Guest Post: How To Cut America's Healthcare Spending By 50%

Tyler Durden's picture

Submitted by Charles Hugh Smith from Of Two Minds

How To Cut America's Healthcare Spending By 50%

The current sickcare system is financially unsustainable. Physician correspondent "Ishabaka" proposes practical ways we could cut costs by 50% while improving care.

Since sickcare is fiscally and demographically unsustainable, it will eventually be replaced by something that is sustainable. Our only choice is to either let the current system collapse and then start pondering sustainable alternatives, or begin an honest discussion of sustainable alternatives before sickcare implodes in insolvency.

In the spirit of openly discussing a variety of sustainable, systemic healthcare options, we present this essay by correspondent "Ishabaka" M.D. on how to cut our current (18% of GDP) healthcare spending by 50%. Ishabaka received training in Canada, so he has direct knowledge of the Canadian system from the inside. Having spent decades as a primary-care and emergency room physician in the U.S., he also has deep knowledge of the U.S. sickcare system from the point of view of a care provider to under-served (i.e. uninsured) Americans.

Here is Ishabaka's essay:

Some time ago I told you how I could cut health care costs in half and provide every American with the healthcare they need (not necessarily the healthcare they want!). Here goes. Some of my points might seem drastic, but we are facing a drastic problem.

 

1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE.

 

2. Like Canada, this will cover all doctor's office, E.R., clinic, hospital etc. visits. Unlike Canada (the biggest mistake Canada made), there WILL BE co-pays for routine office visits and visits to the E.R. that are NOT serious emergencies.

 

Here is why Canada's no co-pay system is wrong. A family physician friend of mine in London, Ontario had a family in her practice. The little girl got an ear ache, with a low-grade fever on a Saturday. The mother took her to an E.R. and got an antibiotic prescription. On Sunday the girl was feeling better with no fever, but the mother took her to a walk in clinic "Just to make sure everything was all right". The doctor said "Yes". On Monday the mother took her daughter, who was now feeling fine, to my friend's practice "Just to make sure the other doctors knew what they were doing". The ear infection was cured.

 

That was two totally unnecessarily visits the Canadian tax payers paid for, and the first visit should have been to the walk-in clinic, which is much cheaper than the E.R.

 

Co-pays have to be meaningful - not too much to dissuade patients from necessary care, but enough to make them think. That should apply to all aspects of healthcare.

 

Let me give you another example - right now, where I live, a basic ambulance ride (no drugs or treatments) is about $500. I have had a patient come in by ambulance for a TOOTHACHE. The paramedics should be able to say "No" and not worry about being sued.

 

3. Like Britain, every person will choose a primary care provider, who will provide their primary care. Referral to a specialist will require a request for consultation from the primary care doctor. In the U.S., there are no restrictions on seeing specialists who charge twice as much or more than a primary care doctor. I saw a guy who went to an ear nose and throat doctor to have his ear wax cleaned - a procedure any nurse can do!

 

4. Immediate tort reform. Not quite sure of the details, but I estimate that probably 50% of the tests done in the U.S. are to C.Y.A. against malpractice suits, and are medically unnecessary. What would probably be best would be a no-fault system. You are injured by the health care system, you are compensated a REASONABLE amount for your injuries, regardless of who was or wasn't at fault. You aren't really injured, you get nothing. This could be handled by arbitration panels which would take the lawyers out of the system.

 

Right now, it takes on average $50,000 to defend a doctor against a frivolous lawsuit - the doctor wins, but still $50,000 is down the drain. On the other hand I was involved in a suit where a patient died due to real negligence on the part of two doctors and the family lost the lawsuit and got nothing. This would cut malpractice premiums by at least 1/2 and drastically reduce the amount of testing.

 

5. We spend WAY TOO MUCH money on end of life care. We have to get together as a society and decide what we will and will not provide for end of life patients, and that doesn't just mean cancer patients, it also applies to end of life heart failure patients, emphysema patients, etc.

 

For example, a reputable study in The New England Journal of Medicine showed 0% survival from treatment of cardiac arrest on kidney failure patients on dialysis. Zero. I have had to do numerous "codes" on kidney failure patients on dialysis - they all died. A code costs thousands of dollars. The first code I ever ran was on a 38 year-old accountant having an acute heart attack. In the old days (1960's) I would have simply pronounced him dead. He lived, and was FINE, no brain damage from loss of oxygen, walked out of the hospital a week later and went back to work. That was money well spent. We don't have infinite money. We need to get the most bang for the buck.

