Key Messages
A Comprehensive Guide to Understanding the United States Health Care System: Why It Is Broken and How We Can Fix It
An American Sickness provides an in-depth analysis of the US health-care system and why it differs so drastically from other countries.
Over the sections, readers will gain a better understanding of how this system has come to be by exploring its history, current situation, and what might lay ahead for it.
This book also explains the costly pricing models for prescription drugs in the United States and which tests are actually necessary (and which have been recommended just to generate profits).
Furthermore, readers can benefit from discovering ways to start reducing their own health-care costs right now.
For those interested in obtaining a comprehensive knowledge of our country’s health-care system – An American Sickness is an excellent choice to get informed.
The American Health-Care System: Profits Before Patients?
The growth of the American health-care system is nothing short of remarkable.
Just over a hundred years ago, the introduction of health insurance was designed to help provide some form of financial relief to those who were unable to work due to illness or disability.
It was non-profit and designed to provide assistance across all classes.
Fast forward a few decades, and companies began emerging that saw an opportunity for profit in health insurance.
Taking on more clients, these companies soon flourished and began pocketing a large portion of the revenue their policies earned them.
By 1993, Blue Cross had nearly tripled its profits since the 1950s, keeping 95 cents of every dollar they earned instead of spending it towards patient care.
It wasn’t until the Affordable Care Act that regulations were put in place requiring insurance companies to spend at least 80-85 percent on patient care expenses.
This requirement not only benefited individuals, but insurance companies as well – allowing them to satisfy their legal obligations while continuing to make high profits from their policies.
Big Business Takes Over American Hospitals, Resulting In Expensive Healthcare Costs for Patients
When it comes to our hospitals, it’s not a surprise that they have been shifted from charitable organizations to becoming corporate giants.
This major transformation began in the 1970s when hospitals sought out the help of business consultants like Deloitte & Touche who specialized in “strategic pricing”.
In other words, what we have here is a system where the hospitals are running on maximizing their profits whatever way they can.
As a result, every action taken by them seems to be prejudiced and solely serves their purpose of making money; this includes jacking up ‘miscellaneous’ bills or even holding doctors accountable for productivity bonuses (paid based on how much they charged).
Furthermore, underperforming areas like dialysis units were outsourced so as to make space for better-paying orthopedic and cardiac ventures.
Needless to say, with all these changes that were taking place, patients should expect higher costs coming their way!
Statistics between 1997 and 2012 alone showed that service fees hiked up by over 149 percent; in 2013 hospital stays amounted to an average of US$4,300 per day – indicative but also far greater than any other country in the world such as Spain.
All things considered, it goes without saying that hospitals are set up and run like typical profit-seeking corporations today – with no consideration for fairness nor actually helping those that need medical attention most – creating a great barrier between what is medically necessary and what people can afford.
Doctors Have Become Smart Entrepreneurs: Exploring New Ways to Increase Revenue
Doctors have found that if they want to make more money, they have to think like entrepreneurs.
They are looking for new and unusual ways of bringing in extra revenue streams.
For example, many doctors now own ambulatory surgery centers (ASCs) – a concept made popular during the eighties and nineties which involves a new kind of privately owned hospital facility.
Not only do doctors charge for their services, but by charging a “facility fee” for the use of their high-end suites (which can be between $5000-$10000 per night), they stand to make a lot more money than was possible before.
In addition, some doctors are also running private practices where they contract with hospitals as specialists – such as anesthesiologists or radiologists – providing services without direct patient contact.
These contracts can be expensive, adding greatly to doctors’ incomes.
All this goes to show that today’s American medical profession is no longer just about taking care of patients – it’s also highly lucrative business venture ripe with potential revenue opportunities that savvy doctors know how to take advantage of.
Big Pharma: How Greed and Abuse of Patent Laws Lead to Exorbitant Prices for Medications
Pharmaceutical corporations are highly adept at finding ways to continue making insane profits off of their drugs by manipulating patent law and raising prices for medications.
