The title of this piece should be in quotation marks because that advice is not my own. Based on my ineptness, I never give financial advice to anyone. Stock tips? I’m a Cumaean Sibyl in reverse. If ever money or finance come up in conversation, people who know me head for nearest exit in order to cut their losses.
This financial advice came from a patient, quoting her business school professor’s graduation speech: “Stay healthy. Stay very healthy.”
The professor probably assumed he was preaching to the converted. By the time most people finish a postgrad education, they usually know that a majority of the potential health issues they’ll confront are caused by unhealthful lifestyle choices. If you’re in a position to hire a new MBA who smokes or has cheeseburger breath, don’t bother. She was probably at the bottom of her class.
What I hope my patient’s forward-thinking professor conveyed, and am fearful he did not, is that once you enter the healthcare system as a consumer, whether as a casualty of unhealthful lifestyle or the recipient of a bad draw of the illness cards (diseases like MS or ALS can occur in those with the most pristine health habits), prepare for the sticker shock of your life.
Three guidelines for interacting with the US health system
I’ll add a corollary to the professor’s advice. The healthcare system in the US today is so dysfunctional–currently providing us with mediocre service (I’d rate it a C-) at egregiously inflated prices–that I suggest three rules:
- Learn the finances of the system.
- Question authority.
- Get multiple opinions not only from other MDs, but also from so-called alternative practitioners as well.
In 1906, Irish playwright George Bernard Shaw had finished his play “The Doctor’s Dilemma.” Being a man of strong opinions, he was prone to writing prefaces to his plays that were occasionally longer than the plays themselves. Click here for the play’s preface and to see evidence that little has changed in 112 years. Most Westernized countries solved many of the issues Britain faced in 1906, and we still face today, by creating single-payer health systems.
According to Michael Wolff’s book Fire and Fury, just after winning the election President Trump opined “Why can’t Medicare simply cover everybody?” Sadly and perhaps predictably, the notion was promptly swept under the Congressional rug and repealing Obamacare became the Republican idee fixe.
I’ve written many Health Tips on this topic, most recently “Pigs at a Trough,” which embodies my view of the entire system, from insurers (both health insurance and disability insurance) and virtually all health care providers to the most astonishing goniffs on the planet, Big Pharma.
Over the next several Health Tips, I’m going suggest some tactics so that you don’t fall victim to a system driven, as one person remarked in a Health Tip comment, “by greed, waste, and inefficiency.”
I’ll mainly focus on insurance, primary and specialty care, hospitals, surgery, and pharmaceuticals, including some patient experiences I’ve heard over the years.
Three quick anecdotes
I recently had as a new patient an MD anesthesiologist from a well-respected hospital. I said, “I’m kind of embarrassed to ask this, but if anyone would know the answer it would be you. In your professional opinion, what percentage of surgical procedures are probably unnecessary?”
“Oh, maybe half,” he replied. (Right in line with the George Bernard Shaw preface mentioned earlier.)
I remarked to a highly respected orthopedic surgeon (not a back surgeon), “There seem to be more back surgeries than ever. Here at WholeHealth Chicago, with two chiropractic physicians and three acupuncturists, we see a lot of patients with back issues, but only a tiny percentage ever need surgery. What are the actual criteria for proceeding with back surgery?”
“Two criteria,” he said. “Does the patient have good insurance and does the patient have a back.”
New Big Pharma crime of the week. Rheumatologists prescribe high doses of ibuprofen (Motrin) for rheumatoid arthritis, sometimes as high as 800 mg three times a day. A dose like that can give you stomach ulcers, increase your risk for heart attacks and strokes, and cause chronic kidney disease. To reduce the stomach risks (but not the other risks), doctors recommend taking Pepcid (famotidine) with each ibuprofen.
The cost for 90 tablets of 800-mg ibuprofen is $12 (even without insurance) and for 90 tablets of famotidine about $17. Note that if you click these links, Walgreen’s generally has the highest price.
Horizon Pharma, whose specialty is finding cheap orphan drugs and then price gouging (the same business model as that created by currently incarcerated Martin Shkreli), has released Duexis, which is dosed at one tablet three times a day.
You could take your daily three doses of 800-mg ibuprofen along with the three 40-mg famotidine tablets and your out-of-pocket expense would be about $29 a month.
Or your doctor could write you a prescription for Horizon’s Duexis, in which the two drugs are combined into a single pill you take three times daily. The difference is that 90 tablets of Duexis cost $2,400.
With a healthcare world as dysfunctional as this, follow the MBA prof’s advice and stay healthy. At the same time, start to learn more about how the system operates.
Be well,
David Edelberg, MD