I really couldn't make this stuff up!

I blogged a few weeks ago about the current flu vaccine being only 40% effective (see "does preventive care really lower cost?"). The vaccine is a guess at what flu virus will be prevalent this year and it turns out that the current one missed by a long shot. In yet another example of how the cure for bad health care is more, there is news out today that a federal advisory panel in Atlanta has voted to extend the flu vaccine to all children except those under the age of six months. For once, I am at a loss for words. I mean this is wrong on so many levels but lets just start with the science. Since when is 40% effectiveness satisfactory enough that all children will be required to get the vaccine? Are we going to just ignore that part. They will try to claim that this year is an aberration but let me assure you it is not. The failure rate on the flu vaccine is high year in and year out.
Next, what about the parents. Many parents are paranoid of vaccines and believe firmly that vaccines cause autism. While there is no solid evidence for this I have spoken to more than a few parents who are sure beyond a shadow of a doubt that a vaccine created autism in their child and given the state of our health care system I am inclined to believe them more than some quasi-scientific study. So now we are going to force parents to accept a vaccine they are frightened might cause some untoward outcome in their children for a vaccine that historically is woefully effective. Good choice.
Finally, lest I forget to talk about cost, this is as good an example as any why our health care costs are out of control. We are going to administer a costly vaccine to an unsuspecting public in the name of lowering costs. In other words, theoretically if we administer a vaccine it should lower the number of people accessing the health care system for a serious complication. Good idea except that in practice this vaccine is largely ineffective and from this years numbers it would appear will not do much good. So in practice it wont work like the theory states. What if in fact it does cause other complications? In that case a costly vaccine is ineffective and adds to the overall costs by causing other complications.
Oh well, why ask all these questions. I am sure that administering a vaccine will be useful. After all, doing something is better than doing nothing. Right?

High health care costs finally explained, exclusively on the Talus post.

Seriously folks, why do we have high health care costs? I am only old enough to remember the 80's so lets start there.
In the 1980s doctors were the culprit. They were paid too highly and unfortunately I had not become one yet. So insurance companies and Medicare started to bring theire costs down by capping what doctors could bill for procedures. This helped in one area of health care but costs still soared through the 90s due to high hospital costs which insurance companies and medicare are still trying to get under control. Then along came the drug companies and they are the experts. They create drugs to save lives and advertise them on TV so we all want them. (That reminds me, drug companies were going to save lives so how come we have all the erectile dysfunction pills and sleeping pills costing the most........do you think they told us they would save lives so we bought into it?) Drugs have become so expensive that Medicare passed "part D" which pays for drugs for seniors - just not the ones in high school, they still have to get them on the black market. So Medicare part D will fix it right? Wrong. The Bush Administration put a clause in the bill that forbids Medicare from negotiating in bulk to lower drug costs. And you cynics out there suggest that corporations are running Congress! They are saving our lives people and I for one don't like your tone!
Two recent articles in the world of health news will explain this further. Experts are befuddled by a recent finding in which strokes in women have soared despite the fact that many women are taking cholesterol lowering medications (called statins). With no better explanation the experts have blamed it on fat people even though the study didn't focus on how fat these people were. They just simply blamed fat (like they do for every other terrorist act) and concluded that people had to lose weight. Back in the olden days -- before any of us were around -- scientists would have actually studied that possibility and if found to be true they would have done two things. 1)Start people on a program to lose weight and 2)told people to quit taking the statins because obviously they are doing no good. And therein lies the exact problem. Statins are a $10 billion drug in the US alone for one single company and that means they are upwards of $30 billion worldwide when all statins are taken into consideration. It makes sense to look at the statins critically and stop using them if they are not helping and then focus on another area. But in the moderna age of health care what happens is that we keep piling on. If the blood pressure pill isn't working then take statins but continue to take the blood pressure pill. If the statins aren't working then your too fat so lose some weight. And, oh yeah, keep taking the blood pressure pills and statins. If Losing weight doesn't work then take a biolongitudinal eradicator pill. By the way, the biolongitudinal eradicator pill hasn't been invented yet and it is a word I made up but I am sure that something like that will be made and this will be the next pill to save us all from death......and dont forget to keep taking the high blood pressure pill, the statin and lose weight too because those will help as well.

Say It Ain't So! Health Spending Set to Rise Dramatically?

Here's a shocker everybody saw coming. A posting in the journal Health Affairs is about to be published proclaiming that health care costs are set to rise dramatically and will reach $4 trillion by 2017 at which time 1 out of every$5 will be spent on health care. We of course know this won't happen because Talus will ride to the rescue, but nonetheless projections are in place. The Associated Press reported this bit of "news" but what was amazing about it were not the projections of outrageous health care spending but rather the cavalier way in which it was reported. The article went on to detail that health care is in fact expensive (No Way!) and it will only get more expensive as the baby boomers retire (Seriously?). Never does the reporter think to stop and ask why. We always thought that science would save our health care woes, better medications, better coverage, etc. By this point in time we were supposed to have our health care costs under control and HMO's were going to fix it all. Instead all we see is reporting that says "well, get used to spending money on health care cause soon you will spend it on nothing else and you'll like it!". President Bush has a novel approach. He is going to limit the amount of Medicare growth by lowering the Medicare growth rate from 7% to 5% by freezing the rate paid to providers. Haven't we tried this before? What makes us think it will be different this time? Ok, here comes the biased part.......How about trying the Talus solution? You can't say that has been tried before.