Take for instance the former hedge-fund manager Martin Shkreli, who bought the rights to the HIV treatment drug Daraprim and raised the price of one pill from $13.50 to an incredible $750 a pill.
Or take Horizon pharmaceuticals’ painkiller Duexis, which only cost them $9 to produce yet they sell it for over $1600 a piece.
These types of actions mean that patients have no choice but to pay full price, even if their lives depend on it – something that is nothing short of immoral and inhumane.
Pharmaceutical companies are able to get away with this through patent law manipulation strategies such as creating “new” drugs made of existing, non-patented ingredients in order to secure a new patent or through combining old drugs together as a way to earn another patent (like Horizon’s Duexis).
This is simply unacceptable behaviour and needs to be addressed in order for us all to benefit from fair pricing practices within the pharmaceutical industry.
Unregulated Medical Devices Are Putting Pricey Price Tags and Risky Safety Standards on Patients
Medical-device companies are in a precarious position.
With little competition and oversight, they have been able to charge exorbitant prices for their medical devices — often with no rhyme or reason.
This type of market dynamic has played out in the real world.
For example, Robin Miller’s brother had a heart attack and needed an implantable defibrillator, but no one could tell him the exact cost of the device before he purchased it.
Even when Miller decided to cover the costs himself, what he paid was an absurdly high amount – $30,000!
The issue is largely due to an oligopoly that exists within this industry.
Four main manufacturers make up the majority of knee implants and hip implants: Stryker, Zimmer Biomet, DePuy Synthes and Smith & Nephew – ‘the cartel’, as some experts refer to them.
While there isn’t any wholesale pricing in medication devices, sales representatives take 16 to 18 percent from each device sold, distributors get 30 percent and then hospitals add an additional 100 to 300 percent for their cut.
To top it all off there is dangerously little scrutiny imposed on these devices – nothing like what pharmaceuticals must adhere to.
This lack of regulation has already caused many medical disasters—like when a faulty clip led to a patient bleeding out during an operation that typically should be safe.
It’s clear that Medical-device companies are in a dangerous position of having little competition and oversight – something which needs to change if we ever want reasonable costs on medical services again!
The Growing Monopoly of Hospitals: How Conglomerates are Driving Up Medical Bills
Hospitals have become increasingly greedy conglomerates, driven by the desire to maximize profits and diminish competition in their service areas.
Their money-making schemes include prescribing unnecessary tests and services to unsuspecting patients who – quite understandably – want the best treatment for their ailments.
Take Florida Celebration Health Hospital as an example – Björn Kemper’s son was taken there for a stomachache, yet the hospital prescribed a completely unnecessary $7,000 CAT scan.
Unfortunately, these types of revenue-seeking tactics are becoming increasingly more common amongst medical providers as they join larger healthcare monopolies such as Sutter Health in California.
These conglomerates have been known to raise prices without any significant increase in quality of service, driving up health-care costs by up to 50% in towns and cities where they are present.
Without adequate competition or regulation, it’s easy for hospitals to fall into the trap of profiting from people’s medical needs – but that isn’t right nor ethical.
Health Care Today Is Focused on Profits Over Patients – But the Affordable Care Act Has Made Strides to Put People First
Health care today is being run like big business, with organizations more interested in making money than delivering high-quality patient care.
This was made evident by the language being used around illnesses – some medical consultants even speak of “high-value disease states” instead of an actual disease.
Furthermore, research into medical treatments and cures often fails to receive investment from the major foundations solely because there’s no potential for commercial profit.
A prime example of this is Dr.
Denise Faustman’s 2014 diabetes study which was rejected by all the major foundations due to no commercial gain.
The Affordable Care Act (ACA) tried to shift healthcare back towards being centred around patients by prohibiting denial of coverage due to a preexisting illness and reducing the percentage of uninsured Americans from 18 percent to 11.9 percent between 2013 and 2016.
