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USA HEALTHCARE- GLUTEUS MAXIMUS BACKWARDS

June 28, 2016
  1. The pharmacist calls the physician and says the medicine that was prescribed for the patient can’t be filled because the insurance company has a limit on the quantity from the last prescription.
  2. A CT scan was ordered for a patient with cancer to see if the cancer has come back because the patient experienced symptoms. The insurance company has to give the final approval for authorization and says the process takes up to 5 days. Meanwhile the patient has to wait in fear and agony for those five days. And what happens when the request is not authorized?
  3. A doctor bills the insurance company for $120.00 for service that required 40 minutes of care in front of the patient since the patient’s medical history is complex. The doctor collects $20.00 as a co-pay from the patient and the insurance company pays the doctor $49.79. That is a total reimbursement of $69.79 for the doctor. The doctor has to “eat” the rest.
  4. The doctor prescribes an eye drop for a patient suffering from allergies and uses the brand that best suits the condition. The prescription is not covered by the insurance company because it is a brand product and cost too much. The patient asked how much it would cost to pay cash. The answer: $250.00 for a bottle smaller than the size of your thumbnail. Although the pharmaceutical company paid lots of money to get the drug approved, it now cost them $5.00 to make that bottle of eye drops.
  5. We have a pipeline of new drugs that have come to market; many of them are advertised on TV with names no one can pronounce but did you know most of those drugs are not covered by your insurance company because they cost too much? A class of drugs called biologicals (most end with the letters …mab ) are breakthroughs in science but their use will be limited because of their high cost. The drug Zolair used for severe allergic asthma and other debilitating allergic conditions will set you back about $3,000 per month. If these drugs are of limited use our feedback for further research is limited. I think we will abandon the use of chemotherapy and radiation therapy as archaic medicines to fight cancers and replace them with specific products that just fight cancer cells without destruction of healthy surrounding cells and the part of our immunity that fights emerging cancer cell all the time.
  6. Your health insurance company is extremely proficient at saving costs. They “penny pinch every outgoing expense. That’s fine; just good business sense. But did you know the average PERSONAL salary of your insurances’ CEO is not in the simple million dollar range but 200-300 million dollar ranges and that does not include stock options for those that are for profit corporations. There is an emerging club in the US called the billionaire’s club. These CEO’s along with hedge fund operators often compete as to who make more.
  7. In the sixties and seventies all healthcare insurance companies were non-profit; they did not have to answer to stockholders. When HMO’s emerged and later present companies like Aetna, Cigna, United Healthcare, WellPoint became commonplace, the for-profit healthcare industry emerged. Their PRIMARY interest is NOT your healthcare but satisfying the stockholders. MONEY is the GOD of healthcare in the US.
  8. The reason why most people are not satisfied with their doctor and why most doctors are not satisfied with their profession is because of medical insurance and pharmaceutical greed. In order for doctors or the companies that employ them are to survive economically, doctors must see 6-8 patients per hour. With phone calls or other interruptions, that means your doctor can only spend about 5 minutes with you per visit. It is not that they want to leave the exam room quickly; it is just that they are under economic pressure to survive their career. Now here’s the crazy part. Insurance companies know the doctor visit is 5 minutes and that’s their justification for low payments. So who loses in this cat and mouse relationship? YOU the patient.
  9. State agencies that dictate healthcare policy derive such policy without input from the doctors who actually perform healthcare services. They usually consult or hire medical doctors who are solely administrators and don’t see patients every 5 minutes. These doctors are paid well by their parent companies; many are not given voting rights during corporate board meetings.
  10. It is great to be a pharmaceutical representative; you get a free loaner car, car care and gas when visiting doctors’ offices or hospitals. The pay is good too. You operate on your own schedule. However, when the company’s product that you are advertising becomes generic, you may be suddenly out of a job. They treat the reps well when they are doing well and throw you to the trash when business is not good. It’s like being a coach for the NFL or NBA but you don’t have the financial cushion that millionaire coaches have. Again MONEY trumps everything in the healthcare industry.
  11. I remember during the Clinton Administration, Hilary published a handbook outlying a new healthcare system for the country that had many aspects of The Affordable Care Act that we have today. When that book was published, Hiliary’s life was threatened since her proposal would have upset the power of all those who owned the healthcare industrial complex. It was never mentioned again.

The above are a fraction of complaints that can be logged about our healthcare system. My contention is that healthcare is more about financial gain than care for the human body, mind and spirit. I was taught in church that there is only one God; paganism is an insult to God. Yet it is clear that the American way of life treats money as our primary god. It is the main purpose while we are living beings.

“ Well Dr. Darden what would you to improve the system?” one would say.

I would have to remove the premise that human health be put in the same category of goods and services that our economy is based on. Human health is precious and cannot be equated with a certain value. Just ask a person who just lost a child to gun violence or a drunk driver accident. Love ones would sacrifice everything to save another loved one from dying; material wealth has no meaning at that time.  That means that health be removed from our system of economics and consolidated into a right and not a privilege. Just as we have a right to liberty and the pursuit of happiness lets add in that part that says LIFE. So that puts healthcare solely in the lap of government and not in institutions that exist only to make money. If you visited India (much less wealthy than the USA) and got sick or required surgery or mental health care, your services would be free whether you are a citizen or not. If you went to Germany or France or Canada the same would be true. Now I know that to change our healthcare system that dramatically would never happen. So let’s begin perhaps with using our existing insurance companies but requiring health insurance to be non-profit. Those insurances that want to abandon this approach could do so and revert to life and indemnity plans not involving healthcare. Blue Cross and Blue Shield are non-profit so let those companies “take the lead.”

The other item of change would require a salary cap of the CEO’s of all companies now that they would be non-profit. The third leg of the triad would involve the pharmaceutical companies since they too are “fleecing” the healthcare business of trillions of dollars. Remember when new HIV drugs came out and only Magic Johnsons of the world were able to afford them?  Now those same drugs are available via Medicare and Medicaid. The problem with pharmaceuticals involves the high cost of research and development and drug companies say they must charge very high prices for new drugs to re-coup this cost. The ultimate solution to this problem would place drug research only in government institutions such as NIH. Private companies could still invent new drugs but there would be a cap on their retail price in line with the government based drugs.

Such a system would certainly lower healthcare cost in the USA; it’s just that no one would become billionaires working in the system. Where is the value in that amount of greed anyway?

Dr. “D.”

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