Dallas Health Care Ranks Poorly

I've often written about the high (and climbing) cost of health care in America. Our nation spends two or three times what other industrialized countries due to take care of their citizens. Perhaps the reason this is such a sore subject with me is the fact that Dallas, Texas is one of the most expensive health care markets in the country.

The Commonwealth Fund released a report on Wednesday that ranked Dallas 264th out of 306 hospital referral regions across the nation. Granted, it wasn't only cost that caused the low ranking but also the number of uninsured in our area. The story in the local Dallas Morning News said that "Dallas health care representatives did not dispute the report's findings but said many parts of the community are working to improve the situation."

Meanwhile, I'm heading into the hospital tomorrow to repair a torn tendon and I can assure you that it's not going to be a cheap process. I completely agree with the Commonwealth Fund's report!

Bernanke Testimony

Yesterday Federal Reserve Chairman Ben Bernanke testified in front of Congress about the state of the economy. One of the key points in his discussion was when he called rising health care costs the "elephant in the room" that no one is talking about seriously yet.

I've raised the question of how to control health care inflation many times in this blog. I've noted that all of the other industrialized countries use some form of national health program. With only one source of payment it's possible to control the cost of health care far more effectively. The free-market model in America is one of the reasons we have the highest cost of health care in the world today.

Is there another way to reduce the cost of health care other than limiting and controlling what will be paid for health care? I haven't heard of one yet. I'd love to find one, anything, that we can do to stop this runaway train from bankrupting our country. As it is now, rather than controlling what we pay for health care in America we're going to end up limiting how much health care you get. That's the most profitable model for the medical industry in this nation.

Time for Action

A recent column in the Dallas Morning News shows why the time to reform health care has to be now. Steve Jacobs collected health care cost information illustrating why America may have already waited too long to get serious about health care.

By 2020 the average health insurance premium will be $24,917 compared to $14,623 in 2010 according to a Commonwealth Fund analysis. More important, the trend of employees sharing a larger percentage of the cost will continue so the $3,702 in 2010 will grow to an estimated $10,800. Don't think the deductible situation will improve because that's going to rise from an average $1,942 in 2010 to about $5,500 in 2020.

Mr. Jacobs calls this growing financial burden a household budgetary albatross. I think he's being kind. I think this problem will literally be the kiss of death for many.

The Growing Cost of Health Care

Is it better to have health care rationed by a government bureaucrat or by your own inability to pay for it? If you don't think it makes any difference then you're ignoring the potential for huge cost savings for everyone. In a nationalized health care system the government controls all health care and sets the pricing. America has free-market health care so prices have no control and every step in the system is free to charge whatever the market will bear in order to maximize profits. Doctors want to make more money, hospitals want to make more money, insurance companies want to make more money and so on.

Many Americans think we have the best health care system in the world. We don't. We have the most expensive health care system. How can you believe it's the best health care when we aren't as healthy or live as long as those in other industrialized countries? Depending on which study you read we rank #33 to #38 for longevity in the world putting us behind not only every other industrialized country but even behind many so-called, second-world countries. We don't live as long and we don't live as well. In many cases it's because we put off health care because of the expense. Today we're spending 17% of our nation's total Gross Domestic Product on health care while other industrialized countries are spending 7% - 12%. This is not a small difference!

Recently I was reminded of this increasingly dire situation after going through some medical tests. The bills are still rolling in months later and even though my insurance plan pays part of it, just keeping up with my share of each bill can be challenging. It scares me to think about what a major surgery or health crisis would cost. For a growing number of people every year it means either being healthy or going bankrupt. Rationing by cost, even bankruptcy, isn't any better than the restrictions of a government-run system and due to our escalating costs it's much more likely.

Every year medical inflation rises more than regular inflation (and much more than salary increases) so it's like compound interest. It grows and grows and keeps growing out of control. Every level of our health care system wants to maximize their profits, and they do. If you look at a graph of the rise in our incomes and the rise in medical costs in the past forty years you'd be sickened by the huge and growing gap in affordability.

