Medical Technology Drives Choice & Cost

It's no secret that I think Obamacare is a bunch of horseshot, and for one simple reason: You don't 'fix' the American medical system by forcing everybody to buy insurance--that is the most overly-simplistic, erroneous notion of the last two centuries. Frankly, nothing is broken with the current system. It is what it is...and at that, it's the best in the world. Political leaders, namely one POTUS, are trying to pass this idea off to a public that does not think often about such matters. But please let me explain, and illustrate, why Obamacare will do nothing for the American medical system other than weaken it.

The first erroneous idea is that medical costs can be significantly curbed. No doubt, the feds can decrease costs by lowering reimbursements to doctors and hospitals (they do it through Medicare all the time). They can also reel-in fraudulent claims that lead to billions of wasted taxpayer dollars every year. But the idea that health care costs can be reduced significantly by preventing the uninsured from using emergency rooms as their primary care misses one major fact: As technology improves, costs go up because everybody--from doctors to patients--wants to take advantage of the newest in health care diagnostics and therapies. And I've got news for you--be prepared for more cutting-edge research and technology in medicine over the coming decades, because the only way it's NOT going to flourish is if the feds try to curb health care costs.

Case in point: A recent study showed that men will opt for the newest, and more costly, treatment for prostate cancer, despite there being scant evidence to its superiority over other treatments. Researchers analyzed the treatment choices over 20,000 men living inside or outside the regional market for Loma Linda University, a hospital in Southern California with a proton beam facility. All men were diagnosed with low- to intermediate-risk prostate cancer between 2003 and 2006.

They found that patients living near a proton beam facility (only nine in operation in U.S., with eight more in development, according to the National Association for Proton Therapy) were more than five times more likely to receive proton beam therapy than those living outside of the hospital's referral region. This despite there being no evidence showing proton therapy having better outcomes than other forms of prostate cancer treatment, including other forms of radiation, surgery or hormone therapy.

Proton therapy uses a beam of protons to irradiate diseased tissue. The chief advantage is its ability to more precisely localize the radiation dose, thus better targeting of tumor tissue while leaving healthy surrounding tissue intact. The treatment is marketed as having lower impotence and incontinence rates than other radiation treatment options, but, again, there's a lack of evidence to support this, according to Dr. David Aaronson, a urologist at Kaiser Permanente Medical Group in Oakland, California, and lead author of the study.

Prostate cancer is the most common cancer in men, with more than 240,000 diagnosed cases in the U.S. in 2011. Nine out of 10 of those cases were localized prostate cancer, meaning the cancer hasn't spread outside the prostate gland. Nearly all men diagnosed with localized tumors survive at least five years after diagnosis.

What this study really illustrates is that people will gravitate toward the newest and more advanced therapy when available; and to no small part on the advice of doctors, who will also tend to favor the cutting-edge when making recommendations.

But new technology doesn't come cheap--estimates have proton beam therapy costing twice as much as intensity-modulated radiation therapy, another form of external radiation therapy and about five times more than radioactive seed implants (aka prostate brachytherapy). And according to some in the biz, institutions with proton beam facilities--which have been shown to be more effective in treating tumors of the brain, eye and spine (rare cancers)--often look to pad their numbers by treating prostate cancer (one of most common in men).

And this, dear reader, is the reality of medical care in the western world. What humors me, though, is the second erroneous notion: that universal health care will fix the current 'crisis.' As I have said before, there is no crisis, nothing to be fixed, at least not with regard to how the system currently runs.

We have the greatest medical system in the world here in America, at the forefront of modern technology, and we get to enjoy a pretty decent success rate for the treatment of most modern illnesses. What is a fantasy is that somehow it shouldn't cost money--yeah right. The only way that will change will be to stifle innovation, so that all Americans can get the same shoddy care as they do in Canada (don't even get me started, Canadians--I've personally treated too many Canucks who've come to the U.S. to receive the care they just couldn't for months in their own country).

Obamacare ain't gonna fix nutin' except one man's legacy. And the politicos spreading the myth that every man, woman and child needs to purchase health insurance to lower health care costs is the biggest laugh of the new millennium. The only aspects of health care 'in need' of fixing are the public perceptions--and practices--of health and wellness, and especially the regulation of the insurance industry. But that is another story altogether.

When All You Have is a Hammer...

