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Monday, March 24th, 2008:
Healing the Health Care System - Part 3
by Jacob Teitelbaum MD
Our health care system is on the verge of a financial meltdown. In 2002, the average amount spent by each American for health care was $5,440. This has now increased to over $7,000 per American. Meanwhile, insurance premiums increased by 87 percent between 2000 and 2006 — more than four times the growth in wages.
For some of you, the cost of health insurance and uncovered medical costs may be as much as your entire income. Even for the wealthy among us, it can be a major expense. Not only does the cost of health insurance come out of our paycheck (even if your employer pays for it, be assured that it is still coming out of your paycheck!), but it also gets added to the cost of almost everything you pay for. As health care costs continue to skyrocket, fewer employers are able and willing to cover the cost of health insurance and more Americans are uninsured. Our approach to treating people is also becoming more expensive and toxic — and, sadly, not always that much more effective. Despite spending more than any other country on health care, overall health rankings do not put the United States among even the top 40 countries.
The good news is that health care reform is a hot topic of discussion in the current election. Whoever is elected, it is clear that changes will be made. By being informed, we can help to ensure that these changes are for the best.
As a physician, the causes of skyrocketing health care costs have been pretty obvious. In this article, we will discuss how we got into this mess. More importantly, we will discuss how to fix it. We can actually get much better care, and the freedom to choose what kind of care we want, for much less than we're paying now!
So how did we get into this mess?
Imagine what would happen if we took the same approach to cars as we did to health care. We would all feel that having the best possible car was an absolute right and we should not have to pay for it. Everyone should get the best car possible, should have no idea what it cost, and should be under the misimpression that someone else was paying for it. In addition, there would be only one car making company, and they would manage to make it illegal for any other companies to start up. Because of this, they could charge whatever they wanted without significant competition. This might sound like fun, but your car would cost you more than your house — and might not be any better than the one you're driving now.
It would be more effective if we simply recognized that there are many things that we all need to live, including food, shelter, education and health care. It is obvious that as a society, we cannot buy everyone a mansion or a Ph.D., but may agree that everyone should have a right to certain basic levels of these services. If not, why should everyone have a right to health care but not food and shelter? We could then budget a certain amount for each of these, determine where we get the most benefit for the money, and do competitive bidding to get the most "bang for the buck" (which is what we do for everything except health care). Just like with housing and food, individuals could then pay for or buy private insurance for services that are not covered.
It is also important to be aware that medical "fashion" (called 'standard of practice') is based more on what is new (and expensive), than on what is scientifically shown to be the best. As a physician, this came as a shock to me. But think about it. Who pays to get information to doctors (and to patients through the media)? Pharmaceutical companies give a massive amount of campaign contributions. These might also have been known as "bribes" if we look at it realistically. By the way, just as judges have to excuse themselves from cases where they have conflicts of interest, wouldn't it be nice if politicians also had to excuse themselves and could not vote on issues related to where they received contributions? In addition, drug companies spend about as much on advertising/promotion as they do on developing new drugs. Because of this, journals and medical conferences (and drug sales reps) focus predominantly on medications that are expensive. In addition, makers of natural remedies cannot legally make any claims that natural products are effective in treating an illness, no matter how good the scientific data supporting its use. To do so, they would have to go through the FDA approval process, which costs an estimated $400-800 million per remedy. As natural products cannot be effectively patented, vitamin companies can never charge the high prices that they can for drugs, and therefore cannot make up the $400+ million FDA cost. Without companies being able to legally promote natural remedies, and with conservative (and although well-meaning, turf protective) elements in the medical practice having a near monopoly on deciding what treatments are covered by insurance or even legally available to people, it's not surprising that health care is becoming unaffordable (and dangerous — well over 200,000 Americans die each year from drug side effects!).
So how do we fix the problem?
FIRST: Put you, the patient/consumer, in charge of finding the best deal.
When you buy a house, car, or anything else, you shop for the best value for your needs. That's why we all have different cars. Health care can be the same. I recommend that health insurance be for catastrophic care and some basic preventive items. By having a high deductible (e.g. $2,500), insurance companies and health care providers would not have to spend as much on paperwork/administrative costs for the smaller stuff. The insurance company could still negotiate discounts for us (which often save upwards of ½ the cost of tests, etc), but we would pay for these things directly at the time of service. With the high deductible (and other recommendations we are making here), the cost of insurance would drop markedly. This cost difference, which would likely be approximately $1,500 per year, could go into a medical savings account (MSA) that belongs to you. You could then decide what health care you want to use (including seeing your chiropractor, naturopath, buying supplements, etc). This MSA plan is currently available now to those who are self employed. I have one, and it's wonderful. I do not have to argue with the insurance company about what is covered, I get the discounts they've negotiated, there's minimal paperwork, and I can choose whatever treatments I prefer. The money to pay for these things comes out of my medical savings account, and I can carry over the unused funds from year to year, and use it for other family members (unlike the current "use it or lose it" approach of some government policies which force people to spend everything that's left in the account at years end or it's gone). Because the money comes out of your account (even though it was put there by your employer as part of your health insurance benefit), people will shop around and decide what they really need — instead of automatically doing whatever the doctor says without asking why. You might decide to spend $400 seeing your chiropractor (or use the treatment we discuss in a reader Q&A) for your back pain instead of spending $1,200 for an MRI. Especially if you are aware of the data that shows that most of the "disc" findings on MRI never cause any problems, and radiologists can't really pick out the MRIs of those with back pain from those without. The MRI often simply results in unnecessary back surgery (at a cost of over $15,000 — CaChing!). It is best saved for when conservative measures fail, or for when there is evidence of neurological damage.
