Category Archives: healthcare reform

April 20, 2018 · 4:01 PM

Costs of Diabetes in the U.S. in 2017

Healthcare dollars

Most of the numbers below won’t mean much to you because they are mind-boggling. Also note that most of the cost is caused by type 2 diabetes in people over 65. From Diabetes Care:

“The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).”

Source: Economic Costs of Diabetes in the U.S. in 2017 | Diabetes Care

Drastically reduce your diabetes healthcare expenditures by incorporating the ideas in my books. The ball’s in your court.

Steve Parker, M.D.

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March 25, 2018 · 3:49 AM

Not As Bad As Cancer, But Diabetes Is Still Outrageously Expensive

Kelley at her Below Seven blog writes about the sad state of the U.S healthcare “system,” mostly about how insanely expensive it is for those of us not in a socialized program like Medicare or Medicaid. If your tempted to put the blame only on doctors, hospitals, and Big Pharma, know that insurance companies and politicians are also at fault. Politicians alone could solve the cost problem.

If you want to learn how to negotiate lower healthcare prices, check out this post at ZeroHedge. You could save thousands of dollars.

If you have 15 minutes to spare, read Karl Denninger’s article on comprehensive healthcare reform.

From Kelley:

This year, I have a deductible of $6,500, which means that I have to pay 100% of expenses until I reach that deductible. I’m not sure if “healthy” people realize how much money a person with a chronic disease spends on healthcare each year, but $6,500 isn’t chump change. That’s a whole lot of money!

Since my husband and I have our own company, we go through peaks and valleys when it comes to income. Sometimes, it’s just not feasible to spend $3,000 in one month for diabetes supplies, which is when I’m thankful I was able to stock up so I can make it another month.

I’m not trying to write a woe is me post, but because I have to pay so much out of pocket, I am frustrated at how the health care system works. You never get an exact price of how much something is going to cost before it goes through insurance. But because of my insurance plan, I am on the hook for 100% of whatever they decide the cost is.

Source: Unknown Costs with Healthcare – Below Seven

Physicians are not immune to this malarky either. Health insurance for my family-of-four is about $12,000/year, with individual deductibles of $1000/year, family deductible of $3000/year, and family out-of-pocket maximum of $9000/year. And of course if I want to keep my out-of-pocket expenses at a mininum, I have to use the healthcare providers the insurer picks for me.

Kinda make you wanna do everything possible to stay healthy and out of the medical-industrial complex, doesn’t it?

Steve Parker, M.D.

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June 3, 2017 · 6:50 AM

I Solved America’s Narcotic Use Epidemic. You’re Welcome.

Not your typical street-level drug pusher, but a great source of hydrocodone (e.g., Norco)

The mainstream news outlets in the U.S. tell us we are in the midst of a narcotic use epidemic, an “opioid crisis.” What’s worse, folks are dropping like flies from overdoses.

I’m talking about oxycodone, hydrocodone, hydromorphone (Dilaudid), morphine, fentanyl, heroin, etc. Not Xanax, Ativan, or Valium.

On average, it takes three weeks of daily narcotic use to get physically dependent on it. This means that when you stop the drug completely and suddenly, your body may crave it and you could have withdrawal symptoms. The severity of withdrawal symptoms varies from person to person. Possible symptoms include anxiety, sweating, nausea, vomiting, diarrhea, hyperactivity, restless legs, weakness, easy fatigue, shaking, suicidal thoughts, insomnia, and muscle pain or cramps.

Good and bad news, bad news first: Narcotic withdrawal can be very uncomfortable but rarely causes medically serious complications. The serious complications are usually in folks with pre-existing heart disease, high blood pressure, low blood pressure, or heart rhythm disturbances.

Here’s how you stop your chronic daily narcotic habit without suffering a withdrawal syndrome (if needed, see the postscript for an example):

Total up your current total daily dose in milligrams
Determine 10% of the amount by dividing the milligrams by 10
Reduce your daily milligram intake by that 10% every week
Nine weeks later you’ll be off narcotics

Congratulations! You’ve done your part to solve America’s opioid use epidemic. You’ve reduced your drug bill, avoided Opiate Use Disorder, and reduced your risk of narcotic overdose death by 100%. And you did it without political meddling or an expensive stay at a detox center.

Be aware that as you taper off your narcotic, you may have a flare of an underlying psychiatric condition such as depression, anxiety, PTSD, bipolar disorder, panic attacks, or psychosis. If so, see a mental health professional posthaste.

Good luck, America!

Steve Parker, M.D.

PS: As an example or narcotic tapering, let’s consider Percocet 10/325. It’s 10 mg of oxycodone and 325 mg of acetaminophen. Say you’re taking Percocet 10/325, four pills at at time, four times a day. That’s a total daily oxydocodone dose of 160 mg (16 pills x 10 mg). 160 mg divided by 10 = 16 mg. We have to round off 16 mg to 15 mg due to the availability of various strengths of Percocet. So starting today, you reduce your daily oxycontin dose by 15 g, which is one-and-a-half pills. After one week, you reduce your daily pill count by another one-and-a-half pills. Etc.

PPS: Let you’re doctor know what you’re doing beforehand. He’ll be overjoyed and ensure it’s safe for you to do this taper.

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Tagged as narcotic addiction narcotic tapering schedule, narcotic dependence, narcotic overdose, narcotic use epidemic, opiate addiction, opiate use epidemic, opioid crisis, opioid overdose

May 4, 2017 · 1:04 AM

Competition is the Only Way to Improve U.S. Healthcare and Reduce Cost

This is costing way too much

The only way to improve U.S. healthcare while bringing costs down is to introduce serious competition for healthcare dollars.

