Real Healthcare Reform Starts With Prescription Drug Reform
Believe it or not, there is a way to pay for President Obama's $1.04 trillion healthcare plan without spending a penny: Eliminate the $1.2 trillion dollars squandered each year on wasteful and inefficient expenditures.
So where is this $1.2 trillion being wasted?
According to PricewaterhouseCoopers, about $500 billion is spent on medical interventions stemming from harmful lifestyle choices like smoking and obesity. Another $210 billion is lost in 'operational costs' like bureaucracy and redundant paperwork. And clinical problems -- which include prescription drug abuse, prescribing the incorrect medicines, and over-medicating -- account for another $90 billion.
More than 50 million Americans -- about one in six -- have admitted to abusing prescription drugs, according to a CBS Evening News report. Billions of dollars are spent on this in fraudulent charges to Medicaid and Medicare from doctor shopping (surreptitiously seeing multiple physicians in order to obtain large amounts of medication), the use of aliases, and from doctors who are ill prepared to prescribe and end up overprescribing medications.
When one factors in broken marriages, lost jobs, emotional trauma, and needless deaths, the real cost of prescription drug abuse is in the hundreds of billions. We see the tragic endings of such stars as Heath Ledger, Michael Jackson, Anna Nicole Smith and believe prescription drug abuse to be a problem of the wealthy and elite. In reality, this is a problem that effects us all either directly through watching a loved one struggle with an addiction or indirectly as we all suffer the consequences of escalating healthcare costs.
Solving the problem of prescription abuse and misuse requires a three-pronged approach: more stringent physician standards and certification, a national drug monitoring registry, and patient education.
Better Training and Advanced Certification
'John Smith' was a plumber who hurt his back while working. He started taking pain medications, and by the time he came to me, was not only dependant but also addicted to his prescriptions. Desperate and angry, he would no longer listen to my warnings and follow a proper treatment regimen. He hit rock bottom when he was caught trying to buy drugs on the street.
Shakespeare could have penned the tragic ending: his employer fired him because of his conviction, and his wife divorced him because of his destructive behavior.
John Smith was over-medicated by his physicians -- something that is unfortunately all too common. This happens partly because an alarmingly high percentage of doctors do not understand how to prescribe powerful pain medications, or how to spot signs of addiction. These are not mere anecdotal observations: the vast majority of American physicians received no training in medical school in how to identify prescription drug abuse or diversion, according to The National Center on Addiction and Substance Abuse.
Many physicians also lack an understanding of the difference between addiction and dependence. There are many people on chronic pain medications who don't abuse their medications. They are dependent on their medications and require the relief these medications provide to perform normal activities (cooking, cleaning, bathing, working, etc) but they stay at the prescribed dosage. In contrast, people who abuse their medication exhibit an entirely different set of behaviors. These people constantly seek more medication, are frequently out of medication early, obtain medications from multiple doctors and tend to use their medication for reasons other than pain control (i.e. as an emotional crutch or to get high). Managing chronic pain patients requires additional training to be able to differentiate between patients who abuse their medication and patients who are just dependent on medication.
Requiring physicians who want to prescribe pain medications to receive additional education is an essential step. ASIPP has created a two-day certification course and examination that teaches and tests physicians on dosing, drug interactions, managing difficult patients, and other critical topics. This or a similar class should be a requirement for all doctors who want to prescribe these powerful drugs.
A Nationwide Drug Monitoring Program
Doctor shopping has reached epidemic proportions. According to the Coalition Against Insurance Fraud, doctor shoppers cost insurers $10,000 to $15,000 per year (per patient) in office visits, ER treatment, and drug rehabilitation.
Funding the National All Schedules Prescription Electronic Reporting Act (NASPER) will significantly curtail doctor shopping and prescription drug abuse. Passed unanimously by both the house and the senate and signed into law in 2005 by President Bush, NASPER would create a national coordination of the individual states drug monitoring programs. This would allow physicians to detect prescription drug abuse and identify if patients are doctor shopping--even if they cross state lines to avoid detection.
Despite the vocal support of Senators John D. Rockefeller, Bob Corker, Jeff Sessions, Richard Durbin, and Representatives Ed Whitfield, and Bart Stupak, backroom political maneuvering has prevented NASPER from being fully funded (and yes we do know who has repeatedly blocked this funding). If NASPER receives its full funding of $45 million, it will lead to the first truly coordinated drug monitoring system. It will save countless lives and significantly reduce the exorbitant cost of prescription drug abuse on our health care system. According to ASIPP's estimates, it also will pay for itself in less than a year.