In addition, as noted in a recent CBS News report, drug makers increased their prices last year by an average of 7.4 percent for brand-name medicines most commonly prescribed to the elderly, according to the advocacy group AARP. This increase was about 2.5 times overall inflation, continuing a long-standing trend. As generics are often safer and more effective, if you were paying the bill (with your MSA money) you'd ask if the more expensive brand name medication is really worth it!
SECOND: Do realistic research on what tests and treatments really give the most bang for the buck — and have those be paid for first.
We currently spend hundreds of thousands of dollars on long shot treatments on one person that may have a minimal chance of success. We do this despite allowing thousands of children to die of malnutrition or lack of basic services that are inexpensive. For example, the WIC program for pregnant mothers in poverty has been one of the most successful programs in medical history, yet is under-funded because it is not glamorous.
To give another example, thousands of American's die each year (and many thousands more Americans have infertility, miscarriages and learning disorders) simply because doctors do not adequately diagnose OR treat hypothyroidism — which would cost under $200 per year. Simply giving optimal nutritional support during pregnancy is cheap and would also save enormous amounts. In addition, for those with infertility without structural problems, natural remedies can often effectively treat infertility for under $100-$200 — instead of $20,000-$40,000 for in vitro fertilization. The insurers (and government agencies) could make a budget that would decide how much they would spend each year, and then pick those things that are cost effective to cover. Although people complain that this is rationing (which it is), we are now "rationing" in a highly ineffective manner by simply having NO care available for an ever increasing number of people.
THIRD: Show the health insurance companies that natural therapies can save them billions of dollars.
Although you may feel like it when you submit a claim, health insurers are not the enemy. They are also hemorrhaging dollars with sky rocketing health care costs. If we can show them with good science that Comprehensive Medicine (the next generation of medicine after Integrative Medicine) can save them massive sums, they may put their political clout behind your having access to natural remedies (and maybe even pay for some of it!). As of now, M.D.'s that are on their payroll, and who are usually hostile to natural remedies that they think are all quackery, decide what is paid for. The insurers try to say that all natural therapies (and many allopathic ones as well) are "experimental/unproven" in a desperate attempt to stem the flow of payments. Unfortunately, this simply pushes people to more testing and ineffective therapies, resulting in increased costs with less benefits. As an example, the average Chronic Fatigue Syndrome / Fibromyalgia patient spends $50,000 on ineffective testing and treatment before finding a doctor who is trained in effective therapies (see our "gold standard" study showing a 91% improvement rate with proper treatment). Instead of saving money and lives by paying for these effective therapies, some insurance companies continue to shoot themselves (and you) in the foot by not covering treatment. As an aside, with the medical savings account approach above, you decide what treatment to get and the insurance company doesn't have to play the bad guy.
I propose 3 simple, straight forward and relatively inexpensive studies to encourage health insurers to look into cost savings through natural remedies:
1. Disc disease — Two studies (one placebo controlled) with over a thousand patients show that back pain/sciatica from disc disease can be eliminated over 70% of the time simply by giving Colchicine (an old, herbally derived gout medicine) intravenously once a week for 6 weeks. Using this approach, I almost never have to send people for back surgery. My colleagues who use it have had the same results. Conservatively, disc/back surgery costs ~$15,000. IV colchicine is cheap ($18 total for the 6 doses — which is likely why you never heard of it). The main cost is starting the IV @~$60. Cost for treatment is ~ $500 vs. $15,000+. If one guesses that there are 300,000 disc surgeries a year (I have not been able to get the exact numbers), this represents a savings of over $4 billion yearly for this treatment alone! Sadly, the FDA recently pulled this medication from the market until the companies making it go through the FDA manufacturing approval process — which may not happen because it is so cheap and not patentable. The FDA's action may result in not just a large escalation in health care costs, but many deaths and much unnecessary suffering as well. (Click here for more info on the FDA Colchicine action.)