Does preventive care really lower costs?

Many people are fond of saying that preventive care reduces costs and that if more people sought preventive treatment that costs would go down. Is this true? Intuitively, I doubt it but statistically it is questionable as well. There are many definitions of preventive care and to be fair I believe that some help. Keeping yourself healthy and in shape is preventive care and that helps. Having your eye looked at when you are bleeding out your eyeball is a good idea as well. But what about other things like having a colonoscopy annually, getting vaccinated for every disease known to mankind, having a checkup every 6 months, etc.? Are these good for you and do they lower cost. Well, according to some evidence the answer is no and no.

A large study was recently published on prostate cancer (by Dr. Grace Lu-Yao of Robert Woods Johnson Medical school) in which it was determined that delaying treatment was best in many cases. Some people have whispered about this in the past and the suggestion was that most people would die of natural causes long before prostate cancer would kill them. While this is not entirely true, it does turn out that in this study cited that only 10% of the 9,000 men who chose to delay or skip treatment had died of the cancer 10 years later. The vast majority of these men were still alive without significantly worsening symptoms. In general, more people than this usually die while actually receiving treatment.

While this may sound complicated, it is actually quite simple. Anyone who has received treatment for prostate cancer may in fact not need it and therefore all the treatment such as rectal exams, MRI's, surgeries, radiation , chemotherapy, etc. MAY (and I emphasize MAY) have been wasted. The point is not whether this study is right or wrong but rather that this needs to be looked at in more detail so we can determine when to treat and when not to treat. So why isn't this being done? Simple. No single party in the health care industry has any vested interest in not treating. Patients are scared and want treatment. Doctors would rather treat than not treat since doing something is better than nothing once the word cancer has arisen. Hospitals of course treat when possible for obvious reasons. Drug companies don't create a drug unless it is going to be used. Everyone wants to treat and nobody wants to look at when not to treat. So treatment and intervention continue and in many cases the necessity of such treatment is not considered. Strange, isn't it?

One more thing and I'll let you go. Vaccines. They are great right? It turns out that so far the 2007-2008 vaccine is one of the worst performing vaccines to date. All flu vaccines are basically guesses at what viruses will cause the flus for the upcoming seasons and this is never an exact science and so therefore it doesn't cover 100% of the outbreak. This years vaccine is only 40% effective which is terrrible to say the least.

This is not to cast doubt on all preventive care but it does mean that we should consider the unintended consequences of preventive care that is not helpful. In the overall picture though one thing is for sure, increasing the amount of preventive care in the health care industry will never control costs like many people say it will.

Medicare not the answer?

New government data was reported on by USA Today and others on Thursday(Feb. 14, 2008) that revealed that "senior benefit" costs are up 24% beyond the inflation rate since 2000. Now for those of you who had never heard the term "senior benefit" (like myself) before, it is a measure of all costs the government pays for seniors for health care, nursing home and Social Security combined. The report showed that health care costs were by far the largest part of that 24% increase as Social Security remains fairly stable. This means, as "cost not coverage" has always suggested, that even Medicare couldn't solve the excessive inflation rate in health care.

It is a common misconception amongst Americans that Medicare is the answer to our health care woes. I have stated all along that in fact universal health care in countries such as Germany, Britain, Canada, etc. is not the answer to our health care inflation. These universal payers do not eliminate inflation beyond the CPI, they simply control it better than inflation is controlled in the US. In other words, they are failing too but just failing at a slower rate than the US health care system.

Here is what will happen over the next 10-15 years in the politics of health care (no, I am not consulting a psychic I am just making a prediction). Universal coverage will be implemented within the next two presidential cycles in some form and this form will most likely be mandated coverage that you must buy through your employer or personally. This will be mandated much like auto insurance is right now. Costs will soar as a result and a public outcry will arise the likes of which we have never seen and Congress and the administration will rush to our aid. They will implement "universal Medicare" where the government becomes the single payer and costs will continue to soar. Strict rationing and controls will be placed at that point and this will also not work in the same way that the HMO experiment has failed. So in 20 years or so we will look back at a failed universal health care experiment and where will we go from there?
How can I be so negative as to say that Medicare will not be the answer? Because we have this report from 2008 that is telling us exactly that. Some people say you can't tax your way into prosperity and I am going to modify that to say that you can't universally cover your way out of high health care inflation. Not quite as catchy I guess but maybe someone will quote me on it some day. In the mean time I won't hold my breath.