paid your co-pay, pre-pay etc. so what do you care? The medical facility is paid for what they do, not their results.
  • Excessive administrative costs – for example, during my recent broken collarbone rather than visiting a single hospital and doctor/specialist, I had to visit 2-separate facilities, each duplicating the entire billing, insurance debacle, requiring many pages of documentation and background information. Every medical facility comes with it’s own army of billing and administrative staff to negotiate the insurance rules, claims and reclaims.
  • Inefficiently delivered services – Americans with insurance take great pride in the system as it delivers choice and prompt service and treatment. The reality it doesn’t, it does it through the illusion of choice based on whats available through insurance, and through a long list of appointments which are “first” available, but compared to a single payer system where you can move quickly and efficiently between providers, it isn’t efficient. For those without insurance there is little or no option but to sit in the emergancy room and hope for the best.
  • Prices are too high – because they have to cover an inefficient system and high administration costs.
  • Fraud – of course there is fraud, in any efficient system there are always those that seek to exploit the system; also in a system which excludes many, they look for a way to get what they can.
  • Missed prevention opportunities – and of course any system which generates huge amounts of money to deal with problems isn’t really focussed on prevention. While their are pockets of good practice in prevention, mostly there is a lack of priority in prevention.

Add up the numbers, you could pay for a single payer system with everything except the prevention missed opportunity.