Think for a moment if America had enacted some type of national health care plan when Clinton was president. Can you imagine how more affordable health care would be today because we wouldn't have nearly 20 years of medical inflation compounding costs? Instead we let the TV commercials of Harry and Sally persuade us to let the health care system continue to take more and more of our money.

The question today is: What are we going to do about it? Many people complain about Obamacare but I haven't heard any suggestions that will do any better. A free-market system does not work in health care, we have plenty of research showing that from all over the country. Dallas is one of the most "competitive" markets in the country because we have so many different companies that are supposed to be competing for our health care business. Instead of lowering costs this is one of the most expensive markets in the nation. Just down the highway in Waco, Texas the Scott-White medical system enjoys a near monopoly in the market prices are lower and it has a higher performance ranking than Dallas. In the health care field competition simply means trying to charge more than the guy down the street.

So what do we do? As individuals and as a nation we're facing the prospect of health care bankrupting us. How much lower does America need to fall in the world rankings or how much more of our GDP does it need to cost before we come up with a different system? One highly respected doctor I know predicted decades ago that if America's health care costs ever reached 8% of our GDP, health care would be nationalized. Today it costs more than twice that amount and it continues to grow every day we do nothing to change it.

Sickness in Health Care

When you read a lot of health care news (as I do) there are times you run across really sickening stories. Today I read about a study published in the New England Journal of Medicine done with Harvard University and Dartmouth Medical School researchers about dementia patient care. It seems that almost 20% of hospitalizations by nursing homes may have been motivated not by their concerns over patient health but simply by money.

It seems Medicare pays three times more for nursing homes to care for patients after brief hospitalizations. The transfer rate varied from just 2% in Alaska to 37% in Louisiana. In McAllen, Texas 26% of the study participants had multiple trips to the hospital for conditions that can easily be treated in a nursing home like urinary infections, pneumonia and dehydration. Only 1% of the patients in Grand Junction, Colorado were transferred to hospitals for the same conditions.

For some nursing homes to take advantage of the weakest and sickest in our society speaks volumes about the state of our health care system. Too often it's all about the money, not the people.

Rising Costs

This isn't going to come as a surprise to anyone paying for health insurance today, but the costs continue to rise. According to the Kaiser Family Foundation family plan premiums are now up to $15,073 on average, an increase of 9%. This is triple the growth just last year.

Increases for single employees grew 8% to $5,429 per year. Premium increases have had a starring role in the ongoing health care debate. Before the new health care law the insurance company WellPoint tried to raise rates in California by 39%.

All of this while America has an unemployment rate over 9%. Some reports put the unemployment rate for men 44-62 at 25% or above Great Depression levels.

Health Care Costs

Interesting article in the current issue of the Harvard Business Review about the escalating costs of health care. The Big Idea: How to Solve The Cost Crisis in Health Care has a very simple core concept. We can't reduce the cost of health care because we're measuring the wrong things in the wrong way. It would at least be a place to start.

Lifestyle vs. Money for Health

There's an interesting story in 24/7 Wall Street comparing how much countries spend on health care and their resulting longevity. As expected, the United States fares poorly. We spend more than anyone else by a long shot but don't live as long as most other industrialized countries. What makes the article interesting is that it highlights the importance of lifestyle.

Japan was rated as the best and they spend only 8.1% of GDP on health care compared to the nearly 17% spent by the United States. However more important is the fact that just 3.4% of Japan's population is obese compared with 34% in America. In short, lifestyle matters.

As much as we need to change our health care system it's even more important that we change our lifestyle.

U.S. Life Expectancy Rising But Falling

Recently the media had a wonderful feel-good story about how the life expectancy in the U.S. has increased according to preliminary government figures from 78 years in 2008 to 78.2 years today. They were practically gleeful in their proclamation that a child born today can expect to live longer than ever in U.S. history.

