SOME REASONS WHY AMERICAN MEDICINE IS SO EXPENSIVE

Below is an article written by a U.S. medical specialist who wishes to remain anonymous

JCAHO (Joint Commission on Accredition of Healthcare Organizations) is a quasi private organization that is approved by Medicare for accrediting hospitals - to assure quality care. Like most bureaucracies, JCAHO has mushroomed to become an end in itself - the "quality assurance" process has become more important than the quality itself. JCAHO produces guidelines that have become almost the law itself - violations can lead to loss of Medicare funding, and malpractice settlements.

There is great controversy over whether JCAHO does, in fact, improve the quality of care. Citations for incomplete or absent dictations for surgical procedures, when the emergency room is overwhelmed with patients, hardly improves anything; often, the doctors and everyone else may be operating on accident victims all night long and may simply forget to sign the records or do the dictation. Likewise, citations for lack of proper physician signatures, how often the ivs are changed, whether the nurse knew the fire safety rules, whether they have proper IV badges, hardly determines quality.

Prior to the JCAHO visit (every 3 years) there is great hysteria among QM (quality management) nurses and other highly-paid "consultants" to make sure the hospital is spic and span - walls are painted, floors are polished, and many drills are held to make sure everything is perfect. Much time and effort (and eventually money) is spent on this essentially circular motion. An adversary relation develops among these QM people and the entire hospital staff - they demand "quality" while the budget is cut.

The bottom line with JCAHO is that much money is spent on questionable procedures "because Medicare requires it".

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The HIPAA (Health-Insurance Portability and Accountability Act) was allegedly introduced to "protect patient privacy". Not so. Much effort and many compliance seminars by highly-paid consultants, and massive expansion of the IT staff (for "compliance" with encryption technology, etc..) has created an adversary relationship between staff and hospital. Sneaking into your mother's medical records could get you fined or fired or put in jail.

While limiting public access to "sensitive medical data", Government has even more access. In truth, the only real harm could come from insurance companies denying you coverage because you have "high risk" conditions; but they have this data anyway.

Perhaps someone who has comitted sex crimes may not want their medical data public, but police records usually have this information and it is often a public record. So a massive expensive process has been introduced to solve a non-problem.

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MALPRACTICE: This is a problem that some say adds 10-20% to the cost of medical care. The problem is massive. Not only are predatory trial lawyers legally protected (mostly by Democrats) because of their massive political contributions, but many patients feel that "they owe me" if something bad happens. We call this the "lottery mentality" - many people truly believe they will retire with a medical malpractice settlement. Of course, dishonest judges make the problem worse. Aside from the money extracted from doctors and hospitals, there are additional expenses that result from the threat of malpractice, and prevention of lawsuits.

One example was the mother who brought her son to the ER (emergency room) with a bump on his head. The ER doctor ordered a neurological consult, CT scan, MRI (x-ray tests costing thousands of dollars - total visit about $3000) - reason? The ER doctor probably has marching orders (called "policy" ) to "cover all angles" -- "just in case the patient has a brain injury". This is purely medicolegal - it the child has not lost consciousness and has no "localizing signs" (like weakness of a hand or leg, dizziness, etcc. ) there is simply no reason for all these tests - simply observing the patient and a little ice to the head and a mother's hug is all that is needed. Wisely, this woman signed out "AMA" (against medical advice) - still probably got charged over $100 just for showing up).

As an Obstetrical Anesthesiologist, I face "unnecessary cesarean sections" daily. Of course, "necessary" is defined by litigation potential, not medical judgement. Several examples illustrate this problem:

1. A lady with premature twins (24 weeks) was in labor. Some would do an immediate C-section to protect the fragile premature baby - some believe that a normal delivery would be hard on the delicate premature baby's head; others disagree on this. But the only "no risk" way to do this is a C-section, so no one can sue a doctor for not doing it. My colleague did not do a C-section because the results on such a premature fetus are dismal - survival is low, and damage to survivors is common; he simply let nature take its course and the patient delivered. He took a chance on being sued, but practiced better medicine.

