Articles by JCS

Squeeze Care

Squeeze Care to Expand Profits

Wall Street in Healthcare

By

JCS

Columnist Walter E. Williams who writes for Creators Syndicate attempted to enlighten readers about “affordable health care” in his article, “Can government deliver ‘affordable health care’?”[1] He suggests that socialized medicine in Canada and the UK are plagued by delayed surgery, “health tourists” fleeing to other countries for care, and that the solution is more free enterprise. As usual for many uninformed writers on the healthcare dilemma in America, Mr. Williams fails to enlighten readers to the dire situation of American healthcare itself and why it’s failing.

The problem is that there is never has been nor ever will be free enterprise in American healthcare. Unlike the free market where meritocracy prevails, in the medical plutocracy where profiteers control the HMO boards, hospitals, drug companies, and every aspect of the healthcare industry, the best or cheaper mousetrap often fails to emerge in the marketplace. Compound the perverse economic motivation with intransigent MDs who ignore innovative mainstream medical or CAM methods, and we have an industry stuck in time, bias, tradition and tons of money. Medicine is wrought with too many surgeries, too many expensive MRI scans, too costly, ineffective, addictive, and dangerous medications, and an emphasis on disease care rather than preventative health care.

The Institute of Medicine, a part of the National Academy of Sciences, a private organization chartered by Congress to advise the government on scientific matters, released in its report, “Crossing the Quality Chasm: A New Health System for the 21st Century” mentioned that “Despite the major advances in medical research and disease treatment, the American healthcare system is failing to improve the care of patients.” This report also states that most troubling is that proven methods that can save lives and improve patient outcomes are not being used in everyday practice.

This publication courageously concluded that "the American health care system is in need of a fundamental change," especially because "what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns."

We now know that superficial makeovers will not suffice. The IOM indicated that entirely new patterns of thinking will be necessary to escape this dilemma. "Our present efforts," suggested Mark Chassin, M.D., M.P.P., M.P.H., "resemble a team of engineers trying to break the sound barrier by tinkering with a Model-T Ford. We need a new vehicle, or perhaps many new vehicles. The only unacceptable alternative is not to change." [2]

Indeed, if the electronics industry had such resistance to change, we’d still be in the vacuum tube era. Only in the medical plutocracy do we see such intransigence to change for no other reason than to suppress competition and maintain profits. Perhaps this explains the poor stats in the WHO study that rated the USA as #1 in cost, #37th in health care delivery, and 72nd in population health.[3]

The system is obviously broken, but the fat cats have no interest in changing this profitable albeit ineffective healthcare system since they’re making too much money with the present HMO system, a note Mr. Williams failed to mention in his column.

Profiteering in American Healthcare

Not only has Wall Street revealed how shysters with golden parachutes operate in a deregulated opaque environment, the healthcare industry has the same shysters in the HMO businesses. The public remains unaware of these shysters since the health care insurance industry hasn’t collapsed, yet. Instead of a $700 billion loan from Congress, the HMO industry has been propped up by double-digit increases in healthcare premiums for the past 8 years as it “squeezes care to expand profits.”

Shortly after George Dubya Bush was elected, the White House told all the healthcare lobbyists not to come around speaking about Health Care Reform or the proposed Patients’ Bill of Rights—issues begun during the Clinton administration. Instead, Bush decided to let the health care industry manage this huge issue of healthcare reform. In other words, the Republican wanted to “privatize” these services to let the “market” decide by eliminating governmental oversights or regulations. The rest is history, not unlike the present oil and banking scandals with the consumer paying more for less service.

After 8 years of this medical/HMO/pharmaceutical plutocracy—this wealthy class that controls or greatly influences the government of our society—we see the horrible results with over 47 million Americans without any coverage, decreasing patient services as premiums escalate and, most of all, HMO executive salaries escalating beyond imagination

According to Richard Coniff, the problem is the vast difference between for-profit and non-profit healthcare systems in terms of administrative costs. Medicare now covers about 40 million seniors, gets high marks for customer satisfaction and whips the private sector on efficiency by allocating approximately 5% toward administrative costs. On the for-profit side, private insurers spend six times as much on administration, proportionally—mostly to weed out costly customers or fight payment. This is a cash cow for HMO executives too.[4]

Indeed, the policy holders have been bailing out the healthcare insurance industry for years now, while CEOs have their golden, if not platinum, salaries and parachutes, most notable the former CEO of United Healthcare, Dr. William McGuire, who in 2004 was paid $158 million along with 5-year bonuses totally $1.6 billion.