Well no doubt that all this talk about health care reform has brought some long overdue can-o-worm opening. Take, for instance, unnecessary surgeries: a medical nuisance of the worst magnitude, and common practice for decades. A recent report discloses that riskier surgeries for low back pain have risen in number and in cost, yet many are unwarranted. Well n-o-o-o chit! You know what they say, "When all you have is a hammer, everything looks like a nail."

Data on more than 32,000 Medicare patients with low back pain stemming from spinal stenosis (a narrowing of the spinal canal causing a squeezing low back pressure) showed that costlier, more complex spinal fusion surgeries were recommended and performed over a six year period. Less expensive decompression surgeries, costing roughly $20K, were often bypassed for $60-90K spinal fusions, despite the more expensive surgeries having greater complications and even leading to death.

Worse yet, many a spinal fusion was lacking in evidence for appropriateness of care. You don't say? Our doctors doing the unnecessary? Nah, not McReamy. You bet your assets they are. And I love it, because we chiropractors have known about it for years, and we haven't been quiet about it, either. We have tried to sway the public toward more natural and highly effective treatment options, but noooo, stay away from them chiropractors, they can hurt you.

Yeah? Listen to these number:

• Risk of stroke in a $20K spinal decompression (part of vertebrae hacked out to take pressure off nerve): 1 in 50
• Risk of stroke in a $80K complex spinal fusion (vertebrae connected and joint removed): 1 in 20
• Risk of stroke in a $3K round of chiropractic care: 1 in 5.85 million

Frickin' duh!

According to the study, more than half the patients who had complex fusions had a simple stenosis, which usually calls for decompression alone. Rates of complex fusions in Medicare patients rose 15-fold from 2002-2007, while decompressions declined, and hospital charges grew 40 percent. There have been allegations of kickbacks to spine surgeons for using products of a particular hardware manufacturer. Hey Izzy, them screws you got in ya back sent me and the missus to Reno...

Listen, I don't really think there's some big conspiracy here: It ain't rocket science. The medicos are admittedly deficient in their training in treating musculoskeletal issues. Surgery is also notoriously ineffective at relieving low back pain for any significant stretch of time. So why are drugs (equally ineffective) and surgery still the treatments of choice by the cultural health authority? Simple. When all you have is a hammer...

Bye, Bye Doctors

OK people--say goodbye to doctors, and hello to nurses, physician's assistants and disease educators, because that's what you'll be getting under the new health care system. That's right, primary care physicians are on their way out--in droves. But you're not surprised, right? I told you just that in this here blog, remember? And for my fellow chiropractors, I made that very clear in my Dynamic Chiropractic article, Chiropractic Suited for Primary Care?, last year.

Awright, good, you knew...just wanted to give a heads up, because new estimates have 40,000 primary care physicians leaving practice within the next decade. That's how money is saved in a nationalized health system. Reminds me of the time my wife's esthetician told me that she was a doctor in Russia. "Awesome!" I said. "Not really," she replied. "Being a doctor there is not like over here, it doesn't pay much and the hours are long; very few people want to do it." And now she's giving facials in Beverly Hills. Nice.

Only 30% of all doctors practice in primary care. If you don't know, these are the docs that see you first. Don't know why your gassy all day? Primary care physician. Don't know why your baby toe tingles? Primary care physician. Pissing fire? You get it.

Interestingly, 65 million people currently live in areas designated as having a shortage of primary care physicians, according to the government. But never fear, the new health plan will offer to pay doctors 10% more to serve in those areas. Wow! So if I were to serve in those areas, they'd pay me an additional $3.10 (Medicare pays $31.00 for chiropractic; trust me, it's my humanitarian gift to society to treat the elderly). Love the government--they sure know how to value a service.

Not only are primary care physicians leaving practice, but when the new health care system takes off in 2014, both the newly insured and existing patients will make a mad rush to doctors' offices, putting a strain on an already buckling specialty.

No worries, less educated physicians assistants will pick up the slack. They'll have their government manuals telling them how to handle each condition. Who needs doctors? Differential diagnosis is soooo overated.

I just hope I never see my PCP, Dr. Weiner giving haircuts at the local Fantastic Sams--that'd be awfully embarrassing.

Hospitals Oppose Reform

Here we go. Hospitals, medical technicians and a medical imaging access coalition all oppose President Barack Obama's latest health care reform proposal to reduce Medicare and Medicaid spending. These organizations believe that the proposed cuts will impair access to medical care to many who need it.