 

The $90,000 chemo drug that extended terminal prostate cancer patients' lives by 6 months should NOT have been paid for by taxpayers' money. Patients who want it should have to pay for it themselves.

 

6. We have GOT to get the gold-bricks off disability and workmen's comp. If we did, we could put the truly disabled and injured-on-the-job folks in suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind boggling to see how many gold-bricks there are.

 

I really liked the system in Ontario, Canada. Any primary care doctor could certify a patient as disabled or off work for up to two months. After that, the patients had to be seen by a panel of specialists paid by the government. They had NO INCENTIVE to either certify the patients as disabled/unable to work or not. To make these specialists truly independent they should be salaried - and the government CANNOT fire them except for the reasons that would cause them to lose their license (sex with a patient, drug addiction, etc.).

 

7. All advertising immediately banned. We go back to the 70's. No doctor, hospital, clinic, drug company, can advertise to patients. Period.

 

8. All new drugs have to be compared to existing drugs (if there is a similar existing drug). ONLY if they prove superior to existing drugs should the FDA approve them. Every time a new drug is invented, all the other pharma companies copy it, change a molecule or two, and then study it compared to PLACEBO. We end up with 20 drugs that do the same thing. It's ridiculous.

 

9. Get rid of fraud and abuse - for real. This means doctors AND patients. You get caught committing health care fraud you pay in fines THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial - fraudsters MUST be made to do time.

 

Everybody's charges get audited by an independent panel. You charge for patients you didn't see, or wheelchairs you never provided to patients - you go to jail. It must be recognized that nobody is perfect, mistakes happen. A doctor accidentally charges for a patient they didn't see once in five years is not fraud - it's a mistake.

 

In the same way, patients caught "doctor shopping" for narcotics and selling them pay three times what they made and go to jail for a year. Same for patients selling blood pressure pills (this is a big racket for Medicaid patients) - doctors are usually suspicious of healthy looking patients seeking narcotics, but see a Medicaid patient who is on expensive blood pressure pills, says they ran out and can't contact their doctor - they will usually get a prescription. You can make a nice income on welfare doing this.

 

10. Eliminate health insurance companies, except for people who want to buy extraordinary coverage like for the $90,000 prostate cancer drugs. Do like we did in Ontario - fee for service with the fees paid by taxpayers via a Department of Health, the fees negotiated annually by either state or national medical associations.

 

11. Electronic medical records THAT WORK. Right now we are in the "pre-internet" era of EMR. There are a thousand different ones, they are very expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH OTHER. I worked for a long time in an ER in Florida in an area where elderly people from the north came to winter. They would get sick all the time and come in not knowing their allergies, meds, or medical history. It was a nightmare. If I hear "I'm on a little white pill for blood pressure" one more time I may scream!

 

With a national standard EMR I could find everything I needed to know with a few mouse clicks. It will be a disaster if this info is stolen or hacked, so the punishment must be severe - TEN YEARS in prison WITHOUT PAROLE, and a hefty fine. No excuses. Set up something with Interpol and the UN so this applies to all countries. And, since EMRs would benefit patients, doctors, and the entire country, doctors and hospitals pay half, the government pays the other half.

 

12. Get rid of the bad docs/nurses/hospitals/ etc. I'll just speak for the docs here - there are two kinds of bad docs - ones who are bad usually due to lack of knowledge or drugs/alcohol but WANT to be good, and those who are bad and don't care. The second ones are immediately banned from healthcare for life. The first group gets extensive education/rehab, whatever they need. Then close monitoring. In my experience, most of them will turn out to be good docs. A few won't, and get banned from healthcare for life.

 

13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats. We know they are poisonous. Again, minimum one year prison for the CEO and board of directors of any company that violates this law, whether it's a mom and pop shop or Kellogs or McDonalds.

 

That's it, except for a few tweaks. Fifty percent cheaper, everyone gets what they need.

Thank you, Ishabaka. Here is a story Ishabaka sent recently that highlights the consequences of fast-food on human health:

This is an article from the July 2, 2012 issue of Circulation, the journal of The American Heart Association. It shows how frequency of eating fast food per week increases the risk of heart attack - up to 80% if eaten four or more times per week! This is a highly respected medical journal, not some crackpot website.

Western-Style Fast Food Intake and Cardio-Metabolic Risk in an Eastern (Asian) Country.

Conclusion: "Western-style fast food intake is associated with increased risk of developing type 2 diabetes and of chronic heart disease (CHD) mortality in an eastern (Asian) population."

