An American Sickness:
How Healthcare Became Big Business
and
How You Can Take it Back
by
Elisabeth Rosenthal
It takes a lot of hands to mess up healthcare as badly as we have done in this country. And Elisabeth Rosenthal has described pretty nearly all of those interested parties and how they have affected us and our health care in this book. She has done it in a way that makes each aspect of the healthcare disaster personal to each of us.
Rosenthal is a writer and non-practicing physician who now writes for Kaiser Health News. Not only is the book well-researched, but she does have her finger on the pulse of American healthcare. In the book, she documents chapter by chapter the different pieces of the healthcare puzzle, with personal stories about wrestling with the massive and systemic incompetence and corruption. These personal stories come from people not in the field, but also other physicians, and Rosenthal herself. Importantly, the people whose experiences she describes are not anonymous. They have all come forward to tell their story in order to help change this awful system. And then she details practical ways we can effect both political change and fight personal battles over things like drugs and hospital bills.
I would like to run down all the most important details, but it seems that I would have to basically transcribe the entire book. There is critical information on every page. And it is information that could affect any of us. Rosenthal has broken the book down into chapters about each aspect, from insurance, hospitals and doctors, to pharmaceuticals, medical appliances and research.
Each of those facets of health care, since the sixties, has contributed to changing the goal from improving health to increasing profit.
Blue Cross Blue Shield was once a true non-profit which goal was to make health care affordable, but when for-profit companies like Cigna stepped in, the competition forced Blue Cross to make profit a goal in order to survive. Money was increasingly spent more on advertising and executive salaries than on health care, to the point that the Affordable Care Act now requires that the industry spend at least 80% of premiums on health care.
The initial function of hospitals was charitable. These days many of those hospitals have become an important way to bring in money to the Catholic Church. Again, executive pay and advertising run up the bill. Hospitals compete by offering the services that will increase profit rather than those that are most needed. Part of their business model is that they must continually get larger, swallowing up smaller hospitals or forcing them to close. Hospital administrators now tend to have business backgrounds rather than medical experience. And those administrators work hard for their big paychecks, by figuring out ways to increase profit. Unnecessary tests and extended hospital stays, $10 aspirin, contracting out rather than having in-house doctors -- just a drop in the bucket of creative ways to jack up hospital profit, with little to no accountability.
Likewise, physicians were increasingly likely to run their practices with an eye to profit rather than the needs of their patients or community. The doctor that stops by your bed to see how you are doing is billing you for it. "Physician extenders" can step in and do the work of the specialist without the qualifications; double billing; coding for a more costly procedure; out-of-network physicians who are contracted by a hospital without your knowledge, leaving you with a huge out-of-pocket bill. And you may never see the doctor who quickly scans your treatment from an office miles away, yet bills you as though he has actually provided treatment.
If you are wondering why our drugs cost so incredibly much more than those sold in any other country, the culprit is a for-profit system with a pharaceutical industry that pays lobbyists a fortune to keep government regulations at bay. The tricks they play to keep the prices sky-high are mind boggling. There are actual legally accepted methods that can keep a generic off the market for years after the patent should have expired. Competitors actually make deals with companies that have big-name drugs, agreeing to keep their drug off the market for a price.
Remember Martin Shkreli, the cocky, immoral narcissist who bought the rights to a cheap generic and raised the price from $13.50 to $750 a pill? The thing about Shkreli is not so much what he did, but that he did it so publicly and shamelessly. In fact, that kind of abuse goes on all the time, at every available opportunity. The government is unwilling to step in and regulate. The drug companies make billions from our suffering. Marketing new, expensive drugs that are less effective than older generics, extending a patent by adding a new coating to a pill, fishy FDA rules that allow drug approval with inadequate testing... again, I could go on and on.
Medical devices are another area of creative price gouging, one that is buried in other bills. The device manufacturers' lobby has been so successful that as some members of the Senate are attempting to work together on fixing the ACA, thus far the only item that has been altered is eliminating the 2.3% medical device tax, which is actually closer to 1.5% after deductions. 20,000 jobs were not lost as a result of the tax. The tax is not on consumer devices, like eye glasses, but only on "non-retail medical devices," like MRI's and pacemakers. And like the $4,000 screws used in some back operations. The prices from hospital to hospital vary like crazy; there is no rhyme or reason to the pricing.
