An American Sickness Book Reflection Paper

An American Sickness Book Reflection Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON An American Sickness Book Reflection Paper Based this readingsChapters 4 -6Chapters 7 -9Chapters 10 -12Chapters 13 -15Chapters 16 -18in An American Sickness in 250-500 words respond to the following:Identify and describe an issue brought-up in the bookWhat actions can/should be taken to remedy this issue (use your imagination and dream big)Who is responsible for taking this action? (e.g., patients, doctors, policy makers, insurance companies, hospital administrators)Please write each assigned reading respond in a separated file.an_american_sickness_how_healthcare_became_big_business_and_how_you_can_take_it_back_by_elisabeth_rosenthal__z_lib.org___1_.pdfUnformatted Attachment PreviewPENGUIN PRESS An imprint of Penguin Random House LLC 375 Hudson Street New York, New York 10014 penguin.com Copyright © 2017 by Elisabeth Rosenthal Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader. Library of Congress Cataloging-in-Publication Data Names: Rosenthal, Elisabeth, 1956– author. Title: An American sickness : how healthcare became big business and how you can take it back / Elisabeth Rosenthal. Description: New York : Penguin Press, 2017. Identifiers: LCCN 2016042934 | ISBN 9781594206757 (hardcover) | ISBN 9780698407183 (e-book) Subjects: LCSH: Health care—United States. | Medical care—United States. | Medical policy—United States. | BISAC: MEDICAL / Health Policy. | BUSINESS & ECONOMICS / Insurance / Health. | POLITICAL SCIENCE / Public Policy / Social Policy. Classification: LCC RA395.A3 .R655 2017 | DDC 362.10973—dc23 LC record available at https://lccn.loc.gov/2016042934 Neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book. While the author has made every effort to provide accurate Internet addresses and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party Web sites or their content. An American Sickness Book Reflection Paper Version_2 Dedicated to all the patients, doctors, and other healthcare professionals who so generously shared their stories and experiences to bring this book to life. Waiving privacy concerns, they agreed to have their real names appear in print. In the hope of contributing to change in our healthcare system, they spent hours digging up copies of their bills, insurance statements, correspondence, and other documents to provide verification. I’m deeply grateful for their help, commitment, and courage. They—and all Americans—deserve better, more affordable healthcare. Contents Title Page Copyright Dedication Introduction Complaint: Unaffordable Healthcare Part I HISTORY OF THE PRESENT ILLNESS AND REVIEW OF SYSTEMS 1. The Age of Insurance 2. The Age of Hospitals 3. The Age of Physicians 4. The Age of Pharmaceuticals 5. The Age of Medical Devices 6. The Age of Testing and Ancillary Services 7. The Age of Contractors: Billing, Coding, Collections, and New Medical Businesses 8. The Age of Research and Good Works for Profit: The Perversion of a Noble Enterprise 9. The Age of Conglomerates 10. The Age of Healthcare as Pure Business 11. The Age of the Affordable Care Act (ACA) Part II DIAGNOSIS AND TREATMENT: PRESCRIPTIONS FOR TAKING BACK OUR HEALTHCARE 12. The High Price of Patient Complacency 13. Doctors’ Bills 14. Hospital Bills 15. Insurance Costs 16. Drug and Medical Device Costs 17. Bills for Tests and Ancillary Services 18. Better Healthcare in a Digital Age Epilogue Acknowledgments Appendix A: Pricing/Shopping Tools Appendix B: Tools for Vetting Hospitals Appendix C: Glossary for Medical Bills and Explanations of Benefits Appendix D: Tools to Help You Figure Out Whether a Test or a Procedure Is Really Necessary Appendix E: Templates for Protest Letters Notes Index About the Author INTRODUCTION Complaint: Unaffordable Healthcare I n the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less singlemindedly to its own profits. Everyone knows the healthcare system is in disarray. We’ve grown numb to huge bills. We regard high prices as an inescapable American burden. We accept the drugmakers’ argument that they have to charge twice as much for prescriptions as in any other country because lawmakers in nations like Germany and France don’t pay them enough to recoup their research costs. But would anyone accept that argument if we replaced the word prescriptions with cars or films? The current market for healthcare just doesn’t deliver. It is deeply, perhaps fatally, flawed. Even market economists themselves don’t believe in it anymore. “It’s now so dysfunctional that I sometimes think the only solution is to blow the whole thing up. It’s not like any market on Earth,” says Glenn Melnick, a professor of health economics and finance at the University of Southern California. Nearly every expert I’ve spoken with—Republican or Democrat, old or young, adherent of Milton Friedman or Karl Marx—has a theoretical explanation as to why the United