 

* * *

And this from Zero Hedge - want to live to 100? Here's how:

The Centenarian Diet
Via: TermLifeInsurance.org

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Chuck Bone's picture

No mention of EMTALA and the anti-trust exemptions for the health care industry within? Then no solution. 

Pladizow's picture

Easy, let those who create their own health problems die.

You somke or are fat = your left to die!

TAKE RESPONSIBILITY!

AlphaDawg's picture

The plans are not facist enough, they will never work for congress

James_Cole's picture

 

Being in Canada watching this from the outside is a headscratcher.

Americans will fight to the death to be able to pay a conglomerate of "health insurance" (read: financial) companies some of the highest costs per capita in the developed world with some of the poorest results.

And then scream fascism when someone proposes reforms like this article. 

 

El Tuco's picture

 Canada's health care is fucked. Ontario is close to 1/2 a trillion dollars in debt. That's a province of what? 10-12 million people max? How long are they going to be able to afford giving people healthcare without raising taxes beyond the 30-45 % they are now. Currently they are cutting the rate they pay doctors. Hospitals don't have enough beds forcing people to sleep in hallways. Just go to a hospital in Toronto and tell me what you think. Try seeing a specialist...good luck.

I could go on but this is a dead horse. Socialized medicine is fucking garbage.

kaiserhoff's picture

A little dated, but a stat that sticks in my head is that the "average" Canadian visits the doctor 24 times per year.

That which is "free" is abused.

Oh regional Indian's picture

Only one change would ROCK this sick-making world.

 

Get your ph checked. Blood/Saliva/Urine....whatever. You should be slightly basic/alkaline.

Most diseases canot survive a basic solution. They need acidity (meat is the biggest culprit, stress is probably next).

Very simple. To get basic, brush with baking soda, gargle with it, quit meat, slow down, learn to how to breathe OUT deeply. Drink the wine you make.

Bye bye doctor...

ori

kaiserhoff's picture

Good point.  Coffee and tea are acidic.  The average American diet is almost perfect for bacteria and fungus-among-us.

Acidity leaches minerals and flushes B vitamins out of the body.

As to stress, St. John's wort reduces stress in the best possible way, by reducing cortisol levels, in the blood, but I still prefer Cabernet;)

Stackers's picture

uh, and here I thought we needed tort reform, and to reform America's mentality that since their health plan is part of their "pay" that they MUST use all of it each and every year or they risk not getting the full "compensation" of it in their work. And here all along the best plan is to actually follow the failed plans of other western socialist governments.

 

"Reform #9 of getting rid of fraud and waste" shows just what complete NONSENSE this plan is. How the hell do you get rid of fraud and waste in a government run mega bureaucracy. Thats like trying to get rid of the milk in ice cream.

fuu's picture

"1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE."

Fuck off.

Precious's picture

"You get caught committing health care fraud you pay in fines THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial - fraudsters MUST be made to do time."

Fucking insanity.  Worse than the TSA granny gropers.  As if society hasn't criminalized enough.  Kiss my ass DOCTOR ISHIBAKA (trans: "stupid stone")

LowProfile's picture

Funny, if he just got rid of #1 - 3, I would be on board 100%...

But he HAD to go all statist on us, again...

Newsboy's picture

Isha = Doctor

Baka = stupid, maybe demented

Ishabaka = Dr Demento.

Clever, really...

Pegasus Muse's picture

"13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats. We know they are poisonous. Again, minimum one year prison for the CEO and board of directors of any company that violates this law, ...."

Barack O'bummer:  "All this Central Planning is making hungry."

Rahm Emanuel:  "I've got just the place, O!  And it ain't no Chick-fil-A joint."

http://www.zagat.com/r/n/five-guys-washington-2/photos

 

nmewn's picture

Mr.Charles Hugh Smith is a little heavy on his state sponsered eugenics isn't he?

I can just imagine the cackling banter between him and Bloomberg at society parties over shrimp cocktail & French pastries...what no Big Gulps?!?!?

(Hillarity ensues)

ParkAveFlasher's picture

First they laughed at him.  Then, they saw what he was drinking.  They they thought for a mo. And then they avoided him.

KK Tipton's picture

No wonder.

 

I'm sure when he ran out...he hit the streets looking for more.

Seer's picture

Not that I'm looking to test this out myself, but one CAN safely drink one's urine for up to three days in a row IF NEED BE.  This is pretty well known in survival circles.  Your kidney is a very good filter and urine is pretty sterile.  Now, if one is eating one's own shit, well, That would be another story (a pretty sad/sick on at that)!

nmewn's picture

I'm a firm believer in makin them eat the same shit they pass on the rest of the country...but they exempt themselves from the law.

