Consumer Directed Healthcare

By Richard C. Dillihunt
Guest column
Bangor Daily News
6/25/09

I have been a proponent of universal health care and single payer since retiring from the practice of surgery more than 10 years ago. During this decade I have never waffled on my conviction that our nation should transition to a system in which every citizen has an equal opportunity to obtain their health care from practitioners of their choice.

Further, I am convinced that the for-profit form of health care has morphed into an uncontrolled hierarchy of greed that has escaped from the normal restraints of personal ethics, compassion, empathy and basic unqualified concern for one an other without reservation. I feel that social justice should leap to the forefront of our decisions when an individual — any individual — has a health problem. Accordingly, it is obvious that universal health care has my support, and it is not surprising that polls of physicians, nurses and the general population concur.

Now, we have arrived at a point in the history of our nation where it is reasonable to say that universal health care is near at hand, and after trying practically everything else, the vast majority are convinced that a reform has arrived. Black, white, Republican, Democrat, Green, young, old, Catholic, Jew, Muslim, Asian, Native American, rich or poor — a modern melting pot has come to be, and we are all in it together. After a 10-year wait, I am delighted, the bus has arrived. I hope.

Single payer usually tags along when universal health care is the subject at hand. At times when being discussed, they are wed, and health care reform may be referred to as “universal single payer.” That’s too fast for many who look upon this as two separate entities. Not me, though. I believe we, as a nation, deserve both. I further believe that single payer will happen, and we need to work diligently to make this happen sooner, rather than later.

Another decade of waiting, with its stymieing of small business, its shameful financial effects on the middle class, its drain on state treasuries, its primary etiology in bankruptcy and its continuous release of wealth to special interests, cannot be tolerated by a nation already brought to its knees by mammoth fraud, greed and incom-petence. We cannot add health care to the list that includes Enron, banks, brokerages, insurance companies, a protracted automotive industry collapse, and stunning Ponzi schemes. We, as a nation, are on the ropes. The time has come to learn to say no. No more rip-offs. No more robbery. We have come to a fork in the road with a hairpin turn. We need to take the high road regardless of forks and turns, regardless of the consequences to those who have taken advantage of us. We cannot tolerate another hit.

Single payer is a great way to start. A great way to express the confidence we have in our federal government to do the right thing on our behalf. To show that we are tough at home as well as abroad. All we want is a fair and inexpensive accounting of expenditure of health care dollars. This is single payer, not socialized medi-cine.

When we hear criticism of the federal government, with critics saying they do not trust the government to run health care, then we simply should remind such skeptics that our federal government already administers and funds well over 50 percent of total health care expenditures by this nation. We should remind them and our-selves that the government already runs a stable of health care agencies which are national jewels, and include: Medicare, Medicaid, military medicine, Food and Drug Administration, National Institutes of Health, Centers for Disease Control and Prevention, Public Health Service, health care aid to the Third World, World Health Organization participation and aerospace medicine.

We are fortunate to have such a list — a list whose executives are employed by us and whose compensation is Main Street, not Wall Street. A list that could be enhanced enormously simply by adding single payer.

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Richard C. Dillihunt, M.D., a retired general, vascular and transplant surgeon, lives in Portland.

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Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance
By: Catherine Arnst

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.

Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings. This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School, and Deborah Thorne, a sociology professor at Ohio University, found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.

But medically bankrupt families with private insurance reported average out-of pocket medical bills of $17,749, while the uninsured’s bills averaged $26,971. Of the families who started out with insurance but lost it during the course of their illness, medical bills averaged $22,658. “For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”

The study underscores President Barack Obama’s arguments in calling for health-care reform legislation this year. In a letter to Democratic Senate leaders this week, the President said: “Health-care reform is not a luxury. It’s a necessity we cannot defer. Soaring health-care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need.”

Highest Costs for Diabetes, Neurological Illness
The study was funded by the Robert Wood Johnson Foundation and published online June 4 by the American Journal of Medicine. It will appear in the Journal’s August print edition. The researchers examined the court records of a random sample of 2,314 bankruptcy filings across the nation during early 2007, and also contacted those filers for written explanations. The researchers then followed up with extensive phone interviews of 1,032 of those filers.