States spends nearly 20 percent of its gross domestic product on healthcare—more than twice the average of developed countries. But each one also has a story of personal exasperation about the last time a family member or a loved one was hospitalized or rushed to an emergency room or received an incomprehensible, outrageous bill. Stephen Parente, Ph.D., a health economist at the University of Minnesota and an adviser to John McCain in the 2008 presidential election, believes that studies overstate the excessive healthcare spending in the United States. But when he talks about the hospitalization of his elderly mother, his dispassionate academic tone shifts to one I’ve heard thousands of times, brimming with frustration: There were a dozen doctors all sending separate bills and I couldn’t decipher any of them. They were all large numbers and the insurance paid a tiny fraction. Imagine if a home contractor worked this way? He estimates $125,000 for your kitchen and then takes $10,000 when it’s done? Would anyone ever renovate? Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the copilot, and the flight attendants. An American Sickness Book Reflection Paper That’s how the healthcare market works. In no other industry do prices for a product vary by a factor of ten depending on where it is purchased, as is the case for bills I’ve seen for echocardiograms, MRI scans, and blood tests to gauge thyroid function or vitamin D levels. The price of a Prius at a dealership in Princeton, New Jersey, is not five times higher than what you would pay for a Prius in Hackensack and a Prius in New Jersey is not twice as expensive as one in New Mexico. The price of that car at the very same dealer doesn’t depend on your employer, or if you’re self-employed or unemployed. Why does it matter for healthcare? We live in an age of medical wonders—transplants, gene therapy, lifesaving drugs, and preventive strategies—but the healthcare system remains fantastically expensive, inefficient, bewildering, and inequitable. Faced with disease, we are all potential victims of medical extortion. The alarming statistics are incontrovertible and well known: the United States spends nearly one-fifth of its gross domestic product on healthcare, more than $3 trillion a year, about equivalent to the entire economy of France. For that, the U.S. health system generally delivers worse health outcomes than any other developed country, all of which spend on average about half what we do per person. Who among us hasn’t opened a medical bill or an explanation of benefits statement and stared in disbelief at terrifying numbers? Who hasn’t puzzled over an insurance policy’s rules of co-payments, deductibles, “in-network” and “out-of-network” payments—only to surrender in frustration and write a check, perhaps under threat of collection? Who hasn’t wondered over, say, a $500 bill for a basic blood test, a $5,000 bill for three stitches in an emergency room, a $50,000 bill for minor outpatient foot surgery, or a $500,000 bill for three days in the hospital after a heart attack? Where is all that money going? — BEFORE BECOMING A REPORTER for the New York Times, I went to Harvard Medical School and then trained and worked as a physician at what is now NewYork-Presbyterian Hospital, a prestigious academic center.* To explore the American system and its ills, I’ve fallen back on the “history and physical,” an organized and disciplined form of record keeping that every doctor uses. The so-called H&P is a remarkable template for understanding complex problems, such as sorting out a patient’s multitude of symptoms, in order to come to the proper diagnosis and to allow for effective treatment. The H&P has predictable components: chief complaint: What major symptoms does the patient notice? history of the present illness and review of systems: How did the problem evolve? How has it affected each organ separately? diagnosis and treatment: What is the underlying cause? What can be done to resolve the patient’s illness or symptoms? What you are reading right now is the chief complaint: hugely expensive medical care that doesn’t reliably deliver quality results. Part 1 of this book, “History of the Present Illness and Review of Systems,” charts the transformation of American medicine in a little over a quarter century from a caring endeavor to the most profitable industry in the United States—what many experts refer to as a medical-industrial complex. As money became the metric of good medicine, everyone wanted more and cared less about their original mission. The descent happened sector by sector, and we will explore it that way: insurers, then hospitals, doctors, pharmaceutical manufacturers, and so on. First as the child of an old-fashioned doctor—my father was a hematologist—then as an MD, and finally during my years as a healthcare reporter for the Times, I’ve had a lifetime front-row seat to the slow-moving heist. I have spent months poring over financial