Whilst this goes some way in improving patient care, there’s still much work left to do for healthcare organizations to put patients first over profits.
How We Can Put an End to ‘Health-Care Refugees’ in the United States
Americans don’t have to stand idly by and watch their wallets shrink every time they step into a doctor’s office.
There are steps that can be taken to reduce the costs of medical care and help make health-care more affordable.
The first thing to do is to speak up and ask questions.
Don’t be afraid to ask how much a treatment will cost, and explore what cheaper alternatives are available.
Why is this test necessary? It’s also wise to investigate where you’d be receiving the procedure, as this could affect the price tag.
When getting referrals, make sure that the recommended doctor is part of your insurer’s network–or else find one who is.
In addition, other nations have been finding ways to make health care more accessible for citizens without breaking their bank accounts–the U.S.
could learn from these strategies!
For instance, setting a national fee schedule for certain drugs or procedures could generate reasonable prices which would not be suddenly elevated overnight.
Alternatively, a single-payer system similar to those in Canada or Australia could cut out middlemen (like private insurance companies) from most basic services and only factor them in for elective treatments such as cosmetic dentistry or laser eye surgery.
Overall, American don’t always have control over the bigger picture of healthcare prices but there are fortunately things that can be done at an individual level which can help with medical costs in the future!
How to Choose the Right Hospital and Minimize Your Medical Bills
Choosing the right hospital and health insurance are important steps in getting the best medical outcome, while also avoiding unnecessary costs.
Before deciding on a particular hospital, read reviews on Yelp to get an idea of what other customers have experienced.
U.S.
News & World Report and Hospital Compare also provide useful rankings and data, so make sure to check those as well.
Once you get to the hospital, keep an eye out for documents requiring you to pay for costs not covered by your insurer; if you see this form, look at the “limited consent” clause which states agreement is only valid if providers are in-network with your plan.
Furthermore, don’t be afraid to negotiate when you receive an unreasonably high bill—hospitals are often open to major discounts even from entry-level clerks.
Finally, ask for a detailed itemization of all costs associated with treatment.
When it comes to selecting a health insurance plan, carefully consider each option and read the small print before making your decision.
Affordable Care Act’s Health Navigators can be helpful in providing advice with choosing the right insurer; additionally, contact your doctor’s office for a list of insurance plans they accept if switching companies is not desired.
Overall, taking these extra steps ensures you get quality care without breaking your budget!
How to Lower Prescription Drug Costs: 5 Tips for People with Poor Health
American Sickness reveals that owning a large chunk of the healthcare system has enabled big business to charge exorbitant prices for both prescription drugs and medical services.
Thankfully, there are ways to reduce these costs.
For prescription drugs, try asking your doctor if there are any cheaper alternatives available or if you can take half the dosage at a lower price.
Do some research online too and compare prices at different stores – websites such as GoodRx.com will have coupons available to help you save even more!
You may even want to consider purchasing from an overseas pharmacy, just make sure that it’s legitimate by visiting PharmacyChecker.com first.
When it comes to medical services, try to decline the ones that don’t come with your insurance network and always double check that they are included in the coverage plan before undertaking them.
Also, consider having blood tests and other fluid specimens tested at commercial labs instead of hospital labs, since they tend to be much less expensive than the in-house services offered by hospitals.
Wrap Up
An American Sickness offers a sobering take on the state of the American health care system and provides actionable advice on ways to protect yourself from exorbitant costs.
The key message is that it’s important to update your knowledge on health insurance and negotiating with hospitals in order to get the most value for your money.
The final summary of this book is that if you are considering health insurance, think about choosing a nonprofit plan.
A nonprofit health-insurance plan will keep more of your hard-earned money out of the hands of corporate shareholders and help ensure that patient care remains the primary focus.
And make sure you know exactly what you’re paying for, so you don’t get stuck with any unpleasant surprises down the road.
