Medical Care (a Health Issue)
Prior to the 1920's, we did not have much in the way of advanced medical treatment. Back then, the main treatment for most illnesses was for us to try to remain as comfortable as possible while our bodies tried to heal themselves. Of course, there were some home remedies that had been around for a long time. A few doctors were available, but they only had access to a limited number of treatments and medicines. Health insurance didn’t really exist, so we generally suffered through the illness and then either dealt with a financial loss from lost wages, or we died.
Starting in the 1950's, the face of medicine began to change rapidly. This was the beginning of an ever-increasing supply of new and improved medications, vaccines, and surgical techniques. There was even the first organ transplant. With all this new medical care, the cost of medical care began to rise rapidly, which resulted in a need for health insurance. By 1958, 75% of Americans had some form of health insurance coverage.
Today, there are tests, treatments, procedures, and medications for things that could never have been treated before. In the past, we would have had to live with or to die from these problems. In addition, many conditions that were never much of any real problem started to be treated. For most of us, this has led to higher medical costs and an even greater need for health insurance coverage. To help meet this need, we now have a hodgepodge of private health insurance and health insurance coverage provided by big business and the government that is often subsidized.
Over the last few decades, there has been rapidly growing costs for medical care. These growing costs are also causing the cost of our health insurance coverage to get increasingly expensive. This means that fewer of us can afford care or coverage. In fact, unsubsidized health insurance has become too expensive for the average person to afford. With the cost of medical care rising at a much faster rate than inflation, health insurance is now becoming too expensive for even big business or the government to subsidize health insurance coverage adequately.
One reason for our rapidly rising medical costs is the rapidly increasing financial cost for the growing list of modern medical treatments that we now have. Some of them can save our lives and others will allow us to live longer and healthier lives. There are now treatments for many diseases that did not have any treatments before. Instead of suffering or dying from these diseases, we now spend tens or even hundreds of thousands of dollars to treat them.
For instance, the average cost of cancer treatment per person is about $150,000. Overall, the total yearly cost to treat cancer in the United States is about $200 billion. Although some older heart drugs cost less than $10 per month with insurance, newer ones cost in the range of $50 to $500 per month with insurance. If you need a heart transplant, the cost is about $1.3 million before insurance. Many other types of surgery can cost over $100,000. The average cost per month for our new diet drugs is around $350, but some can cost more than $2,000 per month.
Another reason for these rapidly rising medical costs is that many of us seem to be under the mistaken belief that if there is any treatment or medication that could help us then we should be able to get it, and our health insurance should cover it. It doesn’t seem to matter that some of these treatments could end up costing millions of dollars and that there may be much less expensive alternatives available.
Let’s say that tomorrow, a new vaccine is found that would help prevent the common cold, but it costs a million dollars per person. If insurance companies were forced to cover the cost of this vaccine, premiums would need to skyrocket to the point where only the super-rich could afford health insurance coverage. There needs to be a point where we draw the line or one day all our resources would be needed just to cover health care costs, and nothing would be left over to make life worth living. Where do we draw the line?
The rising cost of medical care itself is leading to even more rapidly rising medical costs. This stems from the fact that medical costs are so high that many people cannot afford to pay their medical bills. In 2021, it was found that about 15% of households had medical debt, with about 6% owing over $1,000 and about 1% owing over $10,000. The average medical debt was about $18,660. About half of hospital bills are never paid. Between 2000 and 2022, hospitals provided almost $745 billion in uncompensated care to their patients.
When hospitals do not get paid, they need to raise their prices so that those patients who do pay their bills will end up helping to pay for the patients who do not pay. That means more of the patients who could have paid the lower prices may then not be able to pay the higher prices. This would lead to more patients not being able to pay their medical bills and to more price increases. If this continues, things could spiral so out of control that only the super-rich will be able to afford many medical treatments.
Given how high medical costs have gotten, many people without health insurance or with high deductibles will often put off getting routine medical care and only go when they get very sick and then may need to go to the emergency room. The problem with this is that without routine medical care some medical issues may not be caught in their early stages where they may be easy and relatively inexpensive to treat. This means a condition may continue to get more serious and then be more difficult and expensive to treat.
Another reason for higher medical costs is that many of us today are in much poorer health. We have been exposed to a lot of pollution, we have had unhealthy diets, and we have not been getting enough physical activity. Add in the overcrowded conditions that we live in, all our global travel, our growing vaccine hesitancy and antibiotic resistance, and that we are exposed to more dangerous diseases, catch more diseases and get sicker from them. This has led to the need for more research and more expensive medical care.