This egregious compensation didn’t escape the comments of columnist Steven Pearlstein of The Washington Post: “Isn't it odd that a company could be so persnickety when it comes to pinching pennies from doctors and patients, and so cavalier when it comes to lavishing executives with hundreds of millions of dollars of shareholders' money? Or maybe it's not. Maybe what we have here is the most outrageous corporate scandal since Enron and WorldCom.”[5]

Fat Cats

While healthcare insurance costs have risen dramatically with double-digit inflation since 2000, we’ve seen patient services drop substantially.  Why are Americans paying more for health insurance, but getting less coverage and poor service? The problem with American health care is not the doctors or patients, but the real culprits are the greedy executives in the Health Maintenance Companies (HMOs), hospitals, and drug companies.

Indeed, health care in America is a function of plutocrats and bureaucrats who are living high on the hog, to say the least, at the expense of patient and providers. Take a look at these numbers of the HMO kingpins and ask yourself why the USA doesn’t implement nationalize healthcare for all as we do for our seniors with Medicare.

 Top 6 Health Plans Annual Totals compared to US Government salaries:

         Grand Total for 6 HMOs in 2007 was $277,998,393

         U.S. Government Leaders Salaries $95,974,600

         Executive Branch $3,517,600

         President $400,000

         Vice President $221,100

         Cabinet Secretaries (15) $2,896,500

         Judicial Branch

         Justices (9) $1,881,000

         Congressional Salaries $90,576,000

         U.S. Senate - (100 members) $16,930,000

         House of Representatives - (435 members) $73,646,000

 

Taken together, these six health plans paid 37 executives three times (average salary of $7,513,470) what the top 562 leaders received in the federal government (executive, judicial, and legislative; average salary of $170,773).

Not only is this incomprehensible for working class people, it’s a rip-off for their own stockholders and clients who are bilked by these insolated executives with platinum parachutes.

Perverse Motivations

If these egregious salaries aren’t enough to make you scream out for a total change to a nationalized healthcare system, what would? Sadly, these medical plutocrats control the system with the blessings of the Bush White House and defended by the largest medical/drug lobby in Washington. Until this tragic market failure is known by every American, we’ll continue to see such inequities in USA healthcare.

Mr. Robert Kuttner is co-editor of the American Prospect and a senior fellow at a New York–based public policy research and advocacy organization. In The New England Journal of Medicine, he wrote an eye-opening article about this HMO mess, Market-Based Failure — A Second Opinion on U.S. Health Care Costs.

“The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies…raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system

“Comprehensive, government-organized, universal health insurance systems are far better equipped to realize these efficiencies because everyone is covered and there are no incentives to pursue the most profitable treatments rather than those dictated by medical need.”[6]

Obviously the present American HMO system of healthcare is not working for citizens, especially the 47 million uncovered. While Mr. Williams criticizes those universal systems in Canada and the UK, the fact is they do get more bang for their buck—less costly and better overall results. Just as Wall Street proved unregulated capitalism is corrupt, so too have the HMOs proven that their brand of healthcare is expensive and ineffective. Until we overhaul the best of universal healthcare with a dash of American ingenuity, we’ll continue to see more dollars spent on less effective treatments, allthewhile the HMO fat cats laugh all the way to the bank.

 

Two Epidemics: Back Pain and Back Surgery

To relate these figures to back surgery, 17.6% of the more than 500,000 lower back surgeries performed each year would equal 88,000 unnecessary surgeries, at a hospital cost of $11,000 per surgery[7][6] for a total cost of $968 million. Again, this 17.6% rate for unnecessary surgery is a conservative figure for back surgeries in as much as the AHCPR experts admit that back surgery is helpful in only one in 100 cases of back cases.[8]

In fact, this epidemic of back injuries is fueled in part by unnecessary, ineffective, and expensive back surgeries that could have been avoided by the use of chiropractic care and active rehab measures. Hubert L. Rosomoff, MD, from the University of Miami, called a moratorium on back surgeries when he realized, after two weeks of rehabilitation, his back patients no longer required surgery. “Following this kind of concept, you can eliminate 99% of the surgical cases. In fact, the incidence of surgery if one really looks at this appropriately is one in 500.”[9]