This too shall pass.

dugorama's picture

well, tell that to any Frenchman or German or Dane or.... every citizen of every OECD country but the US.

James_Cole's picture

"Ontario is close to 1/2 a trillion dollars in debt. That's a province of what? 10-12 million people max? How long are they going to be able to afford giving people healthcare without raising taxes beyond the 30-45 % they are now."

^ Here comes the ignorant strawman argument. 

"Just go to a hospital in Toronto and tell me what you think. Try seeing a specialist...good luck."

My brother had an appointment (in T.O.) with a specialist a week ago. Went well as it usually does. 

"I could go on but this is a dead horse. Socialized medicine is fucking garbage."

Explain away the actual point I brought up - why does Canada's socialized system have better results with lower PER CAPITA costs comparative to for profit models?

Desert Irish's picture

If Canada's Tier 1 health care sytem is so great why have only 2 countries copied it - North Korea and Cuba.

El Tuco's picture

Listen fucker. A family friend had a stomach aneurism that was ready to burst. He was visiting a hospital in Mississauga. The doctor in emerg basically told him to go home and come back on Monday because the surgeon is too busy and can't do it till then. It burst the next day and he passed away after a long struggle. Don't tell me I don't know what I am talking about you fucking dick. It took me 9 months to see a neurologist after I had a bulging disk. 9 fucking months. Thankfully it healed in 4 months and I survived the pain.

 

Don't give me this bullshit that I don't know what I am talking about you cum guzzling pos. I lived it and I also lived in the USA for many many years and had the best healthcare one could imagine.

Canadian health care is fucking garbage.....but that's all you know so you think it's awesome....

SamuelMaverick's picture

Canadian health care has been a big income booster for upstate New York healthcare providers, Canadians come down to NY in a steady stream and pay out of their pocket in order to get timely and needed procedures. 

jplotinus's picture

An ah ha moment:

"Canadian health care has been a big income booster for upstate New York healthcare providers, Canadians come down to NY in a steady stream and pay out of their pocket in order to get timely and needed procedures."

I had wondered what accounted for Canadians being healthier and living longer than Americans. I knew it wasn't the weather. So now we see it's because they come to the US for healthcare...(not)

James_Cole's picture

"Canadian health care is fucking garbage.....but that's all you know so you think it's awesome...."

That's a great strawman but you didn't answer my question.  

Cyclerider's picture

Don't give me this bullshit that I don't know what I am talking about you cum guzzling pos. I lived it and I also lived in the USA for many many years and had the best healthcare one could imagine. [emphasis added]

In fact, more cum guzzling might reduce health care costs by 50%.  It's has lots of good stuff in it.  That should have been one of the doctor's suggestions.

http://wiki.answers.com/Q/What_is_the_nutritional_content_of_human_semen

There would also be a lot less stress in the world.  Less stress=better health.

Joe Sixpack's picture

Sounds like gay propoganda to me...

rwe2late's picture

 I would rather think the comment was primarily meant to recommend a way for women to improve their health,

with the added benefit of reducing men's stress levels.

dogbreath's picture

I am up for women's health

Oldrepublic's picture

 

re el tuco

Your friend in Mississauga should have discreetly slipped the good doctor a c note.

that is done everyday all over the world! Service should have improved,

no need to visit south of the border or check out early in life!

JohnKozac's picture

People will spend $100 bucks on massive fat laden dinners but complain when they have to fork out $50 for the doctor. Obamacare has no incentives for people to stay healthy. That is one of its major problems. The Gubbermint and public just look for someone else to pay for their care instead of eating an dliving a healthy life style (at least most do this).

https://www.youtube.com/watch?v=WPkOv0-u6A0

Anyone go to Walmart lately?

http://www.peopleofwalmart.com/

Joe Sixpack's picture

It's not the $50 or $100 that hurt people- it's the $50,000 emergency room visit otr the $350,000 cancer treatment.

kaiserhoff's picture

I share your opinion of corporate drug pushers, but those who indulge get what they deserve.

Know what happens when "Doctahs" go on strike?   Mortality drops like a rock!  Same thing happened in DC of all places, when most of the saw bones were out of town for a convention.  Caveat emptor.

smiler03's picture

That's a great idea. Get rid of all doctors completely and everybody will live longer. 

Really?

 

kaiserhoff's picture

The best stats on the subject ( from Hahvud, but WTF) estimate that 98,000 Americans die each year from medical mistakes, hospital acquired infections, etc.  Compare that to 43,000, more or less, from highway deaths. 