The president suggested yesterday that $200 billion could be saved over the next ten years by trimming federal payments to hospitals. He justified this change by noting broader insurance coverage, so in other words, they'll make it up in volume. Many hospitals, especially those with large numbers of poor patients say these cuts will be unfair and will only hurt the poor, sick and elderly.

Although congress will sculpt the new laws, the president has influence. Obama has urged the congress to resist powerful lobbies trying to maintain their clout and profits. Like those greedy hospitals, medical technicians and imaging centers (X-rays, MRIs, CT scans), I presume. All in all, the president wants to cut $313 billion in both federal programs over the next decade.

All I can say is, "Wow!" Already being one of the worst reimbursing insurances in the country, Medicare under Obama's proposal would pay even less? Does anybody have any idea of what the consequences will be? Why don't we ask The Access to Medical Imaging Coalition, a trade group representing diagnostic imaging centers and their patients,

It would "impair access to diagnostic imaging services and result in patients' delaying or forgoing life- and cost-savings imaging procedures."

The group also said Obama's efficiency estimates were based on a flawed survey. You don't say...

What else? Some believe that providers--doctors, hospitals, imaging centers--will have to ration services due to the cuts. No kidding--what else do you think will happen? Do you think that doctors will pay for a patient's lab tests themselves? C'mon! If you have been reading this blog lately, then you know I've been saying it repeatedly--health care reform, as proposed by our current government, will do little to improve health care and a lot to diminish its quality. Unfortunate, since quality is the one thing American health care has got going for itself.

Barack Obama Supports Chiropractic

Earlier in the year I wrote a post titled, Are Chiropractors Real Doctors? It has been, by far, my most popular post. The responses were overwhelmingly negative. Aside from the "quack" comments, much was written that I couldn't keep up--it was nasty, vulgar, insulting, and worst of all, posted entirely by Mr. and Ms. "Anonymous". That led me to write this post. I, frankly, would have been happy to leave up the nasty comments, and would have loved to respond to them had any author claimed them with a name; but I wasn't going to get into a debate with a hidden identity--not interested in that.

So what was all the hullabaloo about? The main gist was that chiropractors are NOT real doctors! "Quacks, that's all," according to one poster. Well, I think I made my points rather concisely in the blog post, and especially in the concurrent podcast [The Dr. Nick Show (Episode 5)]. But to put a little more weight behind my argument, why not listen to what President-elect Barack Obama has to say on the subject.

In his position statement to the chiropractic profession, he stated:

• As you know, chiropractic care is low-cost, drug-free, noninvasive, and has been shown to have a positive impact on patients' health.
• I believe steps should be taken to acknowledge the important care chiropractors provide, and knock down unreasonable barriers of access and discriminatory insurance coverage that stand between so many patients and the care they need.
• I have a plan to support doctors of chiropractic. I support expanding the range of chiropractic services covered by Medicare.
• I support commissioning doctors of chiropractic as officers in the Uniformed Corps of the U.S. Public Health Service...to deliver the nation's public health promotion and disease prevention programs and advancing public health science.
• My health care plan also prioritizes preventive care, and chiropractors play a significant role in this effort. As we shift our health care delivery system towards a culture of wellness and disease prevention, I believe that chiropractors must play an integral role in expanding access to preventive care and strengthening our public health system.

Booyah! There you have it...from the President-elect. To honor this great health-promoting statement by what's promising to be a great leader, I will leave all comments up on this one, so fire away, Anonymous.

Health Care Changes On the Rise

You know how I feel about our current health care system--fabulous in many regards, but definitely in need of changes. One obvious change needs to be the enormous waste that goes on in the U.S. hospital system. Along with that needs to be better measures toward curbing medical mistakes, now one of the leading causes of death in this country.

But times, they are a changing: Recent reports disclose that Medicare, the nation's federal health insurer, will stop paying for medical errors and waste starting October 1, 2008. Whoa. Like what, exactly? Preventable hospital errors that will no longer be covered by Medicare are, among other things, catheter-caused urinary tract infections, injuries from falls, and objects left in the body after surgery. The rationale from Medicare is that not only will hitting hospitals in the wallet press them to tighten up on mistakes, but it will also lower costs, as the government estimates the cost of errors to be $10,000 to $100,000 per mistake, which usually gets tacked on to the patient's bill ($9.3 billion in excess charges per year). Doh! Next year, there will be three more errors added to the no-pay list--ventilator-caused pneumonia and drug-resistant staph infections head up the list--and Medicare believes that it will save the government $190 million over five years.