They found that a number of medical factors contributed to a family’s financial disaster. More than 90% of medically related bankruptcies were caused by high medical bills directly or medical costs that were so high the family was forced to mortgage their home. The remaining 8% went bankrupt because a medical problem caused them to lose income. The authors were not able to track credit-card defaults caused by medical bills, but a 2007 study found that, of low- and middle-income households with credit-card debt, 29% used their plastic to pay off medical expenses.

Individuals with diabetes, one of the most common chronic diseases in the U.S., and those with neurological illnesses such as multiple sclerosis had the highest costs, an average of $26,971 and $34,167, respectively. Hospital bills were the largest single expense for half of all medically bankrupt families.

Dr. Woolhandler, an advocate of a single-payer health-care system, said lawmakers in Washington should reconsider health-care reform in light of the study. “Covering the uninsured isn’t enough,” she said. “Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it.”

Arnst is a senior writer for BusinessWeek based in New York.

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Ever wonder how much it would cost to have knee surgery or any other type of surgery? 

Medical tourism is the practice of “outsourcing” healthcare services to an area outside of the patient’s home country.  Many common operations cost a fraction of what they might cost in the United States. 

As healthcare costs continue to rise, more and more patient’s are beginning to realize the potential cost savings!  Not sure I would be willing to leave the comforts of home, but I understand that some may not have the option…  

Medical Procedure       USA               Mexico       Cost Rica       India      Thailand   Korea

Angioplasty              Up to $57,000     $17,100      $14,000    $10,000     $9,000     $21,600
Heart Bypass            Up to $144,000    $21,100     $26,000    $10,000     $26,000   $26,000
Heart Valve Rep.      Up to $170,000    $31,000     $31,000     $3,000       $24,000    $38,000
Knee Replacement Up to $50,000       $11,500     $12,000    $9,000        $14,000   $19,800
Hip Resurfacing       Up to $30,000+    $13,400     $13,000    $10,000      $18,000   $22,900
Hip Replacement      Up to $43,000      $13,800     $13,000    $10,000      $16,000   $18,450
Special Fusion        Up to $100,000    $8,000       $16,000    $14,000      $13,000   $19,350
Face Lift                 Up to $15,000      $8,000       $6,500       $9,000       $8,600       $5,000
Breast Implants      Up to $10,000       $9,000       $4,000      $6,500       $5,700      $13,600
Rhino Plasty           Up to $8,000         $5,000       $6,000      $5,500       $5,400       $6,000
Lap Band/Bariatric  Up to $30,000       $9,200       $9,000      $9,500       $14,000    $11,500
Hysterectomy        Up to $15,000       $7,500       $6,000      $7,500       $7,000      $11,000
Dental Implant   Up to $2,000/10,000   $1,000       $1,100      $1,000       $1,000      $2,000

 *Prices are as of 2009 -  Prices are approximate and not actual prices and include estimated airfare for patient and companion.  Prices will vary based upon many factors including hospital, doctor’s experience, accreditation, currency exchange rates and more.  Not included are costs for meals, miscellaneous expenses and any hotel costs or tourism costs. 

Prices obtained from Medicaltourism.com.

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There is a huge disconnect between Health care consumers and Health care producers
 
The normal Market driven consumer choice leverage is not being applied.
   
    Consumer choices based on price and quality; that drive Producers to lower costs and improve quality
 
We are mis-using the Term “Insurance” as it is currently applied to Health Care.
 
What is being called Health Insurance is really pre paid all you can eat health care consumption in the minds of the Consumers.
 
For example Fire Insurance – does it entitle the Consumer to unlimited consumption of Fire Fighting resources at no additional cost to the consumer ?
 
Unless and untill free market consumer choice forces are brought to bear on health care, the costs will continue to escalate at a rate much greater than either inflation or GDP growth.
 
This means on average paying more to get less. Having government beaurocrats in charge of this mis directed ship will only make things worse.
 
Consumer need to feel the economic pinch of their health care choices, and the economic benefit of their choice not to consume health care resources.

Craig

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