According to Dr. Lynn Johnson, director of the Center for Pain Medicine of North Carolina, while back surgery has a place, there are too many surgeries being done, and that most doctors fail to apply conservative measures such as chiropractic, physical therapy, and minimally invasive surgical techniques before suggesting surgery.[10]

Many health insurance programs like the Blues still deny or severely limit access to and treatment by chiropractors, and many workers’ compensation programs also limit chiropractic care to injured workers despite the overwhelming evidence supporting spinal manipulative therapy as well as evidence indicating the ineffectiveness of spinal surgery. Part of the problem and the reason for the ongoing denial is the long-standing medical influence on these huge insurance conglomerates.

Federal Guideline Recommends Spinal Manipulation First

Due to this epidemic of LBP and the huge costs, the US Public Health Service’s Agency for Health Care Policy and Research (AHCPR) conducted what many people consider to be the most extensive study ever done consisting of a two-year study of nearly 4,000 articles from the National Library of Medicine, which led to a 1994 federal guideline on acute low back pain in adults.

The 23-member expert panel’s recommendations stunned the medical profession for many reasons, such as their recommendation of spinal manipulation as a “Proven Treatment” for acute low back pain in adults. This guideline states: “This treatment (using the hands to apply force to the back to ‘adjust’ the spine) can be helpful for some people in the first month of low back symptoms. It should only be done by a professional with experience in manipulation [chiropractors].”[11]

This federal guideline on acute low back pain also did not recommend treatments commonly done by physical therapists and medical doctors.

“A number of other treatments are sometimes used for low back symptoms. While these treatments may give relief for a short time, none have been found to speed recovery or keep acute low back problems from returning. They may also be expensive. Such treatments include:

  1. Traction
  2. TENS
  3. Massage
  4. Biofeedback
  5. Acupuncture
  6. Injections into the back
  7. Back corsets
  8. Ultrasound

This guideline also did not endorse the prolonged use of strong medications for back pain. The guideline recommends NSAIDs instead of pharmaceuticals. Plus, pain pills only mask the problem without correcting the underlying cause, and they may cause serious side effects and organ damage.

“For most people, medicine works well to control pain and discomfort. But any medicine can have side effects. For example, some people cannot take aspirin or ibuprofen because it can cause stomach irritation and even ulcers. Many medicines prescribed for low back pain can make people feel drowsy. These medicines should not be taken if you need to drive or use heavy equipment.”[12]

The Reason Why Spinal Manipulation Is Effective

To understand why spinal manipulation done by chiropractors is more effective than physical therapy and surgery is to understand the basic anatomy of the spine itself. Unlike what most people have been told by their health care practitioners, the main cause of back is not from “slipped disks” as much as from “slipped joints.”

In the human spine there are 24 vertebrae, 3 pelvic bones, and the skull all interconnected by 137 joints. Whenever someone experiences trauma such as a fall, car accident, prolonged sitting and standing, or lifting improperly, the spine is subjected to an overload of pressure upon these joints and spinal muscles. Just as one can sprain the small joints in the bones in an ankle, most back problems are caused from the sprain/strain of these small synovial joints in the spine and the tearing of the spinal soft-tissues around the joints such as muscles, ligaments or tendons. Nerve compression, better known as “pinched nerves,” also can occur when the vertebrae are misaligned, leading to radiating pain down the leg, known as “sciatica” or radiculopathy.

While disks may swell in this process, disk herniation is not the primary cause of low back pain. In fact, most spinal experts now agree that joint dysfunction is the main cause of back pain,[13] which may explain why manipulation has been effective. This also explains why spinal fusion fails to resolve back pain since the joints are still misaligned. Until these spinal joints are restored to normal motion and stability, back pain is inevitable and re-occurring, which may explain why most back surgery victims never return to work.