One of my favorite boondoggle stories is a personal one. A few years ago, while I was working at a branch of the Charleston County Public Library, each branch had installed a defibrillator. It was a great source of wonder and comic relief for the staff. As a library assistant, high school degree required, the assumption was that one of us would be required, with no training, to operate the defibrillator on a patron suffering a heart attack. One of us thought that it should only be used if the patron was unconscious. We hadn't even been given an emergency phone number. In a very cynical way, it cracked me up. But wasn't it a damn clever idea to sell those things to zillions of local governments across the country? With little proof of effectiveness of defibs in public places, no funds for training, and a pretty good-sized price tag for governments that, in the 2000's were bearing the weight of huge budget cuts. Hate the government? Blame the corporations that prey on them.
Medical tests are overpriced and overused; in-house testing creates greater profit for doctors and hospitals and sometimes ridiculously higher bills for patients. Ambulances are now in many areas contracted out, and the costs non-negotiable, and often, not covered by insurance. Physical therapy used to be an affordable service but is now big business.
Medical coding, rather than being a language that makes it easier for professionals to know a patient's medical status, is now an opportunity for obfuscation and profit. Consultants are hired to find a way to pad the bill by entering a more highly reimbursed procedure code.
And then there is research. Research is the excuse given by pharmaceuticals and device manufacturers for their exorbitant prices and insistence on longer patent times. But "new" items too often these days merely replicate old, tried and true -- and less expensive -- drugs or devices, research is oftentimes not as rigorous as seems to be required. And results and follow-ups, well, they just aren't cost effective when it comes to the bottom line, so when the regulators aren't paying attention, they too often are minimized or don't happen.
Medicare and the Affordable Care Act have both attempted to improve medical outcomes and curb costs, but those who stand to profit work tirelessly to get around those efforts to provide affordable quality care. And lobbyists ensure that our lawmakers don't do much to get in the way of the industry. Al Franken, Amy Klobuchar and -- my god -- Elizabeth Warren, all worked across the aisle to support REPEAL of the medical device tax, which had been intended to finance Obamacare. Why? Because Minnesota and Massachusetts are home base for three of the largest device manufacturers.
On that sobering note, the author goes on to itemize by category our $3 trillion health care bill. And then, in a short but important section, she gives practical instructions for combating the health care behemoth in our own lives, as, for example, when you get an unexplained charge on a hospital bill.
It would be in your own interest to read this book. But we don't all have the time. But I urge you to check it out of the library, glimpse through it, and pick a chapter that calls out to you. Fifteen minutes of your time (if you can put the book down) will give you an idea of why it has taken so long to get to Obamacare and why there has been so much energy, and so many dollars, put into dismantling it. And why it is so important to take down this massive waste of money and lives.
Each of those facets of health care, since the sixties, has contributed to changing the goal from improving health to increasing profit.
Blue Cross Blue Shield was once a true non-profit which goal was to make health care affordable, but when for-profit companies like Cigna stepped in, the competition forced Blue Cross to make profit a goal in order to survive. Money was increasingly spent more on advertising and executive salaries than on health care, to the point that the Affordable Care Act now requires that the industry spend at least 80% of premiums on health care.
The initial function of hospitals was charitable. These days many of those hospitals have become an important way to bring in money to the Catholic Church. Again, executive pay and advertising run up the bill. Hospitals compete by offering the services that will increase profit rather than those that are most needed. Part of their business model is that they must continually get larger, swallowing up smaller hospitals or forcing them to close. Hospital administrators now tend to have business backgrounds rather than medical experience. And those administrators work hard for their big paychecks, by figuring out ways to increase profit. Unnecessary tests and extended hospital stays, $10 aspirin, contracting out rather than having in-house doctors -- just a drop in the bucket of creative ways to jack up hospital profit, with little to no accountability.
Likewise, physicians were increasingly likely to run their practices with an eye to profit rather than the needs of their patients or community. The doctor that stops by your bed to see how you are doing is billing you for it. "Physician extenders" can step in and do the work of the specialist without the qualifications; double billing; coding for a more costly procedure; out-of-network physicians who are contracted by a hospital without your knowledge, leaving you with a huge out-of-pocket bill. And you may never see the doctor who quickly scans your treatment from an office miles away, yet bills you as though he has actually provided treatment.
