Doctor’s Tip: Greed is harming our healthcare system
An editorial in the Feb. 28 issue of the respected medical journal JAMA was titled “Salve Lucrum: The Existential Threat of Greed in US Health Care,” by Donald M. Berwick, M.D., MPP, of the Boston-based Institute for Healthcare Improvement.
Salve Lucrum is a Latin term meaning “Hail Profit.” The central message of the editorial is “The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences.” Below are the important points.
Pharmaceutical companies “have used monopoly ownership of medications to raise prices to stratospheric levels, and not just for new drugs.” An example is tetracycline, a generic antibiotic that has been around for decades and is an important part of the treatment regimen for H. pylori — a 14-day course costs $240 at local pharmacies. “Eye-popping prices for new, essential … drugs, enabled by the failure of any serious drug price regulation, have yielded enormous profits for drug companies even though much of the basic biological research funding has come from governmental sources.”
Medicare Advantage, which now covers more than half of all Medicare beneficiaries, is pushed by participating insurance companies. Research shows that Medicare Advantage will “cost Medicare over $600 billion more in the next 8 years than would have been the case if the same enrollees had remained in traditional Medicare.” The program was originally set up to give beneficiaries “the choice of access to well-managed care at lower cost.” It turns out that, although participants in this program pay substantially more, there is no evidence that health outcomes are any better than with less expensive traditional Medicare.
Hospitals claim large operating losses, but “large systems sit on balance sheets with tens of billions of dollars in the bank or invested.” Hospital prices “for the top 37 infused cancer drugs averaged 86.2% higher per unit than in physician offices.” A patient at the University of Chicago “was billed $73,000 for 2 injections of the prostate cancer drug Lupron, which is available in the UK for $260 a dose. Non-profit hospitals are closing in poor areas of the country and opening new facilities in wealthy areas. “Executives in large hospital systems commonly have salaries and benefits of several million dollars a year.”
What does all this mean for the rest of us? The editorial notes that “although profit may have its place in motivating innovation and higher quality in health care … kleptocapitalist behaviors that raise prices, salaries, market power and government payment to extreme levels hurt patients and families, vulnerable institutions, governmental programs, small and large businesses, and workforce morale” and pose “an existential threat to a sustainable, equitable and compassionate health care system.”
Forty-one percent of US adults have medical debts. Fifty-eight percent of debt collections in the US are for medical bills. Most medical providers go into health care to help people. Once in practice they “find themselves trapped in record keeping, coding behaviors, … productivity imperatives,” and electronic medical record systems that are designed more for billing than patient care, resulting in demoralization and burnout.
According to the editorial, “US health care costs nearly twice as much as care in any other developed nation, whereas US health status, equity and longevity lag far behind.” Because so many powerful people are benefiting financially from the status quo, improvements in our dysfunctional health care system are politically difficult — an example being the struggle to achieve even the modest improvements that “Obamacare” brought about. To address these problems, many physicians have joined an organization called Physicians For a National Health Plan, which promotes “Improved Medicare For All.”
For further information about the problems with our healthcare system, read the 2017 book by Robert Pearl, M.D. called “Mistreated — Why We Think We’re Getting Good Health Care — And Why We’re Usually Wrong.” And, the 2017 book by Elisabeth Rosenthal, M.D. called “An American Sickness — How Healthcare Became Big Business and How You Can Take it Back.”
Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email email@example.com.
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