2. Another lady with a 25 week fetus was immediately taken to the operating room and a C-section was done. This was another doctor who just didn't want to deal with the medicolegal issues; unfortunately, the majority of doctors do this - who can blame them?

3. Another younger doctor did a C-section on a lady that was showing a "trend" on the fetal monitoring strip. There was no "danger signal" of "iminent damage", but there was a definite abnormality. The baby came out screaming. Of course, the C-section was done to avoid any criticism that one wasn't done if something did go wrong. Doing a C-section because "something might go wrong" is like ensuring that a fly is dead by killing it with a sledgehammer.

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MEDICAL WASTE: On my way in to work, I pass by this "Medical Waste" trailer. This trailer is hauled off periodically, and another is placed.

The hospital is full of these boxes with different color coded liners for needles, liquid waste (which is solidified by powder; I am not sure if simply pouring this stuff down the drain would be safer than mixing the powder with the liquid - either way, some exposure id possible), surgical drapes, etc..

There is nothing in the hospital that could be any more infectious or dangerous than what's going down the sewers already, so all the hysteria about "liquid waste" and special containers for it etc.. Is nothing but additional baggage created by regulators.

Likewise for paper drapes and the paper and plastic used to package surgical supplies - much of this stuff could be safely burned on-site (as used to be done) - all germs would be killedI am sure that California greens long ago stopped this practice for "clean air".

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HOUSKEEPING: The people from "environmental services" often wear paper shoe covers and plastic gloves and surgical masks at times when they are dusting. I am unsure whether this is because of some hysteria about germs, regulations, or because the management simply doesn't want to be bothered with lawsuits from unhappy employees who say they had an "unsafe workplace").

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NUCLEAR MEDICINE: Low level radioactive isotopes are used in many tests, and higher level isotopes for therapy for cancer.

Regulations for disposal of this mostly harmless material are just unvelievable - and the low level stuff is subject to almost the same regulations for disposal of atomic bombs.

This regulation has been so expensive to maintain that only a few companies remain to dispose of these isotopes - last count down to 2 or 3 - which has had the predictable effect - disposal costs have increased tenfold.

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MEDICAL RECORDS: It's just difficult for people outside medicine to imagine how hysterical the medical records business has become.

Some records are simply lost - pages fall out of the binder and people forget about putting them back.

Then some clerk spends hours on a single record - going through it to find missing signatures; for a complex patient, there may be literally dozens of signatures missing (people get busy and they simply forget to sign - but to the Feds, this can be viewed as fraud - but that's another problem).

Then, each missing signature is flagged with a color coded tag, and then the fun begins - each doctor with a missing signature receives a nasty letter telling them that their privileges will be pulled it they don't sign the records. For me, I receive the letter, give it to my secertary who then sends a student worker to medical records to get the record, I sign it, and send it back; for each transaction, there is time and money that produces nothing. Then the record is recycled to the other doctors. Just insane, expensive, and contributes nothing to the care of patients.

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COMPLIANCE: Prosecuting doctors and medical centers for "Medicare Fraud" has become big business following laws passed by the Clinton administration.

In the past, many attending doctors signed for residents when the attendings weren't present - everyone did this in a charity institution where much of the care was unfunded. Of course, the Feds see it differently - some of Medicare Part B (hospital funding) is designated for "training doctors" (residents) so the Feds didn't like the idea of an absent attending sending a separate bill. {As usual, the goals of the Feds are out of tune with reality - they want "equal care" for"the poor" but are not willing to fund it equally}.

Our institution was hit with a large fine for "Medicare Fraud" - mostly focused on one doctor. Part of the "Corporate Integrity Agreement" was "compliance training". This was the most bloated waste of time of all - MANDATORY for every worker in the entire institution - requiring a day off of work - even for part time employees {I calculated at least a cost of several million dollars just for lost time; that didn't count the full time "consultants" and "compliance attorneys" and an entire new staff or "experts".

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CONCLUSION: All these expenses add up to make American medical care the most expensive in the world. And Government cannot fix it - they are the cause. HIPAAS and JCAHO have been created by government, and malpractice has escalated because of legal protection of trial lawyers by Government. Solution? Less Government.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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