Tuesday, June 16, 2009
Chronic Disease Costs Out of Control
We absolutely need health care reform and we need it now. A new study shows 3/4 ($1.7 trillion) of all U.S. health care spending in 2007 was related to treatment of the 7 most common chronic diseases. They are cancer, hypertension, mental disorders, heart disease, pulmonary conditions, diabetes, and stroke.
Forty five percent of Americans have at least one of these conditions and 26% have multiple conditions. These patients receive clinically recommended preventive care services only 56% of the time. Here is a jaw dropper...every thirty seconds a limb is amputated as the result of diabetes. That leaves a patient who is unable to work and is probably in an electric wheelchair and still has the other expensive health conditions that are associated with diabetes.
I see so many red flags here I just don't know where to begin. First of all...look at the list and then look at the rising incidence of childhood obesity. Unless we get a grip on this, those kids are going to have chronic problems by the time they are 30.
Why does anyone still smoke? Is there any value to tobacco farming (except for the farm cartel?) Cigarettes should cost $100.00/pack, since we live in the land of the free and don't want to ban them all together.
Why does Medicare pay lucrative rates to doctors who perform procedures (colonoscopy, stent placement, removing moles, passing scopes,) and doesn't even cover business cost for primary care physicians that take care of the people with multiple chronic conditions? The primary care "crisis" has been growing for the past 10 years and nothing has been done to change payments or to address the shortage.
Why is there a shortage of psychiatrists and why are mentally ill people living in homeless squalor? Our jails are filled with mentally ill people and we are happy with "out of sight, out of mind." The prison budget has bankrupted California.
There are solutions to these problems but our fragmented health delivery system will not work. The financial incentives to "pay more for doing more" episodic treatment is pushing us over the edge. We don't need one more dermatologist who does Botox, we need thousands more primary care physicians who work with care teams and are well paid to develop systems of interrelated care. Every time a patient has to go to an Emergency Department because they don't have a doctor or cannot see their doctor...we have failed.
Health care reform means "reform". The special interest groups (AMA is one of them) would like to see status quo for their interest.
The housing/banking crisis will look like a rainstorm, compared to the health care crisis flood that is looming with the baby boomers hitting Medicare age.
Posted by Toni Brayer, MD at 7:02 AM