Health Care Part I

There are some interesting debates shaping up as Obama's health care initiatives gathers momentum and some related financial issues have to be faced--finally and in spite of a legislative body that is terrified of the debates' fall-out.

The health care system we have right now is a self-serving juggernaut created by the legal and insurance industries. It limps along, blatantly overlooking obvious failings, including the fact that the legal system encourages lawsuits against medical practitioners. The practitioners, in order to keep working, pay outsize premiums to the insurance industry to protect themselves from the lawsuits. The lawyers win, the insurance companies win, the doctors keep practicing and the patients get screwed by higher doctor fees and higher insurance costs.

Here's another fact: something like two thirds of today's hospital costs are incured because of (1) drug addicts and drunks who rotate in and out of emergency rooms and (2) terminal patients who must, according to law, be kept alive until the bitter end if they or their families so wish. That's a ton of money wasted, and it is why an aspirin tablet costs two dollars in most hospitals. Add to this the famed two-minute visit from attending physicians who then charge the insurance companies a couple of hundred bucks a pop, and you have something that is neither caring nor healthy.

Lets look at the costs incurred by addicts and alcoholics. Picture this: a heroin addict ODs and is taken to the emergency room. Her heart has stopped beating and a platoon of nurses and staff save her life, care for her a few days and release her. In one Western hospital, exactly this happened 80 times in one year, with the same addict returning week after week for life-saving care. Or consider the drunk in need of a detox. He or she knows that the local care center will detoxify him free of charge, rehydrate him as necessary, and prescribe anti-convulsants just in case an alcohol withdrawal seizure occurs.

Experts estimate that drug abuse alone costs General Motors corporation an estimated $520 million to $1.5 billion annually for treatment, absenteeism, and repair of defective work. In addition, according to an American Medical Association study, nearly one dollar in four of total health care spending goes to victims of drug abuse, violence, and other kinds of social behaviour that could be changed. Such behaviour is adding $171 billion to our nation's health care bill, $85 billion of that cost is attributable to alcohol use. These figures are from more than a decade ago.

Or how about this: In Japan, the alcohol-attributable costs of medical care were estimated to be seven percent of the total national medical expenditure. Reduced productivity as a result of alcohol use was estimated at about four times that amount.

Do you still smoke? The costs attributable to smoking in Texas continue to rise. The most recent estimates show more than $7 billion in 2005 can be associated with the health care costs from treatments for disease and the indirect costs associated with mortality and morbidity due to smoking.

And lastly, Medicaid patients with drug and alcohol problems who received targeted psychological services reduced their subsequent medical costs by 15%. Those not receiving psychological assistance increased their medical costs by 90% . A University of California study found that every dollar spent on drug and alcohol treatment saves society $11.54 in health care and criminal justice costs and lost productivity for business. Additionally, scientists have found that failure to receive treatment for alcohol and substance abuse diagnoses can result in a very rapid escalation of individual medical costs. A study of Medicaid recipients in Hawaii found that patients diagnosed as chemically dependent who did not use mental health services increased their medical costs by 91% during the study period, compared to actual decreases in medical costs by treatment recipients. Some types of intervention produced net decreases of approximately $514 per person in the first twelve months after treatment.

But here's a problem: good treatment centers cost a fortune, along the lines of $1000 a day for the less expensive ones, and three to four times that amount for 'boutique' rehabs. Two decades ago, most insurance companies would cover the cost of 28 days in treatment, the minimum amount of time thought by experts to be necessary for effective treatment. No more... Because the insurance companies now limit their coverage and reimbursements, many rehabs have turned into three-day 'spin-dry' outfit that do an effective job of detoxing, but little else. Other places such as methadone clinics are privatetly run to show a profit and pay only lip-service to counseling. Clients are basically switched from one socially unaccepted drug--heroin--to a socially acceptable one--methadone.

Here's a thought: spend less on interdiction, on the war on drugs both here and abroad, on incarcerating small-time growers and dealers, and use that money for education beginning in grade school, and to open professionally staffed rehabilitation centers that offer addicts a place to go for solace, therapy, meetings and shelter. Our health care system will benefit, and our dependence on drugs will lessen. That's what's called a win-win scenario.