Do you think traditional medicine is a net benefit to society?  You might be right, but there is plenty of evidence on the other side. 

Seer's picture

Key take-away: DON'T RIDE IN AN AMBULANCE!

Freedom In Your Lifetime's picture

Government meddling and trying to 'fix' something (a.k.a. rewarding the companies that give politicians money with monopoly like holds over an entire industry) is what got us into the current situation. Anyone who believes that the government will do anything that lowers the true cost of health care is delusional.

r00t61's picture

It's ironic that the article lays out "X,Y,Z" reasons why big government+central planning has created the current sickcare system; yet the "fixes" all somehow involve government bans, government prosecution of systemic fraud, government reform of the legal code, and last but not least, a nationalized, federal-level government health care system. 

This would be the same government that operates Amtrak, the Defense Department, the SEC, FEMA, and others?

Freedom In Your Lifetime's picture

It is very frustrating that people don't see through this. When so many areas of life are controlled or regulated by government, people tend to forget that there are other solutions. In a sense, .gov has defined the box we as a society operate in. Until people become intelligent enough to realize that there is a whole host of possibilities outside that box, government will be the only possible solution which will in turn just make things worse. Use the Trivium Bitchez!!!

James_Cole's picture

Yes, I think this is why there's such a polarization on this issue. Anyone that really thinks about it, the obvious answer is that a federally run government healthcare system in the US would probably be terrible.

But that's not to say you couldn't have a socialized system through other means. Or even look at other more radical / new models.

You could take many of the common sense solutions offered in this article and use them as a basis of how to formulate a new system. Instead the argument often comes down to ALL gov, or NO gov. 

It's pretty clear the current system is bad & Obamacare will be bad in different ways. I like the system in Canada (though it has lots of issues), but we have a very different approach to gov overall and you couldn't simply transplant our system over. 

Freedom In Your Lifetime's picture

If a group of people all voluntarily preferred having some type of socialized health care they should be free to operate under that system. When someone is given the power to force people to operate in a certain way or purchase certain goods or services, corruption is a short step behind. I have no clue what the best system of healthcare for any group of people would be and I know for a fact that nobody else does either. It should be left at that and people should be able to choose what is best for them.

KK Tipton's picture

"Instead the argument often comes down to ALL gov, or NO gov. "

That's because most easily swayed people have fallen for "the trap"

Living Outside The Dialectic: Niki Raapana talks to herself about communitarianism - http://bit.ly/OuJqSQ

A. The core foundation for the U.S. communitarian system is already established. Community Development is a standard agency in every state. The term Sustainable Development expanded from the UN into the mainstream private business sector in less than a decade. Every inch of the USA has an adopted plan and vision for the future, and the goal of every single one of them is to ensure sustainability.

In the cities, Communitarians have already conditioned Americans into accepting aspects of life in controlled collectives. Borrowing from the most successful collectives in recent history, Communitarians utilize and expand on programs, policies and ideas perfected by the British Fabians, Imperialists, Russian Soviets, Chinese Communists, Nazis, Fascists, and Israeli commandos. This is why you hear so many Americans saying "it's socialism!" or "it's communism!" or "it's fascism!" or "it's capitalism!"; many people recognize these ideologies when they see them manifesting. But it's only once people start seeing more than one ideology going on at the same time that communitarianism begins to make total sense.

 

Anusocracy's picture

"Instead the argument often comes down to ALL gov, or NO gov. "

That's because SOME government turns into ALL government.

My question is why do SOME people have to dictate to ALL people?

Take your shitty,  failed belief systems and shove them up your fucking asses.

James_Cole's picture

""Instead the argument often comes down to ALL gov, or NO gov. "

That's because SOME government turns into ALL government."

Too funny, Anusocracy - walkin' talkin' cliche.

Anusocracy's picture

You can still put your beliefs where I suggested.

I don't care to live my life the way some brain cells in your head want me to.

 

 

James_Cole's picture

I could care less how you or anyone else lives their life as long as it doesn't impact me / others. 

Seer's picture

To be fair about Amtrak, its schedules are subjugated to the rail carriers (who happened to have been GIVEN the land [with help from the US Army], not to mention lots of near-free labor [Chinese laborers in the West], for their tracks).  USPS is also screwed by govt itself in that Fed-Ex and UPS managed to get lobbyists to force USPS to fund pensions for 75 years! (and no one else had to do that)

Not defending govt here (I'm basically a ZERO Govt person), just wanting to ensure that facts are used.

BIG = FAIL (govt OR private, doesn't matter [because BIG couldn't occur w/o coercion happening somewhere along the way])