This post is for U.S. citizens since the federales are going to tinker with our health insurance reform very soon. This would be a great opportunity to make helpful changes to the system. I have no faith they will do it.

Healthcare in the U.S. consumes one of every five dollars spent in the economy. We are not getting our money’s worth, at least judging from average lifespan.

Karl Dennnger has put a lot of thought into the problem over the last decade, and has a concrete legislative proposal that makes a lot of sense. I endorse it. As you consider the possibilities, you need to keep in mind that the cost of healthcare will drop drastically. Not just by 50%. More like 80% or more. Healthcare will be so cheap you won’t even need insurance to pay for most of it.

How are these price reductions possible? Because the Dennniger plan introduces competition and moves us closer to a free market situation without third-party interference from insurers and government.

Here are the major points:

All healthcare providers must publicly post (e.g., on the web) prices which apply to everyone. E.g., not a price depending on which insurance you have, whether you are paying cash up front, etc.
All customers must be billed for actual charges at the same posted prices at the time services or product is rendered. This removes the third party (insurer or government). You file the claim and every one pays the same price. In a way, medical care isn’t too expensive; too often it’s “free,” because someone else is paying. So there’s no comparison shopping. You see posted prices and you pay them yourself when you buy gasoline, groceries, cell phones, computers, TVs, cars, and houses. A valid and collectible bill must be consented to in writing before the service or product is provided. Actual price, no open-ended add-ons.
No event caused by or a consequence of treatment can be billed to the customer. (I’m not sure I like this. What about unforeseeable complications like C diff infection after antibiotics, or anaphylactic reactions to drugs? Providers could eventually get insurance to cover those costs, but it would be a brand new insurance market.)
True emergency patients who are unable to consent must receive the same price for same service as a person who consents to said service.
All medical records belong to the patient and shall be delivered to the patient (customer) at the time of service.
Auxiliary services (e.g., x-rays, lab work) may not be required to be purchased at the point of use. Example: an orthopedist wants you to get a knee MRI scan on his machine. You can shop around other places for a cheaper or better-quality MRI scan.
All anti-trust and consumer protection laws shall be enforced against all medically-related firms, and any claimed exemptions are hereby deemed void. Stiff penalties and fines for violations. Private lawyers must have access to sue.
You are free to purchase any medical test you want if no radiation or drug is required to perform the test. (You can already do this in Arizona, but in many states you need a “doctors order” for the test.)
There will be no government payments for care or products when a lifestyle change will provide a substantially equivalent or better benefit, when the customer refuses to implement the lifestyle change. (This point needs some fine-tuning. Who decides when and which lifestyle change would provide an equivalent benefit?])
Health insurance companies must sell true insurance, to sell any health-related policy at all. No insurance coverage for an event or condition of which you received treatment over the last 24 months. If an adverse event occurs, insurance pays for all of it. E.g,, if you get an expensive cancer, the insurance company cannot drop you. The insurance must cover, with a selection of available deductibles, all accidental injuries and true life-threatening emergencies. Medical underwriting is permitted (e.g., insurers can charge higher premiums for smokers, couch potatoes, obese folks, etc. I have long thought that people in the top 25% of fitness, determined by a treadmill exercise test, should get a discount on insurance premiums).
All health insurers providers selling true insurance, in whole or in part, must provide within their “true insurance” the ability to replace like with like.” (I don’t know what Karl means by this.)
Medicare becomes just another insurance provider. No more Part B (outpatient services).
Medicaid is repealed entirely.
What about U.S. citizens and “lawful permanent residents” who can’t pay for care but still need attention? For true emergencies, the hospital or Emergency Department bills the U.S. Treasury, who pays within 30 days. For non-emergencies, the provider bills the U.S. Treasury and will be paid within 30 days except no billing for government payment if the condition resulted from a lifestyle decision the patient made. After the Treasury Department pays the provider, Treasury will send an invoice to the customer (patient or taxpayer), which may be settled within 90 days at no penalty. If charges are not paid, they become a tax lien subject to collection from refundable tax credits, tax refunds, other entitlement checks (except Social Security retirement), and windfall amounts (either money or property).
Repeal all aspects of Obamacare/PPACA.

You need a break after all that. Almost done. Hang in there!

I don’t recall Karl recommending a specific deductible amount, but often saw mention of $2,000 as a deductible. “Deductible” is what you pay out of pocket before insurance pays anything. I like a high deductible over “first-dollar” coverage, because the high deductible automatically creates 200 million shoppers who are going to check prices for sure before buying healthcare. (Of 320 million people in the U.S., I’m guessing 200 million are adults.)

Karl favors “catastrophic” policies, as do I. Your car needs new tires every few years, oil changes much more often, and periodic repairs, but you don’t expect car insurance to pay for those non-catastrophic costs.

Who would get hurt by this plan? Lobbyists, insurance and healthcare administrators, drug reps, pharmacy benefits managers, and those who refuse to make healthy lifestyle changes.

I don’t recall Karl addressing unreasonable insurance mandates, managed care plans (like Kaiser Permanente in CA), accountable care organizations, liability reform (we need the English Rule), tax parity (businesses buying insurance for employees get a tax break, but private individuals buying their own policies don’t), or much about enforcement. But he may have; Karl’s a very smart guy.

Steve Parker, M.D.