Category Archives: Health Care

The health of our citizens

Life Expectancy vs HALE

Life Expectancy vs HALE

I recently read an ED OP in our local paper that was a reprint from apublication from a Minnesota paper. The writer was pointing out that while most EU countries were making positive progress to improve Life Expectancy, the US has been heading in the opposite direction for several years. The narrative stated that the CDC has placed part of the blame on drug overdoses and suicides. I did a bit of math on these areas and discovered that the increases in these areas has only had a minimal impact. The writer pointed out deficiencies in our health care system and noted increases in pregnancy mortality & heart disease, but again these numbers do not even come close to explainingaway the problem.

My opinion is that the issue lies with our broken and extremely expensivehealthcare system in combination with our inability (or unwillingness) tomaintain our immune systems through regular exercise and moderation of caloricintake. Our healthcare system costs, on average, 2 ½ times that per capita average for EU countries. Yet, according to the World Health organization weonly rank 31st in terms of quality of care. It is interesting tha this is exactly the rank that the US has with respect to Life Expectancy, again 31st. You would think that since we spend so much on health care we should begetting the best?                                                                                                                                                                                                      I think it important to not befooled by Life Expectancy as a true measure of quality. The better measure isone termed HALE (Health Adjusted Life Expectancy). Following is taken from VeryWell Health: “How Is Healthy Life Expectancy Calculated? This is a bit complicated and uses lots of different data sources for each country. In a nutshell, the World Health Organization takes a country’s data like mortality rates and health status information and crunches them to look at things like how long people are expected to livewith about 135 health conditions. The calculation looks at the mortality ratefor different health conditions and adjusts it for the duration or severity of the illnesses.”

 What this measures isyour expectation of a healthy life span, not just how long we can keep you alive! Again, we fall far behind the EU and in fact we fall to 35thoverall. The difference is significant. Currently our Life expectancy from birth stands at 79.3, but our HALE stands at only 69.1. Keeping us alive those additional 10 years is expensive and they are not our best years.

You might be surprised to learn that the following countries have a better HALE than the US: TheUnited Arab Emirates, Slovenia, Malta, Maldives, Costa Rica, Chile & Cuba. Our HALE is equal to that of China.

The Price of Medication

The Price of Medication

I have posted numerous times about the cost of RX in our country. Recently my lovely spouse passed along a link to an article that rekindled my ire on this topic. See the intro below:

“Why a patient paid a $285 copay for a $40 drug

Health Aug 19, 2018 11:42 AM EDT

Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.                                                                                                                                          Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.

The copay for a 90-day supply was $285, which seemed high to Ma.

“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”                                                                                                                                                                     A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.                                                                                                 The pharmacist told him it would cost about $40                                                                                    “I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”                                                                                                                                                           Ma’s experience of finding a copay higher than the cost of the drug wasn’t that unusual. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics.                                                                                                                  USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. They compared the copay amount to what the pharmacy was reimbursed for the medication and found in the cases where the copay was higher, the overpayments averaged $7.69, totaling $135 million that year.

USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.”

I act as guardian for my mother who has both Medicare & Tricare coverage. I just received a detailed account of my mother’s medications for RX this year. There is an “*” on each line item. The note at the bottom of the statement reads as follows: “You can use home delivery from the TRICARE Mail Order Pharmacy for this medication and receive a 90 day supply for less than the 30 day supply co-pay from a retail pharmacy. Shipping is free……..”

I am shocked by this. As a tax payer you should be also. Obviously planned overpayments to pharmacies (with possible collusion by insurance companies) is horrible and in my view constitutes both fraud and an additional “tax” to consumers. However, keep in mind that these are examples were the Co-pay is higher than the retail value of the drug. This is not merely an “overpayment” but outright theft. The attempt at explanations, in my view, are ludicrous. I encourage you to form your own view by reading the entire article at: https://www.pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug

 

 

By far the Earth’s biggest problem – (con’t)

By far the Earth’s biggest problem (con’t)

The good news is that the rate of growth has slowed to 1.1% a year and it should continue to decelerate. The really bad news is that we most likely have already exceed the amount of population that can be supported by the earth’s available resources. Economists have calculated that the ideal world population is somewhere is the area of 4 billion. This would allow us to utilize and share available resources for the foreseeable future. What this means is that we are on track to deplete Earth’s resources. While this will not occur during my lifetime it will definitely have a significant negative impact on our grandchildren and their prodigy. As with our growing national debt, we are mortgaging the future in order that we can maintain out living standards in the very short term.

Currently 80% of the world’s population attempts to survive on under $10 per day!

See details at: http://www.globalissues.org/article/26/poverty-facts-and-stats

While some of this inequity could be resolved by redistribution that is unlikely to occur. Even if it were possible it would require the 20% to severely reduce their living standards. Keep in mind that the next group (say the next 15%) are not living anywhere near a “middle class” existence. I venture that all reading this post are in the top 5% and many are in the top 1% of the world’s income. Since we reside in an affluent country it is difficult to understand what is going on elsewhere, even though 13% in our country exist below poverty level guidelines.

What is the solution you ask? The best approach would be to limit families to no more than one child. Over time, this would cause the world population to decline. At the point that the population reaches a sustainable number, then the allowance could be raised to 2 or 3 which would maintain a fairly stable level. Of course, this only a fantasy, and it would only work if all countries agreed. That is not in the cards. Some speculate that the Earth will eventually strike back and take care of the problem via a massive pandemic. Estimates are that the Black Plague eliminated 50% or more of Europe’s population in the 14th Century. If this were in our future I wonder which solution we would prefer? Others insist that solution is to colonize other planets. While this may have some extremely long-term merit, it could not come about soon enough to provide the solution.