Patient Education
For patients in persistent pain, surgery is often the first and only option. Extremely costly and often requiring a long recuperation period, surgery can sometimes be a highly effective modality when used properly. But specialists will often say that it should rarely be the first option, and that less-invasive alternatives should first be tried.
Here's an example:
'Jane Doe,' a 55-year-old woman, had a tear in a disk in her lower back. This was repaired with a controversial treatment called IDET. Following surgery she recovered and was pain-free for several years. Three years later, she again experienced debilitating pain. Her family practitioner told her nothing could be done and despite her comparatively young age, she should go to a nursing home (at a cost of about $80-$100,000 a year).
Through work up and testing, I discovered that the disks above and below the one that was originally injured were now damaged. Standard surgery would have cost tens of thousands and held the likelihood of a poor outcome. I performed a leading-edge, less invasive surgery that cost about $3,000. Now Jane swims every day and is still able to care for her elderly mother.
If Jane Doe followed her doctor's advice and entered a nursing home, the cost to our health care system would have been at least $2.2 million (assuming she lived to 76). Jane Doe's mother would also be moving into a nursing home because Jane would no longer be available to help her. The cost of a wasted life, of course, is incalculable.
Luckily, Jane Doe found a physician who could help. Far too many Americans are unaware of their medical options, and so suffer in silence or make poor decisions. Better education of Americans about their healthcare choices is vital.
True health care reform starts with tackling areas of waste. A good start would be to require physicians who prescribe pain medications to receive additional training, fund NASPER to implement a nationwide drug monitoring system, and enhance patient education. The healthiest approach to our health care system is to begin by reducing its enormous waste and fixing its glaring inefficiencies. Only then can we truly have a reformed health care system.
I invite the Obama administration to a sit-down with physicians. We, on the frontlines, are in the best position to share what's working and what's not, how to enhance protocols and the efficacy of our work, and how to slash expenditures that result from redundancies, inefficiencies and pure waste. We're ready to get started.
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It is quite alarming that over half of the American population is currently taking daily doses of prescribed medication. But the abuse of some does not necessarily comment on the serious health problems of many.
The truly outrageous part about prescription drugs are big pharmaceutical companies overcharging those sick Americans who do need to take medication daily, and are sometimes forced to decide between affording their prescriptions and affording their next meal.
Fortunately, we have the internet, and a smart consumer can research their name brand prescriptions on search engines (medtipster for example is one) for generic alternatives! Why would you pay triple the cost for just a name brand?
"If Jane Doe followed her doctor's advice and entered a nursing home, the cost to our health care system would have been at least $2.2 million (assuming she lived to 76). Jane Doe's mother would also be moving into a nursing home because Jane would no longer be available to help her."
I agree, and while I come from a caregiver perspective, we all too often are pushed toward nursing homes as the solution when a few simple changes may be all a family needs to stay together and keep costs down.
The last thing any child wants to do is put a parent or loved one into a nursing facility. Yet, that’s the horrendous decision caregivers face when they’re unable to secure the support they need. I served on the Real Systems Change Advisory Board in Illinois, a federally funded pilot project that assessed the financial and clinical feasibility of nursing home patients. We found that many patients, with minor arrangements, could live safely and far happier in community apartments. One woman simply needed a building with an elevator, a twice-weekly home health visit and a weekly visit from a nurse to take vitals and review medications.
Sure, the system has its flaws, but the project uncovered policy and funding barriers and advocated together for change. We aren’t talking a major overhaul – we just considered each patient individually and made adjustments that resulted in a happier patient and a family with peace of mind.
There would need to be a fundamental shift in the Western medical model for any real change to occur. The focus is on disease rather than wellness, and any given treatment mostly revolves taking a pill. Doctors are trained to prescribe drugs rather than looking at a patient as a whole. They spend ten minutes at most with a patient and whip out their prescription pad without a second thought. They are rewarded with kickbacks from Big Pharma, so it's in their interest to keep the drug model going. Patients are also conditioned to think they need drugs. I know people who could change their lifestyle habits to improve their health, but they'd rather take a pill or get surgery than do the hard work.
