Unless you've been hiding under a rock recently, you've probably heard a thing or two about health care reform or Obamacare. Even if you've heard about health care reform, you may be confused about how the law impacts you, your finances and taxes. Whether you already have health insurance or not, here are the top five things you should know.
By Dr. Mercola
From time to time, medical experts reverse course on certain practices and procedures when science dictates a change in the standard of care. One classic example of a “reversal” is when hormone therapy for menopausal women came to a screeching halt when so many women developed blood clots, stroke, and breast and uterine cancers.
In an attempt to determine the overall effectiveness of our medical care, the Mayo Clinic tracked the frequency of these medical reversals over the past decade and published a report in Mayo Clinic Proceedings, August 2013.
The results are discussed by lead researcher Dr. Vinay Prasad in the featured video. Prasad and his team found that reversals are common across all classes of medical practice, and a significant proportion of medical treatments offer no benefit at all.
In fact, they found 146 reversals of previously established practices, treatments and procedures over the past 10 years. Many new medical treatments gain popularity over older standards of care due to clever marketing more than solid science.
Conflicts of interest are rampant in medical research. Shiny new medical treatments nearly always come with hefty price tags, which helps drive up the already astronomical cost of health care in this country. In addition to the end of routine hormone therapy for menopausal women, you will probably recall the following policy reversals over the past decade:
- Changing the schedule for women's Pap tests and men's rectal exams, both of which used to be yearly
- Moving the starting age for women's yearly mammograms from age 40 to 50
- Use of COX-2 inhibitors such as Vioxx (a non-steroidal antiinflammatory drug, or NSAID, that directly targets the COX-2 enzyme; Vioxx killed more than 60,000 people before being pulled from the market in 2004)
More Than Half of All Medical Procedures Are of No Benefit and Many Actually Cause Harm
The most telling data in the report show just how many common medical treatments are not helping patients at all—or are actually harming them. Of the studies that tested an existing standard of care, 40 percent reversed the practice, compared to only 38 percent reaffirming it. The remaining 22 percent were inconclusive.
This means that between 40 and 78 percent of the medical testing, treatments, and procedures you receive are of NO benefit to you—or are actually harmful—as determined by clinical studies. Prasad writes:
“Reversal harms patients who undergo the contradicted therapy during the years it was in favor and those patients who undergo the therapy in the lag time before a change in medical practice.
Most importantly, it creates a loss of faith in the medical system by physicians and patients. The solution to reversal is upfront, randomized clinical trials for new clinical practices and a systematic method to evaluate practices already in existence.”
In an editorial, John P. A. Ioannidis, MD stresses the importance of not only promoting effective medical practices, but also disseminating knowledge about ineffective practices that should be abandoned.
Many therapies continue long after they are deemed useless or harmful, due to inertia in the system. He suggests using incentives to urge physicians to begin testing the effectiveness of common practices and calls for a renewed commitment to rigorous clinical research.
Top 10 Failures of the American Health Care System
In 2007, the Commonwealth Fund conducted a large survey comparing the health care attitudes and experiences of people across seven countries: Australia, New Zealand, the United Kingdom, Germany, the Netherlands, Canada and the United States.5 The results are quite telling about how broken the American health care system really is. Of the seven countries, Americans were the least likely to report being “relatively satisfied” with their healthcare. Let's take a look at 10 of the most significant findings of that survey.
1. We Spend the Most Money on Health Care, But Get the Least in Return
The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia, yet the US ranks last in health and mortality when compared with 17 other developed nations.
Sadly, 30 cents of every dollar spent on medical care in America is wasted, which amounts to $750 billion annually. That is the same amount the Department of Defense estimates we spent on the ENTIRE Iraq War! This $750 billion of waste is made up of inefficient delivery of care and excessive administrative costs, unnecessary services, inflated prices, prevention failures, and outright fraud. The largest defrauder of the federal government is the pharmaceutical industry.
Thirty-five percent of Americans have difficulty paying their medical bills, and nearly two-thirds of all bankruptcies are linked to inability to pay medical bills due to being uninsured or underinsured. Medical impoverishment is nearly unheard of in wealthy nations, other than the US, because all have some form of national health insurance.
