On May 24, Tiger Woods wrote this in a blog post:
It has been just over a month since I underwent fusion surgery on my back, and it is hard to express how much better I feel. It was instant nerve relief. I haven’t felt this good in years. Tiger Woods
Just five days later, he was found slumped over, dazed and confused in his Mercedes-Benz. His arrest for suspected DUI was, of course, front page news. It seems as though a collective sigh of relief was heard when the breathalyzer revealed 0.00 blood alcohol level.
The media, fans and non-fans alike have taken comfort in knowing he wasn’t drunk. Hey, it was just a bad reaction to a mix of prescription drugs. No big deal. Phew, I guess we don’t have anything to worry about.
Please read that again. It was just a mix of prescription drugs. Simply a bad reaction. He wasn’t drunk.
The purpose of this writing is not to point fingers at Tiger and certainly not to preach from a pulpit of ‘shame-on-you’. It’s quite the opposite. I have made my share of poor decisions in my 43 years and cast no judgement on Tiger.
The purpose of this is to point out the ridiculous notion in America today that prescription pain medication is nothing to worry about. Opioids are silent killers and they are prescribed on a whim every day, despite the growing body of scientific evidence refuting any benefit for chronic pain.
Scientific American Mind published a blazing article on the opiod epidemic in May:
The United States is in the grip of an unprecedented public health crisis – one in which well meaning doctors have played a part. Between 1999 and 2014 sales of prescription opioid drugs nearly quadrupled. In 2012 alone, physicians issued 259 million opioid prescriptions – enough to give a bottle of pills to every adult in the country. And in 2015 more than half of all overdose deaths in the U.S. involved opioids – either pain medications, such as OxyContin and Vicodin, or illicit substances, such as opium and heroin. To put that statistic in perspective, opioids claimed roughly as many lives that year as car crashes. Scientific American Mind May/June 2017
We must revisit how we care for people in pain. The excerpt above gives us a wealth of information to dissect.
Let’s begin with ‘well meaning doctors’. As a physical therapist, I have a host of long standing relationships, both personally and professionally with doctors. Doctors are people who have taken on the task of applying science and medicine to human beings. It is a huge undertaking and one that is best done over time. When I was a kid, we had a family doctor. He happened to be my best friend’s Dad, so I got to see him as the person that he was, as well as the doctor in the office. If you are over 40, you know what I mean by ‘family doctor’. It was a comforting thing to know that he or she knew you by name and not by number.
He and his partner’s name was on a sign outside of their modest office. There was no hospital or medical system logo in sight. Those days are gone. Independent family doctors are a thing of the past. In the last couple of decades, they have all been swallowed up by big health care systems. The independent doctor did not have the bargaining power necessary to negotiate with their customer anymore. Yes, I said customer, not patient on purpose.
American health care is a booming industry and has 3 major players:
- The health care systems that run hospitals, clinics, labs and both primary care and specialty doctors offices
- Pharmaceutical companies
- Insurance companies (including private, Medicare and Medicaid)
Notice that the patient is not the customer and is certainly not a major player. Our doctors are still well meaning, but they don’t have time for us anymore. That may not be a popular thing to say, but we all know it’s true. They are too pressed for time and this is why. General practitioners are the first line of defense and then lowest earner on the physician totem pole. They get paid by the volume of patients they can see in a day. Specialists get paid by procedure, which is WAY more profitable.
Talking about money exchange and health care is a squeamish topic. It’s also long overdue. Health care costs have doubled every 8 years for the past four decades. There are more procedures and tests and specialists than ever before. At the risk of offending many people, I will tell you why that is. Procedures, tests and specialties are where the money is. Insurance happily covers them, because they get paid in percentages. The higher the cost of a procedure, the higher the percentage they get to keep. Insurance companies are not villainous, they are smart business. Hospital systems have no incentive to provide services at a reasonable cost, because their customer is happy to pay at premium and pass the burden onto their customer.
In our American health system, that customer is your employer who keeps getting hit with higher premiums on your health insurance. For most companies today, health benefits are the number two line item below staffing. They have to share that burden with you, the employee in order to stay in business. That is the reason for unchecked raises in your deductibles and contributions to HSA’s.
Politicians talk endlessly about health care reform, but never about the rising costs and what is driving them. It’s all a big mystery because very few people understand health care as the big business it has become. Obamacare or the Affordable Care Act and looming Trumpcare are all about insurance reform, not health care reform. As long as the insurance company, whether it’s a single payor system or not, is the customer, we will have no real reform.
Since the enactment of Obamacare, the Big Three Players in Healthcare have doubled and tripled their performance on the Dow. There is no incentive for them to change anything. The higher the cost of procedures, tests and prescriptions the better. Skeptical of this opinion? Consider this; as part of Obamacare, insurance companies are allowed to keep 15% of profit from large businesses and 20% from small businesses. The higher the cost of care, the hight the profit.
Since the money is routed through the insurance system
This is sad commentary on what we have come to expect from out health care system.
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