Of course... first of the List of Blame:
Fat people and Smokers!!
As soon as I read that, I knew this article would be bulls**t... and it is.
First of all, fat people ultimately deal with their weight problems OUTSIDE the medical profession- with diet plans, diet groups, gyms, and the most common of all- suffering in silence and ALONE.
They do not run to doctors, hospitals or health care providers looking for 'the fat cure'. We all know there ISN'T one! As for gastric bypasses, unless you have private insurance, you're not getting one... so that ends the "costs us all" crap.
While obesity can *aggravate* some physical conditions (arthritis in joints, heart and blood pressure issues, etc) being fat does not directly cause ANY disease or physical problem that THIN people don't ever get as well. That is a FACT.
Some of the highest cholesterol readings I've EVER seen (when working for cardiologists) came from thin or average people! As a matter of fact, only about 5% of our total patients were obese. 3%... not 30% or 50% or 75%... 5%.
This "Fat people raise our health care costs" is BS.
Smokers? I don't even want to beat THAT dead horse any longer.....
Let people choose HOW to LIVE, and take their own chances how they will die.
We all die of Something, right? In the end, it's ALL outrageously expensive because we have a FOR PROFIT health care system. Stop blaming PEOPLE... It's the system.
your right! smokers and obese actually lower our costs! If everyone smoked or was obese healthcare could cost nothing! It's those people who don't eat processed food, dont smoke, live an active lifestyle and exercise regularly that are f' ing up everything!
Gee, I can sense a little sarcasm there, LaurenJill...
My point was, even people who don't eat processed foods, don't smoke, live an active lifestyle and do "everything right".... STILL DIE IN THE END -- of SOMETHING.
Many times, they die of exactly the kinds of diseases the "bad fat people" and "the evil smokers" die of... cancer, heart disease, strokes, liver disease, and the list goes on and on.
Mary Tyler Moore is seriously diabetic... is she now, or has she EVER been overweight? Not for one second in her whole life.
I know a woman who died a few years back from cirrhosis of the liver - which had caused other serious complications. She never drank more than a glass of wine on the holidays.
Non-smokers die of Cancer, and other respiratory diseases. Healthy runners and other types of athletes suddenly 'drop dead' of heart attacks, etc... happens all the time and everyone is stunned... "But he was so healthy!"
Doing everything right does not promise us immortality... doing everything "wrong" doesn't damn us to early horrible deaths, either. Both only raise or lower one's CHANCES of living 'longer'... but neither stop us from dying in the end.
So the whole smokers / obesity / unhealthy lifestyle people cause our health care costs to go up is a MYTH. It's a red herring! Our costs are UP because it's a PROFIT MAKING BUSINESS... not "health care" for anyone.
Well, you should write to Obama immediately. He doesn't read blogs!! This is too important to just write it here . It's good that we know of your opinion and understood more of our problems but the man in the WH and all congressmen and women should also know this. Also, if we are ill, how do we know which doctor is good to see? The example of two doctors with completely different approaches to the spine disk is horrible, not only about costs but also about the life of people.
Written by a pain doctor who makes his living on treating conditions using strong medications. While there are some good points in this article, there is no solution written. I read, let's cut this program or access and monitor that one, but no solution for patients who are emotionally drained using medication. Medication has been used as the first line of treatment and making a drastic change without programs and support systems only escalates other problems.
Mental parity was enacted today! Hopefully we will more people able to access a system that was once denied. For those using medications in lieu of counseling may now have the option to do so. Although the legislation does not require employers to cover mental health in the benefit design.
The answer is to flush the drug paradigm. They don't work. They will never work. Mother Nature does not need drugs to keep her humans healthy and strong. Our bodies are self-creating, self-repairing, and self-sustaining entities. Drugs just foul up the process. They inhibit or block natural bodily processes. How can any doctor justify using the vile garbage on his patients?
The medication I've been prescribed recently has either stopped the natural bodily process of death, or that of extreme pain and suffering. It seemed like a good thing at the time, but on the other hand, here I am, still leaving a "footprint" wherever I go. I thought the whole point of medication was to interfere in natural bodily processes when those processes threaten our lives or mental health.
I thought this article would be about the drug companies ripping off the American People (which I would call drug abuse!!!). The high cost of the medications are outrageous. We pay more for drugs (the same drugs) than any other nation.