By dissecting medical bills, Time Magazine writer Steven Brill says we can see exactly how and why you are overspending and where your money is going. Americans are being grossly overcharged; even nonprofit hospitals are making greater profits than some prosperous for-profit businesses. The entire system unfairly affects the poor and uninsured as they are charged the FULL inflated price, while those with coverage have their costs radically reduced through pre-negotiated lowered rates.
How much will you spend for a hospital stay? Certainly more than you would pay for even the most extravagant vacation! The average cost of a hospital say is $18,000, compared to $6,200 among OECD nations, according to this George Washington University infographic. Things add up quickly when you're in an American hospital.
For example, a liter of normal saline rings up at $546. This one-liter bag of saline contains about nine grams of salt (less than two teaspoons), which costs 44 cents to a dollar to produce. But then the bag makes its way from the manufacturer through a series of giant group-purchasing middlemen and distributors before arriving at your hospital's pharmacy. Upon arrival, that IV bag has a mystery formula applied to it, and a price is magically determined, which is then recorded on your hospital's “chargemaster.” No one really understands how these prices are calculated.
Only recently did the federal government release the prices that hospitals charge for the 100 most common medical procedures, revealing tremendous and seemingly random variation in the costs of services. For example, if you need a hip replacement, you can spend $5,300 in Ada, Oklahoma, or you can fork over $223,000 for exactly the same procedure in Monterrey Park, California. You can find out how your state compares in average fees for service using an interactive online chart created by the Washington Post.
2. Our Chronic Disease Rates Are Extraordinarily High
Americans have the second highest rate of chronic disease of the seven countries examined, with Australia being number one. With all of the money we're spending, what are we missing? This statistic reflects poor preventative care and lack of attention to lifestyle habits, such as diet, exercise, stress, sleep, and “electron deficiency” (insufficient contact with the Earth).
The majority of Americans (adults and children) are becoming insulin-resistant due to their junk food based diets, loaded with sugar, processed grains, and chemical additives. Insulin dysfunction is putting many in a state of perpetual inflammation and driving up the rates of chronic disease. Americans consume nearly 4,000 calories per day on average—more than anyone else in the world. Yet, they are malnourished because most of these calories are from processed food, therefore devoid of nutrition.
3. Poor Coordination of Care
This issue is tied to the problem of waste. We drop the ball when it comes to managing patient care, especially if you have a complicated illness requiring multiple providers. As a result, we have poor access to medical records, duplicate testing, gaps in communication, confidentiality violations, and rushed and fragmented health care. According to an infographic based on data from multiple sources, created by Jonathan Govette:
- 3 out of 10 lab tests are reordered because the results can't be found
- 68 percent of specialists receive no information from the primary care provider prior to the referral visit; 60 to 70 percent of referrals go unscheduled; and 25 percent of appointments are missed
- 7,000 people die every year from sloppy physician handwriting
4. Most Americans Do Not Have a Primary Care Provider
One of the reasons Americans' health care is so poorly managed is that they are least likely to have primary care providers. There are 0.5 general physicians per 1,000 people in the US, but the average among OECD nations is 1.23. Americans are also the most likely to say that their physician doesn't know important information about their medical history, which has dire implications for quality of care and increases the likelihood of medical errors. And, speaking of errors…
5. Americans Are the Most Frequent Victims of Medical Errors
It can be argued that medical errors are leading cause of death in the US—higher than heart disease, higher than cancer. The latest review shows that about 1,000 people die EVERY DAY from hospital mistakes alone. This equates to four jumbo jets' worth of passengers every week, but the death toll is largely ignored. Types of errors include inappropriate medical treatments, hospital-acquired infections, unnecessary surgeries, adverse drug reactions, operating on the wrong body part—or even on the wrong patient! One in four hospital patients are harmed by preventable medical mistakes in this country, and 800,000 people die every year as a result. Of those 800,000, 250,000 die as a result of medication errors.
If you have health insurance, you are already covered under the law. Not everyone will need to purchase health insurance through the online marketplaces. If you already have health insurance through your employer, Medicare or Medicaid, you are all set.
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