- - Monday, May 8, 2017


In my first year as a practicing psychologist, a patient asked, “can you help me get into a nursing home? I know I don’t need to be there, but at home I have to choose between buying medicine and buying food. I can’t afford both.”

I will never forget the face of his despair.

If you’ve had enough of Presidents who lie about their health care proposals, and Secretaries of Health who follow up with misleading comments they hope will pass for explanation, and if you have the courage to look the American Health Care beast in the eye, then you are ready to read Elizabeth Rosenthal’s lucid and sensible book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.”

Rearranging the deck chairs on the sinking ship of America’s health – whether by kicking unemployed able-bodied citizens out of Medicaid, as recommended in the House bill, or bringing back the horror of preexisting conditions (in other words, if you’ve been sick or can’t hold on to a job, no health care for you!) – won’t keep it afloat. What’s needed to cure the American Sickness, explains Rosenthal, is much deeper and more radical treatment.

Why are other countries able to provide less expensive health care to their citizens and get better health outcomes? Because our politicians are bought and paid for by the pharmaceutical and health care industries. One expert I spoke to said, “In Europe and elsewhere the government subsidizes patients. In the U.S., the government subsidizes businesses.”

His point is much in evidence in the pharmaceutical sector. Drug prices start out high and – unlike other new technologies whose prices drop with time and competition – drug prices stay high. Even when the generic version of the drugs come out, they often cost 90 per cent of the brand-name, instead of the 20 or 50 per cent that would be reasonable. Reasonable pricing, i.e., pricing based on cost + fair profit, is not the operating principle in health care economics. Rather, what rules is “sticky pricing” – which Rosenthal explained this way in an interview with NPR’s Terry Gross: “Once one drug maker, one hospital, one doctor says, ‘Hey, we could charge $10,000 for that procedure or that medicine.’ Maybe it was $5000 two months ago, but once everyone sees that someone’s getting away with charging $10,000, the prices all go up to that sticky ceiling…”

Americans pay more for prescription drugs and procedures than do people in other countries. Why? One reason is that our government legislates to protect the pharmaceutical industry from market capitalism. For example, in a free market, the largest purchasers of a product have purchasing power and therefore pay less per item. Drugs are an exception to this rule. The industry has protective legislation that forbids the biggest buyer, Medicare, which accounts for about 29 percent of all spending on prescription medicines, from negotiating! The VA and the Department of Defense who are allowed to negotiate pay much less for identical drugs.

Similar sweet arrangements between big health care business and government can be seen in other parts of the system. Hospitals have been allowed to consolidate to the point that in some cities they are a virtual monopoly. To no one’s surprise, the cities that have the most hospital consolidation also tend to have the highest prices for health care without any benefit to patients.

Rosenthal has some recommendations for the individual reader/ health care consumer. They all require assertiveness, which can be difficult to muster when you’re worried and anxious because you or someone you love is sick or injured. One piece of advice applies after the fact: Rosenthal recommends insisting on a fully itemized bill after a hospital stay, and suggests Googling the codes to find out what you are being billed for. You might find that you’re being charged for things you didn’t need.

The mean -spirited House of Representatives’ American Health Care Act and the victory lap in the Rose Garden that followed its passage were a disgrace to America’s spirit and reputation. The slogan, “America First!” is a mockery if our medical system is the least caring in the developed world.

It will take a large dose of political will and a great deal of courage to make the changes necessary to treat the American sickness.

The health of the nation depends on it.

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