The American Healthcare System: Did You Know?

This article relates to An American Sickness

In An American Sickness, Dr. Elisabeth Rosenthal provides many intriguing details about the U.S. healthcare system. Here are a few:

• The first employer-sponsored health insurance plan was developed in Dallas, Texas in 1929 as a sort of pre-paid hospitalization account offered to teachers in the area. It evolved into Blue Cross over the ensuing decade, becoming the United States' first national health insurance plan.
• The healthcare industry spends $15 billion in the USA annually on advertising. In 2000 pharmaceutical company Merck spent more on ads for just one new painkiller (Vioxx) than Budweiser, Pepsi or Nike did for all their products that same year. The USA is one of only two countries to permit advertising of drugs on television (the other is New Zealand).
• 74 percent of the cancer drugs approved by the FDA during the previous decade ultimately did not extend life by even a single day.
• Drug companies can apply for a new patent for drugs that are a combination of older medicines, thereby allowing them to charge more for the new version. Duexis, for example, is a combination of ibuprofen and famotidine (aka Pepcid). A month's worth of the two over-the-counter drugs cost just a fraction of the $1600/month bill for the "new and improved" prescription-only medication. They can also re-patent a pharmaceutical by changing the delivery method, such as developing a capsulized version of a drug currently in pill form.
• Pharmaceutical companies often claim it costs over $1 billion to research and test a new drug. Academic studies, however, have placed the average R&D costs at between $43.4 million and $125 million.
• If the practice you go to is owned by a hospital or is licensed as a surgery center you may end up paying expensive facility fees. If blood tests or radiology testing are needed ask to be sent to an in-network lab. Prices at hospital labs can be one hundred times higher than at commercial labs.
• Be cautious of unnecessary tests, as they may show a "problem" that doesn't really need treatment. For example, MRIs of many healthy, pain-free middle-aged people show bulging discs or arthritis. These "abnormal findings" then often lead to actions that aren't necessary; the rate of spine surgery in the US is about double that of Canada and five times that in Great Britain.
• 80% of doctors will be named in a malpractice suit by the time they're 60.
• Just because we can screen for a condition doesn't mean we should. For example, checking for low testosterone ("Low T") or getting an ultrasound of your neck to see if you have narrowing of the arteries can actually bring risks, since there is no "normal" established for such tests and treatments may do more harm than good.
• Hospital bills are often negotiable. Comedian John Oliver purchased nearly $15 million worth of medical debt for less than $60,000 as a stunt to illustrate how inflated medical costs can be. Prices are often so inflated that even low-level clerks are frequently authorized to approve major discounts. Several studies show that over 50% of medical bills have mistakes that result in overcharges to the patient (one study placed that number at 90%).

Filed under Medicine, Science and Tech

This "beyond the book article" relates to An American Sickness. It originally ran in November 2017 and has been updated for the March 2018 paperback edition. Go to magazine.

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