What we need to do is to find ways to control the rising costs of medical care and health insurance. Since lowering the costs of medical care should also lower the costs for health insurance, then we should start by looking at ways to lower the costs of our medical care. I will discuss some ways to reduce our medical costs in the following subsections. We can start by looking at those things that contribute the most to those costs.
It looks like the biggest contribution to our high medical costs is all the unpaid medical bills. Although it is the bills for the most expensive medical treatments that are most likely not being paid, we could say in general that if half of a hospital’s bills are not being paid, then the hospital would need to double the price of all their treatments to come out even. The logical solution would be for a hospital not to treat any patient who did not have sufficient health insurance coverage or who could not find a way to pay for the treatment.
Although denying treatment to patients who could not afford it might sound cruel, it is in fact a humane thing to do. First, if a hospital knows it would be compensated for all the medical care that they provide, then they could lower their prices to reflect the actual costs of the treatments. Second, if hospitals lower their prices, then insurance companies could lower the cost of their health insurance plans. Third, if patients know they must pay for all their medical care, then those that knew they wanted that care would ensure they could pay or had enough insurance to cover it, which they should find easier to do once prices come down.
The other big contribution to our high medical costs is the fact that nowadays we need a lot more medical care. Since there are a lot of different things that contribute to this, then we will need to make a lot of different changes to reduce our need for so much medical care. Some of the things that will need changes are our overpopulation and overcrowding, and our poor health due to things like pollution, poor diets, lack of exercise and poor living conditions.
If we can reduce our overpopulation, overcrowding and global travel, then we can help to reduce the spread of diseases, our being infected and the diseases mutating into more infectious and dangerous variants. We also want to take care of ourselves through a healthy diet, exercise and getting regular checkups. Things like getting vaccinated and not misusing antibiotics will also help greatly. Basically, if we stay healthier, then we will not need as much medical care so that our cost and the cost of our health insurance will come down.
Our aging population also has a greater need for medical care. Those of us who have grown old while eating a poor diet, not exercising enough, and not doing other things to keep ourselves healthy will need a lot of medical care just to stay alive while suffering in poor health and in pain. On the other hand, those of us who have taken care of ourselves can stay active and enjoy life well into old age with little suffering. The bottom line is that if we take care of ourselves when we are young, we can live and enjoy life well into our old age without the expense of a lot of extra medical care.
An important consideration that is often overlooked when considering any extreme medical treatment is our quality of life. In many cases, we focus on extending our lives by getting any available treatment or surgery and by utilizing all possible means. We may extend our lives, but often it is lived while suffering in poor health and in pain while racking up a lot of medical bills.
We need to ask ourselves; would we prefer having a good quality of life spent with family and friends in our last days, or a few extra days with poor quality of life where we are often alone and burdening our family with our medical bills? For most doctors, the answer is a good quality of life even if it means a shorter life. Doctors often have access to the best possible care, but they have seen how those extreme medical treatments affect their patients and they do not want that for themselves.
Death is inevitable and it will eventually come to all of us. What matters is what we choose to do with the life we have. We can either choose to enjoy it while we can or choose to live a little longer but do so while suffering in pain in the hospital. We can either choose to spend more quality time with our family and friends or to leave our family to suffer under the burden of a lot of medical bills.
One area where the government should provide some medical benefits to help control medical costs is with lifesaving emergency medical care. A hospital should not need to worry about whether we can pay or have medical insurance or not when we are brought in for emergency treatment. The hospital should always provide at least the minimum care needed to stabilize us without worrying about who pays for this lifesaving emergency care.
If we have health insurance, our insurance company should take care of paying the bill. Otherwise, it should be our responsibility to pay. If we do not have insurance and do not pay the bill, then the government would take care of paying the bill and would try to get what reimbursement they could from us, based on what we could afford. This would save the hospitals from financial loss while ensuring that all of us would at least get lifesaving emergency treatment.
Beyond lifesaving emergency care, hospitals should not be forced to provide any treatment unless they have a reasonable belief that they would get paid for it by our insurance company or by us. Again, this would save the hospitals from suffering a financial loss that might force them to raise prices on their medical treatments to stay solvent. It should be up to each of us to ensure we have the needed health insurance or other resources to cover our medical bills.
Another area where the government can play an important role in controlling our medical costs is with some health insurance regulation. We want to make sure that the insurance companies provide the benefits that they have agreed to provide. There needs to be a place where we can go to get a quick resolution when our claims have been denied, or our insurance company is taking too long to decide. This means having a review board that can evaluate an insurance policy to determine if a treatment would be covered and whether we needed that treatment or not.
To help this review board evaluate insurance policies and reduce overall health care and insurance costs, there needs to be a standard way to describe medical needs and coverage. It should be up to the medical profession to spell this out and all insurance companies, hospitals and medical professionals to use it. There also needs to be a standard way of submitting claims. With everyone speaking the same language, it will be much easier for us to compare insurance policies and determine what coverage we need, want, and can afford.