But they weren't telling the whole truth, as usual. I could not find a media story that included the fact that our ranking in the world for longevity continues to fall. While our longevity rate has improved the rest of the world is improving even more and faster. It used to be the U.S. ranked #38 for longevity but according to the CIA's World Fact Book the current estimate would put us at #51, behind Taiwan and ahead of Bahrain. By comparison #1 Monaco has a life expectancy of 89.73 years.

As long as we're on the subject of living longer, did you know that 29% of our population 0r 65.7 people today are caregivers? That number is expected to continue to grow as our population ages. Caregivers spend around $5,500 out of their own pockets every year and out-of-state caregivers will spend even more, about $8,700. Those are serious numbers and the reason many people worry about the impact it will have on their own retirement. Planning for the future was never more important.

U.S. Life Expectancy Lags

A report published on Tuesday by the National Research Council shows that while life expectancy has risen in America over the past 25 years, it hasn't risen as fast as other countries. The poor performance now puts the U.S. behind 21 other countries. The report notes that the results are in contrast to America's spending more on health care than any other nation. However the focus in health care in our country has been on extending life rather than prevention.

How many reports is it going to take before people (especially politicians) stop saying America has the best health care in the world? We have the most expensive health care in the world.

Health Costs Continue to Grow

Talk about Good News/Bad News! The "good" news: Health care costs in America ONLY increased by 4% in 2009. The "bad" news is that it now represents 17.6% of our nation's total economic output (GDP)! The jump of 1% from 2008 to 2009 was the largest one-year increase in 50 years of tracking the statistic.

More "good" news is that it probably would've been much worse if we hadn't been in a huge economic downturn during the year. With high unemployment and economic uncertainty many elective procedures were postponed and even necessary treatments delayed resulting in lower demand for medical services. Slowing demand effectively held down cost increases for the year.

Controlling health care costs is one of the biggest challenges facing America today.

FDA Revokes Avastin

Once again a drug approved by the Food & Drug Administration (FDA) has later been proven to not be worth the risk. This time the FDA even pulled its approval of Avastin for treating breast cancer. Later studies showed the drug to be unsafe. There were "significant" increases in serious side effects with the drugs use including blood clots, bleeding and even heart failure.

Avastin is the world's best-selling cancer drug with global sales of $5.8 billion making it the top product for Roche. The drug is used to treat more than 17,000 breast cancer patients every year. It can still be used to treat tumors in the colon, lung, kidney and brain. Doctors could even continue to use it for breast cancer by using it "off-label" even though the FDA recommends against it. Avastin is also one of the most expensive cancer drugs in the world. It costs a patient (or their insurance company) about $8,000 PER MONTH for treatment.

Health Care Cost Fight Continues

The battle to control rising health care costs continues. One of the current battles is being waged in the Dallas/Ft. Worth area. Blue Cross Blue Shield of Texas is locked in negotiations with one of the largest hospital networks, Texas Health Resources, over cost increases.

The average family health insurance policy in Texas cost $13,225 in 2009, a figure that is equal to 22% of median household income in the state. To put it in perspective, it's an increase of 38% since 2003. Deductibles in Texas went up by more than 80%. (By comparison health care now consumes nearly 17% of America's GDP.)

Who's going to blink first? The insurance company doesn't want to lose customers because they can't use their favorite hospital in-network but health care costs have to be controlled. The 24-hospital network doesn't want to lose customers because they're now out-of-network either. This area, and America, simply cannot afford to watch health care costs continue to escalate.

There are no easy answers to this problem as we saw last year in the health care reform debate. With Republicans coming into power in a few weeks the debate will begin again. The voters and tax payers of America simply cannot afford to sit by and let special interests, lobbyists and others in Washington decide our fate.

American Medical System Is The Problem

During the health care debate there was a lot of information brought to the attention of the American public that was shocking. Most did not realize that we spend more on health care than any other nation on earth (almost 17% of GDP) but with poor results. Americans assumed that we had the best health care in the world so it came as a shock to learn that we rank so far below other industrialized countries.

A new study published recently sheds light on the situation. It turns out that our health care system is the problem, not our smoking, obesity, homicide rate or other excuse. Our current fee-for-service system combined with a focus on specialty health care has produced an upside-down system that while highly profitable for some, is not effective for patients.

