By Donella Meadows
–January 5, 1995–
America has the best health care system in the world, said Bob Dole and the other executioners of health care reform. Once upon a time that claim was true. Now what America has is the most expensive health care system in the world, in spite of the fact that it leaves one-third of its citizens un- or under-insured and ranks 17th of the 24 industrialized nations in life expectancy.
The major reason for the high expense and poor performance is that we are moving rapidly toward an unholy combination of government and corporate health care management. That trend is well documented by Robert Sherrill in the January 9/16 issue of The Nation. Sherrill draws together 11 recent books and articles on drug companies, insurers, hospitals, and doctors. He shows a system that views patients as consumers to be manipulated, health workers as costs to be minimized, and taxpayer support as gold to be mined.
Here are just a few of Sherrill’s startling statistics:
– The top executives of the the nation’s four largest hospital chains earned a combined one-year total of $14 million, while they were firing housekeepers and nurses and working the remaining nurses 80 hours a week, so as to pay only one set of benefits for the equivalent of two workers. These hospitals rent “temp” nurses, when patient loads rise. The temps may be unqualified, but they don’t get benefits and can be laid off quickly.
– Four corporations own seven out of ten of the nation’s for-profit psychiatric beds. They treat only insured patients. The treatments take, with remarkable regularity, 28 days — the cut-off for most employee insurance policies. Some of the major investors in these psychiatric hospitals are insurance companies.
– Private hospitals close emergency rooms to keep out uninsured patients. Meanwhile at public emergency rooms like that of the Los Angeles County Hospital, the average wait is three hours, and 40 percent of the patients are uninsured.
– In the 1980s 550 community hospitals failed. Meanwhile the Columbia/HCA Healthcare Corporation grew from 30 to 311 hospitals in just 14 months. Columbia/HCA’s goal is to own a fifth of the nation’s hospitals by the year 2000.
– There were 7,000 deaths because of poor hospital care in one year in New York State alone. About four percent of all hospital patients are injured in some way by the hospital. The medical staff in one hospital made mistakes in drug dosage one out of every three times.
– Medicare and Medicaid fraud by hospitals, doctors, and drug companies costs taxpayers $100-$130 billion a year.
– Hospitals routinely bill Medicare, insurance companies, and patients $8 per aspirin or $20 per box of tissues. More serious overbilling occurs at for-profit hospitals than at public hospitals. One private hospital in Georgia charges on average $14,582 to treat a stroke victim; a nearby public hospital charges $6,735 for the same service and same length of stay.
– In Florida 40 percent of the doctors own their own testing facilities. Patients of lab-owning doctors are subjected to almost twice as many tests as patients of other doctors, and the charge per test is more than twice as high. Doctors who own MRI imaging equipment order four times more MRI scans than doctors who don’t.
– American doctors are six times more likely to perform cardiac bypass operations than doctors in Europe; two to three times more likely to perform hysterectomies, twice as likely to do cesarean sections. American doctors take more X-rays per patient and give higher doses of drugs. This medical aggressiveness does not produce higher survival rates, only higher costs.
– Only one in eight of the patients who experience medical malpractice actually sues; only half of those who sue receive settlements. Malpractice suits account for less than one percent of the soaring cost of U.S. health care.
– The average wholesale price of drugs in the U.S. is 32 percent higher than it is in Canada. Almost 40 percent of medicines are sold to people over the age of 60, and 40-50 percent of those medications are unnecessary or even harmful. Each year more than 650,000 elderly Americans are hospitalized because of reactions to prescribed medications.
– Two drugs are used to counter blood clots in coronary arteries: streptokinase at $200 a dose and t-PA at $2,200 a dose. The larger seller is t-PA, not because it is more effective, but because it is better marketed.
– Of every dollar in health insurance premiums Americans pay, 37 cents goes to insurance company overhead.
– Canada’s national health care system covers 25 million people using fewer administrators than Massachusetts Blue Cross, which covers 2.7 million. The average American doctor hires twice as many people to handle paperwork as the average Canadian doctor.
– The answer to soaring costs is supposed to be health maintenance organizations, or HMOs. But premiums in American HMOs are rising twice as fast as costs, patients’ choice of doctors and treatments is limited, waiting times are increasing, and services are cut to the bone. HMOs are not “managed competition;” they are anti-competitive monopolies.
Our health care system is wildly profitable for its owners, at enormous cost to patients, workers, and taxpayers. If it is the best health care system in the world, it is so only because the more one knows about it, the more one resolves to take very good care of oneself, in order never to have to go near it.
Copyright Sustainability Institute 1995