In addition, a standard automated medical system needs to be developed where all medical information is entered, and all claims are filed. In this way, a medical professional would only have to worry about entering what needs to be done and what has been done and not worry about entering the information based on what health insurance a patient has or does not have.
This standard medical system would take care of evaluating what is covered by insurance, what information needs to be submitted to the health insurance company, and what needs to be billed to the patient. This will greatly simplify and reduce the cost of doing the medical paperwork and allow medical professionals to spend more time with patients.
We also need to consider the medical costs associated with certain genetic defects. First off, many genetic defects are easily treated and may not even pose much of a problem for the individuals carrying them. In fact, under the right environmental conditions, some genetic defects are beneficial for those of us who have them. For instance, the genetic defect that can cause sickle cell anemia can help to protect against malaria.
However, many severe genetic defects are life threatening and may cause a fetus to be aborted or to be stillborn, or a child to die soon after birth. In these cases, the genetic defect at least does not stay in the gene pool and does not get propagated into future generations. On the other hand, modern medicine can now treat many severe genetic defects or at least prolong the life of those with those defects. Nevertheless, treatment and care can often be very expensive.
Let’s suppose that a child is born with a genetic defect which can be treated with very expensive surgery or medical treatments. Of course, we have a society where we are free to make and to take responsibility for our own choices, so none of us should ever be forced to pay for this or any other medical treatment. On the other hand, if the child’s parents had paid the higher health insurance premiums needed to cover this condition or were wealthy to pay then there would be enough money for the needed surgery or medical treatments.
Now, what happens when this person lives and grows up with this genetic defect and wants to have children? First off, we know that the odds of this genetic defect causing a problem will depend greatly on whether the gene is dominant or recessive. We also know that if a child is born with this gene being active, then it will be expensive to treat. Therefore, unlike one’s parents, this person will know that one’s descendants could inherit this defect. Therefore, this person should understand and take responsibility for whatever happens and knows that any medical costs and health insurance coverage for this genetic defect should be correspondingly expensive.
There is one more important aspect to how we handle these severe genetic defects. If we keep treating and saving the individuals with them, these defects could be passed on to their descendants. That means that future generations could see increasingly more cases of these defects. If we continue treating those individuals with these genetic defects, then the medical expenses will continue to mount, and the cost of the health insurance plans that cover them will continue to rise. It makes more sense to eliminate the genetic defect than to burden future generations with their cost. To do this, carriers should refrain from having children or have appropriate genetic tests or procedures done to ensure that their children will not be carriers.
In the United States, the yearly total purchases of prescription drugs rose from about 579.1 billion dollars in 2022 to about 633.5 billion dollars in 2023. In 2023, the average cost of these drugs was more than 2 thousand dollars per year for senior citizens and more than a thousand dollars for everyone else. Of course, these are averages, which includes a lot of individuals who do not regularly use prescription drugs, so the cost is much higher for many individuals. For those individuals with prescription drug plans, the costs are about half these amounts, but it can still be quite a financial burden.
Each year, doctors are prescribing more drugs to more of us for more problems. Not only does it seem that more of us are suffering with previously known problems, but new problems are surfacing for which drugs are now needed. There is also a rising number of us who are being prescribed and taking multiple drugs at the same time. With us taking so many different drugs, some of us even need to take additional drugs designed just to lessen the side effects of the other drugs.
The problems stemming from us taking all these drugs are growing. First off, it can be very expensive for us to take multiple drugs at the same time, especially with the high cost of some of these drugs. Then, there are many risks to our health and life from the side effects and the bad interactions that can come with us taking multiple drugs at the same time. For some of us, it many come down to hoping that the benefits of taking all these drugs will outweigh all their ill effects.
A good prescription drug plan can help to reduce the cost of our drugs, but they still add to the high cost of our health care and can eat into the profits of drug companies and pharmacies and increase the costs for those of us without a drug plan. Of course, a lot of us feel that drug companies make too much money, but they need to make enough profit to continue funding their drug research.
Having a good prescription drug plan can help us to reduce the cost of our prescription drugs. However, picking the right one can be complicated. Some prescription drug plans are covered by our health insurance plans. Some plans require an annual premium and deductible and require copayments. For those of us who need a lot of prescription drugs we will see saving with the right plan. However, the price for a specific drug can vary greatly from one plan to the next.
The sponsors of these prescription drug plans can offer these cost savings because they have been able to negotiate lower drug prices. The more individuals enrolled in their plans the more leverage they have when negotiating for lower prices. However, reducing the cost for those in these drug plans only shifts some of the costs to those who are not in a drug plan.