I do believe that we are overmedicated. It's way too easy to throw a pill at someone (who is expecting one) than to counsel them on diet and excercise, prescribe nutritional counseling, and refer them for physical therapy and health education which isn't covered by insurance or/and the client can't afford.
However, for those truly in pain, pain management is very important. Part of pain management isn't just the drugs but lifestyle changes that can strengthen the body and the mind.
My mom was put on Lyrica. She is not a diabetic. One side effect was that she was HUNGRY all the time. She was slightly overweight already and put on the pounds. Then she had knee replacement surgery. The excess weight hindered her ability to get on her feet and excercise. I asked that she be taken off the medication, she lost weight and is moving around much better. Her knee did not heal as well as it could have if she hadn't gained the excess weight. It took her longer to get on her feet.
Well said.
Please note that Lyrica is being used for all types of ailments and some believe that it metabolises too quickly, requiring higher doses, and causes destruction to organs. I believe it was originally designed to treat chronic nerve pain.
The author writes:
So where is this $1.2 trillion being wasted?
According to PricewaterhouseCoopers, about $500 billion is spent on medical interventions stemming from harmful lifestyle choices like smoking and obesity. Another $210 billion is lost in 'operational costs' like bureaucracy and redundant paperwork. And clinical problems -- which include prescription drug abuse, prescribing the incorrect medicines, and over-medicating -- account for another $90 billion.
But 500 plus 210 plus 90 only equals $800 billion, where is the other $400 billion?
Then the rest of the article is about the $90 billion problem. I think that is good, but the article leads with bigger savings but only offers solution for 7.5% of the problem.
Furthermore, of this $90 billion or 7.5% of the waste, the doctor seems to be focused on pain medication. How much of that $90 billion is in the realm of pain medication?
When I was first diagnosed with type 2 diabetes, my doctor prescribed 3 drugs for me because my A1C was sky high. But it was clear pretty early on that I only need the one drug, metformin. So I was over-medicated, but that was easy to detect and resolve once I got my blood sugar monitor and then I ended the other drugs that were not needed with doctors and diabetes coordinator advice.
Maybe that is something that should be consider, a pain coordinator, maybe it exists already.
My father was a type II diabetic on medication. He was very overweight. I don't know your circumstances, but he had a mild stroke. Many years before he had a heart attack and bypass surgery. After his stroke the only side effect that remained was that he was able to control his diet, and with exercise lost a lot of weight. His blood sugar levels maintained and he was taken off his diabetic meds along with a few others.
My father has since died because being obese most of his life and not knowing he had blood sugar problems probably for many years before he was diagnosed had taken it's toll on his body.
I am hoping that some of these new weight loss medications will help people lose weight because it is a struggle for all of us. I was in a research program for one of the medications and was able to lose 52 lbs in one year. It's not a magic bullet, but it gave me an edge. I was already exercising. For some us, an edge is all we need. Fewer bariatric surgeries would be performed (saving money). The obese with major health problems could lose the weight with medication and counseling.
Sorry to hear of your father's passing.
I was overweight and inactive. A lot of it to do with a traumatic elbow to mouth injury that kept me gun shy from my preferred type of exercise, team sports. Now I use exercise more than controlling my diet to keep me blood sugars under control. I have found my new exercise, an recumbent bike that I pull in front of a TV and ride for 30-40 minutes, 4-5 times a week. Buying that bike for $90 was one of the best investments ever in my life.
Other than high cholestrol, I don't have any other issues yet. Been diagnosed for 5 years now.
My husband just had triple bypass surgery two months ago.... he's 6 ft tall, weighs only 4 lbs more than when we married 34 yrs ago (171 lbs). He's never been overweight.
His cholesterol was 260 at the time of the bypass. Now he's gotten it down to about 220. (not bad for only two months).
He smoked for 45 years.... his yet his lungs are healthy enough to be mistaken for a non-smoker's. He used to drink heavily until about 15 years ago... quit cold turkey. Yet his liver is fine, and that didn't cause him any lasting damage either. Is he lucky? Oh yes! Very Lucky! But guess what? You couldn't tell that he ate badly, smoked or drank by LOOKING at him.
But we continue to assume (and preach) that all FAT people are unhealthy and disease prone. They aren't.... and thin or average people aren't always healthy, either.