statements, tax documents, patient charts, and bills trying to explain why, for example, a test that costs $1,000 at one of the nation’s leading academic hospitals costs $7,000 at some small community hospitals in New Jersey—and the equivalent of only about $100 in Germany and Japan. These days our treatment follows not scientific guidelines, but the logic of commerce in an imperfect and poorly regulated market, whose big players spend more on lobbying than defense contractors. Financial incentives to order more and do more—to default to the most expensive treatment for whatever ails you—drive much of our healthcare. An American Sickness Book Reflection Paper The central mantra of “innovation” in the past decade has been “patient-centered, evidence-based care.” But isn’t that the very essence of medicine? What other kind of medical care could there be? — ALL THE HARROWING TALES in this book occurred despite the 2010 passage and 2014 enactment of the Patient Protection and Affordable Care Act (the ACA, also known as “Obamacare”). The ACA is not a failure,* as some still assert, but the “affordable” in its name was an overreach to win over votes and public opinion. (Healthcare bills all have happy names affixed for the sell, including the newest mixed bag, the 21st Century Cures Act.) After endless compromises with the medical industry to enable its passage, the ACA was mostly a bill to make sure that every American could have access to health insurance. But it didn’t directly do much, if anything, to control runaway spending or unsavory business practices. Washington being what it is, I doubt we’ll ever see the “Take Back America’s Healthcare” bill or the “Stop Robbing Patients” bill. Likewise, such tales will no doubt continue under the administration of Donald J. Trump, who vowed to “repeal and replace Obamacare with something better” during the 2016 campaign. As many experts pointed out, the president did not actually have the power to repeal the law, just like that, whole cloth. Within days after the election, he said he would likely keep certain provisions—such as guaranteeing access to insurance for those with preexisting conditions—and would allow for a prolonged grace period so that the twenty-two million people who’d obtained insurance through Obamacare would not go without, while the “better” option could be devised. Whatever its final outlines, that Republican replacement plan (Trumpcare? PatriotCare?) is certain to expose patients to more market forces—meaning it is more imperative than ever to understand the convoluted (il)logic behind the extravagant prices we pay. — IT IS EASY TO feel helpless. Our sense of medical urgency combined with bureaucratic confusion is a debilitating cocktail. But we, the patients, can actually do a lot to wrest control of our health from the ledgers of the medical-industrial complex. Part 2 of this book, ”Diagnosis and Treatment,” offers not only advice and recommendations that will make your insurers, doctors, and hospitals more affordable and responsive to you but also a range of potential, and politically viable, government fixes that would tamp down the costs and the financial crimes imposed on our bodies in the name of health. The next steps are up to us. There are self-help strategies you can implement tomorrow to reduce your medical expenses, not to mention political solutions that could revamp American healthcare once and for all if you understand how to effectively press for their deployment. They’re not mutually exclusive. We can start now. — EACH MARKET HAS certain rules that are determined by the conditions, incentives, and regulations under which it operates.An American Sickness Book Reflection Paper Currently, we buy and sell medical encounters and accoutrements like commodities, but how do participants in the marketplace make purchasing choices? Prices are often unknowable and unpredictable; there’s little robust competition for our business; we have scant information on quality to guide our decisions; and very often we lack the power ourselves to even choose. The rules governing the delivery of healthcare in the United States have grown out of the market’s design. The type of healthcare we get these days is exactly what the market’s financial incentives demand. So we have to get wise to them, and be smarter, far more active participants in this ugly, rough–and-tumble world. More important, we have to change the rules of the game, with different incentives and new types of regulation. I’ve set out the current rules at the end of this introduction. And I’ll be referring to them as you read on. In Part 1, you’ll see how they play out, and their terrible effects on the health and finances of patients, as illustrated by real-life case studies. The economist Adam Smith spoke of an “invisible hand” with respect to income distribution. But in American healthcare, there’s a different type of invisible hand at work: it’s on the till. ECONOMIC RULES OF THE DYSFUNCTIONAL MEDICAL MARKET 1. More treatment is always better. Default to the most expensive option. 