It may come as no surprise that in America today profit reigns supreme.
Privatization has become so ingrained in our daily activities, we barely even blink anymore when we’re required to fork over more money for something that should be–and often used to be–part of our common infrastructure. In some cases, it has literally come down to matters of life and death. We can find no better example of this than in the trillion-dollar healthcare industry.
Dr. Elisabeth Rosenthal is a former practicing physician, now a medical journalist and editor-in-chief of Kaiser Health News. She warns the existing system too-frequently prioritizes financial incentives over patients’ health, or science. She says:
“We’ve trusted a lot of our health care to for-profit businesses and it’s their job, frankly, to make profit. You can’t expect them to act like Mother Teresas.”
In her new book, An American Sickness, Rosenthal argues that under the existing system, it’s more lucrative to provide lifetimes of treatments than cures.
Here are some highlights from an interview Dr. Rosenthal gave on NPR:
On hospital consolidation
“In the beginning, this was a good idea: Hospitals came together to share efficiencies. You didn’t need every hospital ordering bed sheets. You didn’t need every hospital doing every procedure. You could share records of patients so the patient could go to the medical center that was most appropriate. Now that consolidation trend has kind of snowballed and skyrocketed to a point … that in many parts of the country, major cities only have one, maybe two, hospital systems. And what you see with that level of consolidation is it’s kind of a mini-monopoly…And so, what we see in research over and over again is that the cities that have the most hospital consolidation tend to have the highest prices for health care without any benefit for patient results.”
“If you’re a pharmaceutical manufacturer and you have a problem like diabetes, for example, if I invented a pill tomorrow that would cure diabetes — that would kill a multi-billion dollar business market. It’s far better to have treatments, sometimes really great treatments … [that] go on for life. That’s much better than something that will make the disease go away overnight.”
On prices continuing to rise to whatever the market will sustain
Dr. Rosenthal applies the term “sticky pricing” to the concept that once a drug maker, hospital, or doctor decides to charge a certain amount for a drug or treatment, the price for the same treatment and/or drug will continue to rise.
She said:
“What you see often now is when generic drugs come out … the price doesn’t go down to 20 percent of the branded price; it maybe goes down to 90 percent of the branded price. So we’re not getting what we should get from a really competitive market where we, the consumers, are making those choices.
On conversations with doctors regarding fees and medical bills
Rosenthal suggests asking a few key questions of healthcare providers before they administer care, such as:
“‘Is there a concierge fee? Are they affiliated with a hospital? Which hospital are they affiliated with? Is the office considered part of a hospital?’ In which case you’re going to be facing hospital fees in addition to your doctor’s office fees. You ask your doctor always … ‘If I need a lab test, if I need an X-ray, will you send me to an in-network provider so I don’t get hit by out-of-network fees?’ And any doctor who won’t help you in that way, I think, isn’t attuned to the financial cost that we’re bearing today.”
On getting charged for a hospital or primary doctor “drive-by”
Again, Rosenthal urges patients to ask questions, even if they seem confrontational:
“You do have to say ‘Who are you? Who called you?’ and ‘Am I going to be billed for this?’ And it’s tragic that in recovery people have to think in this kind of keep-on-your-guard, somewhat adversarial way, but I think if we don’t push back against the system in the way it bills, we’re complicit in allowing it to continue.”
On how to decode medical bills
Dr. Rosenthal suggests patients do some legwork and request from the hospital a fully itemized bill. She adds:
“Some of it will be in codes, some of it will be in medical abbreviations. I’ve discovered you can Google those codes and find out what you’re being charged for, often, and most importantly, you might find you’re being charged for stuff that obviously you know you didn’t have.”
Dr. Rosenthal quipped:
“One expert in the book joked to me … that if we relied on the current medical market to deal with polio, we would never have a polio vaccine. Instead, we would have iron lungs in seven colors with iPhone apps.”
This is a sad reality concerning the state of healthcare in America. People should not have to be this suspicious of healthcare providers and pharmaceutical companies that are supposed to keep them healthy. And yet, people are resorting to unusual means to attain the care they deserve, like crowdfunding to raise money necessary to afford prescriptions.
If in the news we heard about this happening in any other country, we would decry the practice as barbarism. And yet, this is happening every day in the United States of America. We can do better in the richest country in the history of the world.
https://www.youtube.com/watch?v=e96TBt5zNPI
Featured image from Twitter.