You can't judge health by size alone.
Read "The War on Medical Terrorism" available online at amazon.com and barnesandnoble.com to understand what Americans truly need to do to reform healthcare, achieve lower costs with increased quality and accomplish Universal healthcare in America.
Doctors can only accomplish one of three things for their patients: they can cure them; help them to come to terms with their illness or, finally, treat for pain. The DEA, malpractice insurers, and scared practice groups, have (in total disregard for the welfare of the patient) agreed that doctors should protect themselves by no longer treating for pain. Instead, they have agreed it will be better for everyone (with the glaring exception of the patient) that pain sufferers should only be treated by a specialized miniscule sliver of physicians--those who have agreed in advance with the DEA that treatment should be contingent upon the pain patient being deprived of his constitutional rights. My personal experience is that pain clinics exist solely to mediate between the self-interest of physicians and the prosecutorial interests of the DEA. Whatever relief the chronic pain patient finds in these places is incidental. The lives of most will be made decidedly worse.
i haven't smoked pot in a hundred years, but when id did the only side affect i remember was happiness and laughter ?
but then that's not torture is it !
Neither my gp nor my ortho treat for pain (i.e.: prescribe pills). My gp did (stupidly) prescribe Duragesic patches for someone with no opioid tolerance and who takes daily hydrotherapy (my genius ortho didn't see the problem with that, either). The pain clinic's staff routinely condescends, insults, abuses, and lies to patients. Appointment times are dictated; staff will not answer the phone line for patients; appointments cannot be changed, but they still charge if an appointment is missed. My other doctors brush off my complaints with the same pre-rehearsed excuse: "They deal with a lot of difficult people, blah, blah, blah." Maybe--but all I saw were defeated people made extremely docile, yet treated like excrement. My hillbilly upbringing does not allow me to accept such treatment gracefully. Truth be told, I am inclined to respond stereotypically. So, if the day comes I must explain to a judge why I found it necessary to seek relief by illegal means, I'll report without apology that since my doctors and the DEA have conspired to abridge my constitutional rights, and since my treatment as a criminal is foregone, I have chosen to have the state bear the costs of those decisions to which I was not party.
I have a degenerated spine and suffered spinal cord damage in the first of three spinal surgeries which left me disabled. When my neuro washed his hands of me, he sent me to a pain management clinic. But I am in severe chronic pain every day--by my own choice. I could have remained a patient at the pain clinic, agreeing to all the ineffective treatments before they would eventually write me that standard 60 hydrocodone per month prescription. At least I assume its standard--that's the scrip that most of the people selling them seem to have been given. Here's the hoot: I don't care for the pills. In spite of my condition, all I wanted was enough to be able to engage in something approaching normal activity EVERY OTHER DAY. Hence, all I wanted was 16 per month. The problem you ask? [continued]
this country is run by big business. all anyone is really interested in is making money, or making more money, or screwing someone out of money in different ways. big pharmacy isn't the only culprit here. Americans want, and feel they have a right to,everything- and if that means someone else gets less then too f**kin bad. why else you think the public option cannot get broad support?
As a 74 year old who is recovering from over-medication, I believe that prescription drug ads are harmful to our national health. The "rare" side effects are not all that rare, and if you are taking more than one prescription drug, the side effects just multiply. More isn't necessarily better. How many people know that they should only take a drug like nexium for a month or less at a time! .
How can the pharmaceutical companies possibly know our individual case histories like our primary care physicians do? This blanket advertising is a huge disservice to our country, and most developed companies simply don't allow it. America, wake up to the reality that big drug companies are in business to make big money, and we are dumb enough to believe that we "need" that stuff to be healthy.
Obviously there are exceptions. But most of us should not be taking 4-5 or more drugs when there are alternative ways to restore health, like eliminating the causes rather than treating the symptoms and doing nothing about the causes. Good health depends on our own efforts to stop smoking, exercise, cut out the sugars, and eat unprocessed foods in moderation.
By cutting out drug advertising, think how that would bring down the cost of medications we truly do need from time to time, and the overall cost of health care. We might even be able to afford a Public Option!
From another poster....
Watched this last night. Perspective about drug companies, marketing and billions of dollars.
http://video.google.com/videoplay?docid=739609197405993027#
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