2. A lifetime of treatment is preferable to a cure. 3. Amenities and marketing matter more than good care. 4. As technologies age, prices can rise rather than fall. 5. There is no free choice. Patients are stuck. And they’re stuck buying American. 6. More competitors vying for business doesn’t mean better prices; it can drive prices up, not down. 7. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more. 8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all. 9. There are no standards for billing. There’s money to be made in billing for anything and everything. 10. Prices will rise to whatever the market will bear. An American Sickness Book Reflection Paper Part I HISTORY OF THE PRESENT ILLNESS AND REVIEW OF SYSTEMS 1 THE AGE OF INSURANCE J effrey Kivi, fifty-three, a chemistry teacher at New York’s prestigious Stuyvesant High School, has a Ph.D. in chemistry and worked as a researcher at the pharmaceutical company Abbott Laboratories for twenty years. He has a good idea of what medical treatment should cost. Since childhood, he has suffered from a condition called psoriatic arthritis, a disease where an overly enthusiastic immune system attacks the skin, causing rashes, and the joints, causing crippling arthritis. When he was getting his Ph.D. at Purdue University in Indiana, his disease flared up so frequently that he was on high doses of prednisone, a steroid that quells the immune system’s attack on the bone. Even with that, he “had severe problems with [his] feet, ankles, knees, hips, and lower back/sacroiliac joints—often to the point of being unable to work and even walk.” About fifteen years ago, important new arthritis drugs hit the market. His rheumatologist, Dr. Paula Rackoff, said he was a good candidate. The medicine worked wonders: every six weeks, a drug called Remicade was infused into his veins in an outpatient clinic at Beth Israel Hospital, where Dr. Rackoff practiced. The treatment cost $19,000 each visit, but Mr. Kivi, as a New York City civil servant, has excellent insurance under EmblemHealth. He paid nothing himself. On the new medicine he could stand for many hours teaching his classes and navigate Stuyvesant’s labyrinthine network of hallways. The results were transformative. Then in 2013 Dr. Rackoff moved her practice about fifteen blocks north to NYU Langone Medical Center. The support services were better and she wanted to practice in a more academic environment, she told her patients. The setup would be more convenient for Mr. Kivi too. Unlike Beth Israel, the NYU Langone infusion clinic was open nights and weekends, so he didn’t have to find a substitute teacher or use sick time to get his treatment. At first, he was impressed by the Langone Center for Musculoskeletal Care, where services were distinctly more upmarket. “I thought it might be a bit more expensive,” he said, noting that at NYU he was greeted at the front desk by a patient navigator who walked him to his small private infusion cubicle, equipped with Internet, a television, bottled water, and snacks. (See Rule 3: Amenities and marketing matter more than good care.) But the charges that started posting on his insurance Web site, as submitted by NYU, shocked him: the first three-hour infusion at the new hospital, in May, was billed at $98,575.98, the second in June at $110,410.82, and from July on they were billed at $132,791.04. It was the same dose as always, in the same form, prescribed by the same doctor. Both Mr. Kivi and I, independently, spent some weeks trying to get an explanation of the charges from NYU. A pharmacist mixed up the drug. A nurse put the IV into his arm. But beyond that Mr. Kivi just sat occupying a chair for several hours. How did that merit these kinds of bills? When Mr. Kivi complained to the NYU billing office, a patient-care representative offered a range of nonexplanations: She tried to tell me that, although she had no idea how much profit NYU is making, she was sure that it couldn’t be all that much. After all, there are shipping costs, storage costs, and other administrative costs associated with a hospital facility. Really? Enough to justify $120,000 billed to EmblemHealth for a single dosage administered? In the end, she said that I should pay no attention to how much money my insurance company was being forced to pay. After all, it’s not costing me anything. When I tried to pick up the investigation where Mr. Kivi left off, the explanations got even less convincing. The public affairs department told me Mr. Kivi was an “outlier” because he was getting aggressive treatment and he is large. Remicade is d …Purchase answer to see full attachmentStudent has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service.An American Sickness Book Reflection Paper Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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