2. Carpal Tunnel Syndrome — This common problem is associated with a pinched nerve in the wrist. People get pain and numbness in their hands, and often wake with these symptoms in the middle of the night, feeling like they have to shake their hands around. The usual medical approach is to do a nerve conduction study and surgery (~cost $2,600). Unless the person continues to do activities which cause "repetitive stress injury" to the wrist/hand, the symptoms of carpal tunnel syndrome usually resolve within six to 12 weeks by combining the following measures (which can cost less than $100):
A) Taking vitamin B6 @ 250 mg a day,
B) Taking Armour thyroid at the dose that feels best while keeping the Free T4 blood test within the normal limits(even if your thyroid blood tests are normal), and
C) Wearing a "cock up" wrist splint(s) (one that keeps the hand/wrist in a neutral position, which is the position your hand as and when holding a glass of water) at night while you're sleeping. If symptoms bother you during the day, it is also helpful to wear the splint during the day. For every one million of these surgeries that can be avoided, we save 2 ½ billion dollars.
In the few cases where these inexpensive measures fail, one can always still do surgery later.
3. Autism — Both the emotional and financial costs of this condition are enormous. The prevalence of autism is skyrocketing, now affecting as many as one in 500 Americans. Patients with autism can improve, however, using nutritional/enzyme support combined with desensitization using an acupressure technique called NAET (see www.NAET.com). We feel that this approach is so promising, and the need for effective treatment for autism so important, that my wife and I have given a $100,000 grant from our foundation to the NARF (NAET research foundation). Initial reports show 23 of 30 children recovered enough after 1 year of treatment to return to regular schools (versus none of the children in the non-treatment group).
Death with dignity
Death with dignity is critical for both ethical and financial reasons. It is estimated that upwards of 25% of health care costs are spent during the last two months of a person's life. This would be worth it if the person chose to have this aggressive care. Sadly, more often the person is being helplessly tortured as the doctor plays the game of "you'll not die on my watch." I have seen countless cases where people who would love to simply be allowed to die in peace and dignity are tortured by modern technology. Families get drawn in having no idea what they are subjecting their loved ones to. Faced with having to make the impossible decision of letting a loved one die, they find themselves watching helplessly as those they love most are tortured into submission, waiting for death to rescue them in the end. In my role as an internist, I have seen many people plead with me to let them die in dignity and comfort, with their families by their side. In addition, many others have pleaded with me to beseech their families to let go and let them die.
It is time for us to recognize that death is not the enemy, but simply as natural a transition as birth. It is an opportunity for families to come together one last time with their loved ones. It is also a time to express things that must be said and heard/released before the person's death. Feelings that have been bottled up for decades must be shared before it is too late. This allows the healing to begin that leads to forgiveness and peace. From this place of completion, families can share and experience the love and appreciation they feel for each other. From this place of peace, we are then able to let go, allowing our loved ones to move on and allowing ourselves to grieve the loss we feel from their being gone.
Instead, all too often our loved ones die with tubes stuck in their throats, veins, noses, bladders and rectums. To complete the torture, we then perform CPR during their final moments. This has become the American Way of death.
I am not proposing that we withhold life saving measures from those who desire them. I am simply proposing that we make it acceptable and easy for people at the ends of their life to say "enough." It is important to let people choose to simply be kept comfortable, with their family around them in a loving and warm setting. Beyond what is needed for comfort, this is often a time for less technology and more nursing care and counseling. In many cases, it is much more valuable, and much less expensive, to have a compassionate psychologist, social worker, or minister present to help make peace among all the family members, than it is to have the "CPR crash cart." It's time to let the doctors off the hook by letting them know that death, when it is not premature, is natural and quite OK. Given permission to do so, with the assistance and recommendation of a compassionate physician, the patient will usually let you know when it is time. In my 28 years of medicine, I have found that there are usually only a very few (and short-lived) situations where it is not clear if one is prolonging life (where being aggressive is appropriate) versus prolonging death. Take a moment and think. When you reach the point that you realize that your time has come (and it comes to us all) would you rather die peacefully and comfortably with your family around you, or be expensively tortured to death with all that technology has to offer? Either way is OK. I am simply proposing that you have a choice. Please let your family know ahead of time what your preference is, however, as the "default" option is highly expensive technological torture. Be aware that there are levels of choice as well. One level is the "living will" that says that CPR is not to be done if there is no reasonable chance of your reclaiming a livable life. Nonetheless, they will still do everything short of CPR in this situation. You have the option of going one step further, and requesting only "comfort measures" in certain situations. This means you will get everything needed to keep you comfortable, but that treatments which are simply prolonging death will be withheld (e.g. having a tube be struck down your throat and being put on a ventilator). Although speaking about death is uncomfortable, I encourage you to sit down with your family and let them know what your wishes are. I would also encourage you to put them in writing and sign them, giving a copy to your family and to your physician.
Our healthcare system has run amok, resulting in very expensive, toxic and often minimally effective therapies. I have offered some ideas on how to fix it, making it safer, cheaper and more effective — while still giving you the opportunity to choose the type of care that you prefer. There are many other approaches which can be effective as well. It's time for change!
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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