Well I guess I have mixed feelings about this latest news out of the federal government. Overall, I think it is a smart move. There is way too much nonchalance about standard medical procedures. For instance, the Medicare report disclosed that 25% of all hospitalized patients receive urinary catheters as standard procedure, despite the fact that many don't need them. Catheters trigger more than half a million urinary tract infections annually, the most common hospital-caused infection. Ouch! Even worse is that many catheters are left in longer than needed, causing infections. Last year, the University of Michigan conducted the first national study of catheter practices and found that almost 50% of hospitals don't keep track of which patients get one--now that's carelessness. Double ouch!

So, as I said, overall it's a good idea: Money talks; and when you threaten to withhold funds, it's amazing how fast things get fixed. But I am a bit ambivalent for two reasons. First, it might lead to hospitals and doctors hiding mistakes--not a comforting notion. And when the pressure is on, people and organizations have a way of rationalizing their decisions, even if those decisions lead to mistakes, and that might not be good for consumers. The other thing that worries me, especially as a health care provider, is that the insurance companies might use this move by Medicare to rationalize their own denial of claims. Medical insurers do as Medicare does, and they are notorious for using any weapon at their disposal to withhold payment of claims; because for them, it really is all about the money.

So I guess we'll have to wait and see. Nothing comes without problems: All good things come with complications, this situation being no different. But, all in all, we need to decrease the amount of medical mistakes taking the lives of Americans annually--it's just way too high. We have the greatest medical system in the world; it just doesn't make sense to lose so many people to medical mistakes; 82% of the deaths caused by medical mistakes are preventable, so why not nip them in the bud now? I guess that's what Medicare is trying to do. We'll have to see how it turns out, but I'm guessing it's the right move to make.

We've Still Got A Long Way to Go

 They say we're in a health care crisis. Everywhere we turn we hear that our system is failing. I would disagree. In fact, I would say that based on the current health paradigm in which we now live, our system works beautifully, and there is nothing to fix.

Huh?!?! Has Campos finally lost his mind?

Hardly. Let me say this loud and clear: WE ARE NOT IN A HEALTH CARE CRISIS. We are in a conceptual crisis--a crisis of paradigms, if you will. Our current approach to health is to take it for granted until something goes wrong, then to run to the doctor or hospital to get cured.

Please tell me what's wrong with our current system in context of this conceptualization of health care. It's too expensive? Hey, it costs money to save lives. You think drug research, organ removal training, or high-resolution imaging diagnostics come cheap. Why should the medical industry spend years and years studying, researching and developing, and billions of dollars in funding just to give it away free? Think about that real hard.

Let me add even more perspective--why would you spend years studying in college, and many more years learning a business or craft, no matter what the discipline, to not earn a reasonable and proper paycheck today? Dry cleaning is too expensive! Restaurants are too expensive? Hair stylists are too expensive? Fix these industries! They're too damn expensive! (Where's Michael Moore when you really need him?)

Case in point: A new study shows that when women have to pay a portion of a medical bill in the form of a co-payment (sometimes as low as $10), the number who go in for regular mammograms decreases substantially. What the...? This is mind-blowing to me. Women who'd rather not get screened for a life-threatening and essentially preventative (if caught early enough) cancer (breast) to save ten bucks is just incomprehensible. But I think it's more prevalent a practice than we know right now--among all genders, races, ages, and socioeconomic classes. I see it in my own practice all the time. Does this mean the system needs to be fixed? Well the Federal government seems to be buckling to the pressure--Medicare is now considering waving co-payments for routine mammograms. Hmmm.

The reality is that if we want something more out of health care, we need to put more into our own health. Period. It's the concept of taking responsibility for our own health; not relying on the government or our employer to foot the bill for our neglect. This is a new way, and one which I heavily believe in and promote. Take better care of yourself and your health care costs will go down. I've had one major medical and one major dental situation in the last two years. I paid a pretty penny for sure (about $5,000 total) to get them taken care of. And guess what? It was worth it. You think I just had the money lying around begging for a place to spend it?--oh, wouldn't that be nice. Sorry, no fat chance--it hurt coming up with the dough. But it was still worth it.

My point is this: Take care of yourself. It will minimize your need for medical care. When something does come up--and it will--your catastrophic medical coverage will come in handy, but it won't cost you an arm and a leg during more healthy times. Not doing the things necessary to maintain good health in the meantime is just dollar dumb. You might save a penny today, but you'll be a big contributor to the false notion that our current non-health system needs fixing.