Complicating things is the involvement of Pharmacy Benefit Managers (PBMs) who act as middlemen between the drug companies and the consumers. They will negotiate volume discounts and fees with drug makers and reimburse pharmacies based on medications that are covered by prescription drug plans. In many cases, these PBMs make big profits.
The makers of drugs need to earn a profit on the drugs they make. That means they need to sell the drugs for more than the fixed and variable costs of making the drugs. Since the fixed cost would be spread over the total number of units sold, selling more units of the drug would reduce the fixed cost per unit. The drug maker could then make a higher profit, reduce the cost of the drug or do both.
Since drug makers know that they will need to negotiate prices, they will set their price high enough to have room to negotiate and still end up making a profit. For instance, if drug A costs $12 per unit, they might set the retail price at $20 per unit instead of $14. The sponsors of various prescription drug plans could then negotiate to buy the drug at various prices such as $13, $14, $15, etc. The drug maker can still make a profit via the prescription drug plans and may still be able to sell some of the drugs at the $20 price.
A lot of us feel that drug makers are making too much money and that they should lower their prices. However, they need to make enough profit to continue funding their drug research and they already have plenty of incentive to keep their prices low. The real money makers seem to be the PBMs.
The real answer to keeping down drug costs is to simplify the whole complicated mess. We could get rid of all the price negotiations with the prescription drug plans and the PBMs and replace everything with much simpler and less costly system. The cost savings would come from reducing the paperwork and the people needed to handle all the complex negotiations and tracking of all the different prices.
This simplified system would start with the drug makers setting a realistic price for each drug that everyone would pay. Different insurance plans would then cover some appropriate drug costs. An insurance drug agency would track and reimburse pharmacies based on what drug costs their customers’ insurance plans covered. This agency could be the same one that doctors and hospitals would use to get paid for their services performed on insured patients.
Even with lower drug costs, our better course of action would be to find ways to reduce our need for drugs. In many cases, we are taking drugs to cure problems that are caused by our modern diets and lifestyles. Our bodies were not designed to handle our rich diets, and our sedentary and stressful lifestyles, so, like any machine that is not getting the right fuel, is not well maintained and is not used properly, we develop problems. In these cases, some drugs may mask some of these problems, but they may not really fix them.
The first step should always be to try to fix any problems with our diet and lifestyle that could be causing our health problems before we are prescribed drugs. Doctors should make sure that we eat healthy foods, get enough exercise, and manage our stress levels. Of course, some of us may be so overweight, out of shape, or stressed out that we temporarily may need some drugs to help us until we can get healthier.
Only when we are otherwise taking care of ourselves should doctors prescribe drugs for any remaining problems. Although this may require doctors to learn more about us before they just resort to prescribing drugs, it will be far better for our current and future health and finances. It can also help to control our health care costs and direct more drug research towards finding drugs to help real health problems and not towards drugs that would allow us to continue having poor diets and unhealthy lifestyles.
Another important concern is the safety of imported drugs. It is the responsibility of the FDA to ensure that drugs sold in the United States are safe and effective. When we buy drugs in foreign countries or over the internet, they do not have the same guaranties. If we get the drugs that we expected, then these drugs may turn out to be less expensive to buy. The problem is that there are a lot of fake and unsafe drugs being sold. In these cases, the financial and health costs can be very high. It is better to be safe than sorry, so drugs should only be allowed to be bought from sources that can be controlled by the FDA. With the proper inspections, tests, and other controls there is no reason that these could not include drugs imported from other countries.
Malpractice Insurance premiums are a big expense for many doctors. The cost of this insurance needs to be passed along to their patients. Doctors who make a lot of medical mistakes drive up the cost of malpractice for all doctors. In many cases, a state medical board will suspend or revoke the license of a doctor who makes a lot of medical mistakes, but not always. Unfortunately, when a doctor does lose his or her license in one state, he or she may simply move to another state and resume practicing medicine.
To help bring down the cost of malpractice insurance, a couple of things need to be done. First, medical boards need to do a better job of weeding out the doctors who do not do a good job. Second, make it harder for doctors to resume practicing medicine in another state without a thorough review of their cases.
Not only will these changes help to drive down the cost of malpractice insurance and healthcare costs, but they will also help to reduce the suffering that would have been caused by these doctors continuing to make mistakes.
Another factor in our high cost of medical care is the way our health insurance is provided and paid for. Besides reducing our medical costs, there are several things that we can do to make our health insurance coverage better and less expensive. I will discuss many of these in the following section.
Health Insurance -
Improving Health Insurance to give ourselves better coverage without going broke.
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