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Posted May 30, 2014: by Bill Sardi
At a time when health authorities claim they making attempts to lower the cost of healthcare, the exact opposite seems to be happening. More people are now insured under the Affordable Care Act and that means more healthcare dollars will be spent. Insurance premiums are rising beyond affordability.
Medicare enrollment is going to grow from 48 million in 2010 to 81 million in 2020 and there is an underfunded liability of nearly $25 trillion for present and future healthcare to be delivered under Medicare. [USA Today June 8, 2011]
In light of this funding crisis, medical specialties have been called to list five diagnostic tests or treatments that should be abandoned. Doctors groups have not been forthcoming in that regard.
In the midst of this we find that the quality of care is generally not connected to the amount spent for health care. [Congressional Budget Office 2008]
In the middle of a healthcare funding crisis, doctors are up-coding their Medicare insurance claims to the highest reimbursement. Medicare paid $6.7 billion too much for office visits to the 678,000 physicians participating in Medicare in 2010. That amounts to about $10,000 of graft per physician. [NPR.org May 29, 2014]
Hospitals raid the Medicare trust fund as well. For example, a hospital in northeast Kentucky has agreed to pay $41 million to settle claims it overpaid physicians as a covert way to hide kickbacks for referrals of heart patients to the hospital for unnecessary stents placed inside arteries. Of course, the settlement did not include any admission of fault by the hospital or its chief cardiologist. [BusinessWeek.com May 29, 2014]
In the midst of all the rhetoric and infighting and lack of leadership from American physicians, I happened to read the words of one candid doctor who at least uttered words of reality. He is John M. Mandrola MD, a cardiologist in Louisville, Kentucky.
Talking about the scandal in the Veterans health system where patient waiting times were forged to make managers look like they were providing timely care, Dr. Mandrola writes this at MedScape.com:
It’s clear that the private system is broken. If you hold up the US private system — with its humanity-extracting electronic health records expanding layers of bureaucracy, conflicts of interest, expense, inequalities, and geographic and racial differences in care — as a model that the VA should aspire to, you are not mastering the obvious.
Dr. Mandrola is correct in calling the Veterans health system the best in America. It even puts drugs covered under its system up for bid, something Congress refuses to do for Medicare.
Dr. Mandrola continues:
Reward heart catheterizations and you get heart catheterizations. Allow direct-to-consumer advertising and you get disease mongering.
Yes, of course patients die waiting for medical care. It’s utter nonsense to call that a scandal. Why? Because patients die regardless of medical care, and too often as a result of medical care. This death-denying culture has led to a major humanitarian crisis, one playing out in nearly every ICU in this country.
I visited Dr. Mandrola’s website. [DrJohnM.com] His article entitled: “Changing the culture of American Medicine — Start by removing hubris,” caught my eye. Dr. Mandrola:
What keeps popping into my head is the hubris of Medicine. …
In many cases, medical and surgical treatments that were once thought to be beneficial turn out to be not so. Often, these therapies were backed by expert guidelines and taught to young students as law. Think of that for a moment. We do things to people; we monitor, we medicate, and we even cut, all with the aim of helping. But then further study proves that we were actually providing no benefit and in some cases, causing harm. This is sobering.
The AFFIRM trial revealed that the strategy of using rhythm control drugs to maintain sinus rhythm in elderly asymptomatic patients with atrial fibrillation did not reduce stroke, hospitalization and death rates. To this day, nearly ten years out, I still see atrial fibrillation patients on rhythm drugs because a doctor thinks this strategy will prevent stroke or reduce the risk of death.
In interventional cardiology, the idea that coronary blockages need to be ‘fixed’ is ingrained. Fueled by favorable reimbursement, intense marketing from industry and an insatiable public demand for being ‘fixed,’ stent implantation has soared. Then the COURAGE trial showed that implanting stents in patients with asymptomatic coronary disease was no better than optimal medical therapy and lifestyle modifications.
In Pediatrics, therapy of inner ear infections set the stage for a huge medical reversal. Doctors were fearful that recurrent otitis media would cause long-term hearing loss. Guidelines recommended early intervention with surgery (tubes) to prevent complications. But then two major trials showed no benefit.
Thousands of women with advanced breast cancer were exposed to unnecessarily aggressive surgery or chemotherapy (with stem-cell transplantation) before careful clinical trials showed no benefit. Gosh did some women suffer needlessly. Metastatic breast cancer is bad enough; heaping this therapy on at the end of life was tragic.
Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is. The era of paternalism in Medicine is over. Patients should be able to ask their doctor whether the evidence supports the intervention.
Even if no meaningful change is occurring and modern medicine continues to march towards inevitable insolvency, at least one doctor’s voice points to the reality of the situation. – Bill Sardi, Knowledgeofhealth.com
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