Examining health records from 1975 - 2005 the study by researchers at Columbia University's Mailman School of Public Health found that even though there were improvements in our lifestyles relative to other countries, our health declined. This despite the fact that America spends up to twice as much on health care as other industrialized countries. For example, 15-year survival rates for men and women ages 45 and 65 has fallen to the bottom of the list compared to 12 other industrialized countries in the study.

As the cost of our health care system continues to rise in both financial and human terms it's time for change.

Uninsured Population Grew in 2009

Health insurance reform may have passed but its effects won't take effect for many until 2014. In the meantime the need for reform continues to grow. Last year (2009) there were 50.7 million Americans uninsured or 16 .7% of population which is up from 46.3 million and 15.4% in 2008. Most of this change is caused by the current economic recession, either from employers dropping coverage of from people being unable to afford private insurance.

These aren't just numbers on a page, they're living, breathing individuals who now spend hours in hospital emergency rooms waiting for treatment. This lack of coverage is one of the factors in America's low ranking for longevity compared to other industrialized countries.

Expensive Medicine

There was an interesting survey of more than 1,200 doctors across the country (both primary care and specialists) published recently in the Archives of Internal Medicine. Nine out of ten doctors agreed that doctors regularly order too many tests and overtreat to protect themselves from malpractice lawsuits. The study did not ask doctors if they personally practiced so-called defensive medicine.

Overtreatment is estimated to cost the U.S. health care system billions of dollars each year.

As patients we have the right to question every test and procedure to protect our own health, and our wallets.

National Geographic

If you happen to run across National Geographic magazine from last month (January 2010) be sure to look at the article on health care. It has a great graphic comparing several countries on health costs, life expectancy, even frequency of doctor visits. I must confess I had a hard time locating the United States when I first looked at the graph. Our costs are so high that it was above the text, far removed from the rest of the world. It presents a very clear picture of America's health care problem.

Health Costs Rising

Last year 17.3% of our nation's economy involved health care, about $2.5 trillion. The jump in health care's share of GDP was the largest one-year increase since the government began keeping records on it 50 years ago.

The federal Centers for Medicare and Medicaid Services (CMS) also predicted that for the first time government programs will account for more than half of all U.S. health care spending next year, or 50.4% The weak economy is slowing the growth of private insurance and sending more folks into Medicaid. Just last year they predicted that this wouldn't happen until 2016.

Baby Boomers begin turning 65 next year, a sign that America's aging population will continue to require more medical care even as they live longer. Meanwhile health care reform efforts in Congress are stalled as partisan bickering continues to delay any real change in the current situation.

Cost of Change

So how was your year in 2009? Yes, your stock portfolio saw a nice rise after the crash of '08 but how was your income? Are you making a lot more now than you did before? For most industries last year was flat at best as the recession continues to drag on. What does this have to do with health care? I believe that change will come because it has to, we can't afford to keep the current system.

According to the federal Center for Medicare and Medicaid Services health care costs increased 4.4% in 2008. Pricewaterhouse Cooper's Health Research Institute estimates costs increased 5.5% in 2009. We've got it much worse here in the Dallas/Ft. Worth area where estimates are the costs rose 12.3% in 2009 according to the most recent data from the federal Bureau of Labor Statistics. Given the state of the current economy our nation simply cannot afford to keep on the same health care path we've been going down for decades.

One option is Integrative Medicine with its focus on prevention instead of treatment. You might enjoy the new podcast featuring Dr. Eleanor Hynote, President/CEO of the American College for Advancement in Medicine (ACAM). Podcast.

Good News, Bad News

We begin the new decade with the classic "good news/bad news" on health care. The good news is spending on health care in America slowed dramatically in 2008. We only spent $7,681 per person or $2.3 trillion as a nation on health care.

The bad news is the 4.4% growth rate is still far ahead of the 2.6% growth in the GDP.

Health care continues to eat away at America's economy and is the primary reason health care reform is needed.