If you are wondering why our drugs cost so incredibly much more than those sold in any other country, the culprit is a for-profit system with a pharaceutical industry that pays lobbyists a fortune to keep government regulations at bay. The tricks they play to keep the prices sky-high are mind boggling. There are actual legally accepted methods that can keep a generic off the market for years after the patent should have expired. Competitors actually make deals with companies that have big-name drugs, agreeing to keep their drug off the market for a price.
Remember Martin Shkreli, the cocky, immoral narcissist who bought the rights to a cheap generic and raised the price from $13.50 to $750 a pill? The thing about Shkreli is not so much what he did, but that he did it so publicly and shamelessly. In fact, that kind of abuse goes on all the time, at every available opportunity. The government is unwilling to step in and regulate. The drug companies make billions from our suffering. Marketing new, expensive drugs that are less effective than older generics, extending a patent by adding a new coating to a pill, fishy FDA rules that allow drug approval with inadequate testing... again, I could go on and on.
Medical devices are another area of creative price gouging, one that is buried in other bills. The device manufacturers' lobby has been so successful that as some members of the Senate are attempting to work together on fixing the ACA, thus far the only item that has been altered is eliminating the 2.3% medical device tax, which is actually closer to 1.5% after deductions. 20,000 jobs were not lost as a result of the tax. The tax is not on consumer devices, like eye glasses, but only on "non-retail medical devices," like MRI's and pacemakers. And like the $4,000 screws used in some back operations. The prices from hospital to hospital vary like crazy; there is no rhyme or reason to the pricing.
One of my favorite boondoggle stories is a personal one. A few years ago, while I was working at a branch of the Charleston County Public Library, each branch had installed a defibrillator. It was a great source of wonder and comic relief for the staff. As a library assistant, high school degree required, the assumption was that one of us would be required, with no training, to operate the defibrillator on a patron suffering a heart attack. One of us thought that it should only be used if the patron was unconscious. We hadn't even been given an emergency phone number. In a very cynical way, it cracked me up. But wasn't it a damn clever idea to sell those things to zillions of local governments across the country? With little proof of effectiveness of defibs in public places, no funds for training, and a pretty good-sized price tag for governments that, in the 2000's were bearing the weight of huge budget cuts. Hate the government? Blame the corporations that prey on them.
Medical tests are overpriced and overused; in-house testing creates greater profit for doctors and hospitals and sometimes ridiculously higher bills for patients. Ambulances are now in many areas contracted out, and the costs non-negotiable, and often, not covered by insurance. Physical therapy used to be an affordable service but is now big business.
Medical coding, rather than being a language that makes it easier for professionals to know a patient's medical status, is now an opportunity for obfuscation and profit. Consultants are hired to find a way to pad the bill by entering a more highly reimbursed procedure code.
And then there is research. Research is the excuse given by pharmaceuticals and device manufacturers for their exorbitant prices and insistence on longer patent times. But "new" items too often these days merely replicate old, tried and true -- and less expensive -- drugs or devices, research is oftentimes not as rigorous as seems to be required. And results and follow-ups, well, they just aren't cost effective when it comes to the bottom line, so when the regulators aren't paying attention, they too often are minimized or don't happen.
Medicare and the Affordable Care Act have both attempted to improve medical outcomes and curb costs, but those who stand to profit work tirelessly to get around those efforts to provide affordable quality care. And lobbyists ensure that our lawmakers don't do much to get in the way of the industry. Al Franken, Amy Klobuchar and -- my god -- Elizabeth Warren, all worked across the aisle to support REPEAL of the medical device tax, which had been intended to finance Obamacare. Why? Because Minnesota and Massachusetts are home base for three of the largest device manufacturers.
On that sobering note, the author goes on to itemize by category our $3 trillion health care bill. And then, in a short but important section, she gives practical instructions for combating the health care behemoth in our own lives, as, for example, when you get an unexplained charge on a hospital bill.
It would be in your own interest to read this book. But we don't all have the time. But I urge you to check it out of the library, glimpse through it, and pick a chapter that calls out to you. Fifteen minutes of your time (if you can put the book down) will give you an idea of why it has taken so long to get to Obamacare and why there has been so much energy, and so many dollars, put into dismantling it. And why it is so important to take down this massive waste of money and lives.
