Stanley Feld M.D.,FACP,MACE
Let’s forget the forget what President Obama and the mass media (Paul Krugman) are telling us about how wonderful Obamacare is.
Obamacare is a failure.
In 2014, U.S. health care spending increased 5.3 percent following growth of 2.9 percent in 2013 to reach $3.0 trillion, or $9,523 per person.
Obamacare has not bent the cost curve. The only thing it did was raise taxes with 10 hidden taxes in years it did not provide services.
It also increased out of pocket expenses. The first year of services was 2014. Increase in taxes started in 2011.
The faster growth experienced in 2014 was primarily due to the major
coverage expansions under the Affordable Care Act.
Healthcare expenditures increase from 17.2 % of the GNP to 17.5% in 2014.
- Hospital Care: Spending for hospital care increased 4.1 percent to $971.8 billion in 2014 compared to 3.5 percent growth in 2013.
People used hospital services more because the population is becoming sicker. The increase in the Medicaid population brought sick people to the hospital who couldn’t afford to go to the hospital previously.
- Physician and Clinical Services: Spending on physician and clinical services increased 4.6 percent in 2014 to $603.7 billion from 2.5 percent growth in 2013, pre Obamacare spending for services, when spending was at a historical low.
Physicians are receiving less reimbursement. The increase in physician and clinical services is a result of a sicker populations and overuse of the system.
There are at least 22 more increases in expenses in the CMS report.
The consistent common denominators are:
- Cost of complications of chronic diseases
- Overuse of the healthcare system because of under education of consumers about their disease
- Lack of adherence to prescribed therapy
- Insufficient availability of education about disease
- Consumer dependence on providers to fix them and their illness
- The increasing incidence of obesity in the population
- The increasing administrative and bureaucratic overhead
A large part of the overuse of the healthcare system is the onset of illness as a result of the increase incidence of obesity.
Obesity leads to an increase in chronic diseases such as Type 2 Diabetes Mellitus.
Type 2 Diabetes Mellitus affects 22 million Americans at a average cost of $14,000 year. This includes complications of diabetes mellitus. The average cost of care for all consumers is $6700 dollars.
Healthcare policy wonks should concentrate on how to change the eating habits and exercise patterns of Americans.
A decrease in the incidence of obesity would decrease the onset of Type 2 Diabetes Mellitus.
The healthcare policy wonks have not been successful in changing the methods of payment to decrease the cost of healthcare.
The only initiative that will be successful is a consumer driven healthcare system with financial rewards being built into the healthcare system for consumers who work hard to b responsible for their health.
Obamacare has failed to improve the quality of care in the treatment of Type 2 Diabetes Mellitus.
Obamacare has not increased access to care, increased quality of care or decreased the cost of care for Type 2 Diabetes Mellitus.
Type 2 Diabetes Mellitus is an excellent demonstrating the failure of Obamacare.
The incidence of Type 2 Diabetes Mellitus is even increasing in teenagers as obesity is increasing in teenagers.
This fact has been demonstrated scientifically.
- hospital inpatient care (43% of the total medical cost),
- prescription medications to treat complications of diabetes (18%),
- anti-diabetic agents and diabetes supplies (12%),
- physician office visits (9%), and
- nursing/residential facility stays (8%).
People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.
For the cost categories analyzed, care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.”
In the last decade, there have been multiple advances in the treatment of Type 2 Diabetes Mellitus. Over 40 new pills or injections have been approved to lower the Hemoglobin A1C (HbA1c) in the Type 2 Diabetes Mellitus population.
Many of these drugs individually and in combination can normalize the HbA1c to normal.
A normal HbA1c is between 4.5% and 6%. Human being are constantly refreshing their red blood cells. The complete turnover takes about 3 months. If newly born red blood cells are born in a high glucose environment those red blood cells (rbc) are denatured from normal Hemoglobin(Hb) to Hemoglobin A1c (HbA1c). The structure of the protein hemoglobin is distorted.
Certain foods raise the blood sugar in normal people. Normally people have 4.5-6% of their hemoglobin denatured.
People with Type 2 Diabetes Mellitus have HbA1cs as high as 13%. HbA1c is a surrogate for the average blood sugar over a 3 month period of time.
All the proteins in a person’s body are denatured when the blood sugar is high. This leads to a thickening in the lining of the blood vessel (endothelium) and closure of the vessel.
The end result is myocardial infarction, stroke, blindness, amputations and end stage kidney disease. All of these illnesses are very expensive to treat acutely and chronically. They add to the cost to the healthcare system as well as markedly decreasing the quality of life.
NHANES has the ability to measure HbA1c by zip code. Despite new medications and systems of care including uncoordinated educational systems to teach patients about their disease and self-management the new NHANES analysis demonstrated no improvement in the last 10 years.
In fact the average HbA1C has increased and is far from the American Diabetes Association’s HbA1c goal of 7%.
The American Association of Clinical Endocrinologists goal is 6.5%
It has been shown that decreasing HbA1c to 7% will decrease the complication rate of Type 2 Diabetes Mellitus by 33-50 %.
The treatment of the complications of Type 2 Diabetes Mellitus consumes 80% of the healthcare dollars.
A 50% decrease of 80% of the Diabetes related healthcare dollars spent is a very significant decrease in healthcare dollars. It will result in healthier Americans living better lives.
Americans should get smart and demand the government create an environment that helps them stay healthy.
The government should not try to social engineer a system consumers do not want and force them to do what the government wants.
Consumers and the government should start to get smart.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
Please subscribe, and have your friends subscribe. Thank you