Tag Archives: ACA

Why Does Healthcare in the US Cost So Much?! Watch This!

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Book Review – How We Do Harm

How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, M.D., with Paul Goldberg

I thoroughly enjoyed this book, and it illustrates some sinister complications with the US healthcare system. The author provides some fascinating statistical information regarding a variety of medical subject matter. His illustration of life-altering treatments evokes thought-provoking skepticism from the reader. Simultaneously, physicians who read this book should be encouraged to develop honest relationships with their patients. To be a good doctor, you must put the patient first, before prosperity and/or prestige.

There are few things that detract from my giving it a 5/5 rating, however. Unfortunately, the author expresses a fixation on racial stereotyping throughout the book. Being an African-American, the author probably has had numerous racially provoked experiences, but incessantly discussing racial profiling seems beyond the scope of this book.

Although I do agree there is unnecessary spending in medicine, frivolous expenditures occur in low, middle and high income classes. The author expresses obvious bias when he repeatedly states abuse of the system by private insurance patients, but gives little acknowledgement to the other end of the spectrum.

The author’s ultimate goal is to illustrate a broken healthcare system in the United States, and I must say that he does so successfully. I highly recommend this book to any premed or medical student, as well as to all physicians. There is a lot of information that can undoubtedly lead to better physicians throughout the country. Overall, this was a fantastic read.

Description in one word: Eye-opening

Rating: 4/5

Facts of the Day in Medicine

Here are some facts of the day:

  • Life expectancy for Americans is 78.37 years, ranking 50th among nations worldwide.
  • The US ranks only 45th in infant mortality rates, worse than many nations that are actually much poorer.
  • The US ranks #1 in healthcare expenses, spending 50% more than even the 2nd highest nation worldwide.
  • American citizens spend 2.5 times more money on healthcare than on food.
  • At current rates, healthcare costs will exceed 4.5 trillion by 2019 and if the trend continues further, account for almost 1/5 of our gross domestic product by 2025.

From How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, MD, with Paul Goldberg

ObamaCare & Incentives for the Prevention of Chronic Diseases

As I’ve said previously, I’ve been extremely interested in health policies lately and have been attempting to thoroughly educate myself on the Affordable Care Act, aka ObamaCare. I found a “Fact Sheet” discussing a variety of programs for Medicaid patients that provide incentives for adopting health lifestyle choices. The grants provided must be used to address one of the following:

  • tobacco cessation
  • controlling or reducing weight
  • lowering cholesterol
  • lowering blood pressure
  • diabetes prevention (or improved management for diabetics)

The success of ObamaCare is completely dependent on preventive medicine. Incentives offer the best way possible to encourage patients to choose healthy lifestyles, so I am completely supportive of these programs. However, I think some of the incentives of these programs are flawed.

For example, I read about smoking cessation programs offering money to participants for making phone calls to helplines when they feel like smoking in order to prevent relapse. Offering phone support services is great. Sometimes people just need someone to talk to when they are having a hard time. Offering money for people to use the services is just asking to get ripped off. People can easily abuse the system, make the phone call, and then hang up and smoke their cigarette anyway.

I won’t go into details about every program I disagree with, but I think there are some characteristics that a program must possess in order to be successful.

  1. A long-term,  incentive.
    • Obviously, this entire post is about incentives. However, I think the most effective incentives are long-term incentives. What I mean by this is an incentive that is rewarded after extended periods of success (i.e. annually).
      • Example(s): Provide a monetary reward for smoking cessation at 3, 6, and 12-month intervals. Give a reward for yearly weight-loss at primary physician checkups.
      • By providing a reward after months of good behavior, the participant must dedicate themselves to the healthy lifestyle.
  2. A objective way to hold everyone accountable. 
    • A successful program must hold participants accountable. Unfortunately, the game of life isn’t always honest so there’s no reason to think patients are always honest either. Obviously, objective measures for certain healthy choices are easier than others (weight less can be measured on a scale whereas smoking cessation isn’t quite to easy), but an effective way to hold participants accountable keeps everyone honest.
      • Example: I think this needs to be approached in the same manner as someone would train a toddler. If the toddler is offered a reward for good behavior while the babysitter watches them, the parent doesn’t ask the toddler if they behaved well. They ask the babysitter. The toddler wants that reward so they’ll say they were good regardless. The same holds true for many (probably most) adults!
  3. A negative incentive. 
    • In the most basic terms, charge higher premiums for unhealthy lifestyle choices. This is a well-known idea for insurance companies with regards to smoking cessation. However, I think it should apply to other lifestyle choices as well such as obesity, hypertension, etc. Everyone can agree that the US is overweight compared to other nations, and something needs to encourage healthier lifestyles sooner rather than later.
      • This is easy to do with people who pay for insurance, but presents more of a problem for less fortunate patients who are unable to afford healthcare to begin with. Perhaps charging those below the federal poverty level a small fee based on their yearly income would encourage them to live a healthy lifestyle or maybe alternative ideas could be developed.
      • I don’t know the answer to creating a negative incentive for people who can’t afford it, but like I said, the success of ObamaCare is dependent on preventive medicine and studies show that Medicaid patients are typically at higher health risks than private insurance participants.

I decided to post this without much thought, so hopefully my thoughts are at least mostly complete.

Feel free to comment with your own opinions. I always enjoy hearing what others think.

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