A recent article in the New England Journal of Medicine acknowledged that most back pain is “mechanical” in nature, meaning joint dysfunction. According to Dr. Richard Deyo’s article, “Differential Diagnosis of Low Back Pain,” he showed that “Mechanical Low Back or Leg Pain” constituted 97% of these cases, of which “lumbar strain, sprain” accounted for 70% of these cases; “Nonmechanical Spinal Conditions [disc problems] accounted for “about 1%”; “Visceral Disease” [referred pain from a diseased organ] accounted for 2%.”[14]

Dr. Deyo also criticizes the over-reliance on imaging for low back problems.

“Early or frequent use of these tests [Computed tomography (CT) and MRI] is discouraged, however, because disk and other abnormalities are common among asymptomatic adults. Degenerated, bulging, and herniated disks are frequently incidental findings, even among patients with low back pain, and may be misleading. Detecting a herniated disk on an imaging test therefore proves only one thing conclusively: the patient has a herniated disk.”

 

The US federal guideline also concurred on the misleading interpretation of MRI exams to convey the notion of disk problems as the cause of back pain:

“Degenerative discs, bulging disc and even herniated discs are part of the aging process for the spine and may be irrelevant findings: they are seen on imaging tests of the lumbar spine in a significant percentage of subjects with no history of low back problems. Therefore, abnormal imaging findings seen in a patient with acute low back problems may or may not be related to that individual’s symptoms.[15]

This points out the single-most prevalent cause of misdiagnosis in low back pain problems—that is, the use of MRI images to show disc abnormalities to convince patients that some sort of disk problem is the cause of their pain. In fact, as Deyo and other researchers have repeatedly shown, disc abnormalities are not the cause of back pain. Patients without any back pain often have degenerated or herniated disks, while many patients with back pain have perfectly healthy spines.

This outdated concept is the major pitfall in this medical scam, and one the public is largely unaware of. Richard Deyo mentions this problem of medical mistakes in low back treatments: “Calling a [medical] physician a back-pain expert, therefore, is perhaps faint praise--medicine has at best a limited understanding of the condition. In fact, medicines’ reliance on outdated ideas may have actually contributed to the problem.” [16]

 

Misinformation in Health Care

Despite the failure of medical methods to stem this epidemic of low back pain, and despite the recent research supporting the obvious superiority of chiropractic care, the medical status quo remains intractable to implementing this alternative. Whether it’s chiropractic care in lieu of back surgery, or chelation therapy in lieu of bypass surgery, or herbal therapy in lieu of pharmaceuticals, the health care system has ignored the call for quality improvements and alternatives despite the glaring poor statistics that have now surfaced and the growing popularity of alternative health care.[17]

The tendency to ignore research, alternatives and guidelines that conflict with the status quo is not a new phenomenon. For example, the release of the AHCPR federal guideline on acute LBP was delayed for months due to an injunction filed by the orthopedic society that disagreed with its findings. And when the guideline was finally released, an orthopedic group sued the members of the expert panel, their own colleagues.

Perhaps Dr. Deyo is feeling the same type of venomous response to the AHCPR’s guideline that the chiropractic profession has felt from other biased reports. Deyo has written many articles dealing with the ineffectiveness of spinal surgeries, especially spinal fusions. In the AHCPR’s Clinical Practice Guideline, the section on Spinal Fusion clearly summarizes the research.

“There appears to be no good evidence from controlled trials that spinal fusion alone is effective for treatment of any type of acute low back problems in the absence of spinal fractures or dislocation.... Moreover, there is no good evidence that patients who undergo fusion will return to their prior functional level.”[18]

 

For decades medicine and its political machine has called for research from the chiropractic profession to prove itself, yet, when it is finally done by the most universally accepted and acclaimed expert group of researchers ever assembled, the AMA still refuses to acknowledge their findings. Incredibly, the medical misinformers then published in May 1995, only a few months after the AHCPR’s low back pain guideline came out in December 1994, their version of proper spinal treatments in a small booklet, “AMA Pocket Guide to Back Pain,” published by Random House. The cover of the pocket guide claims it contains: “The latest information on all treatment options, including medications, physical therapy and surgery.”

Despite the fact that spinal manipulative therapy is recommended by the U.S., U.K. and Canadian studies (AHCPR[19], Meade[20], Manga[21]), neither chiropractic care nor SMT are even mentioned, plus the AMA’s pocket guide includes many recommendations that contradict the findings of the AHCPR expert panel. Although it does state that there are “More than 100 separate joints connecting the bones of the spine to each other and to other bones,” no mention of manipulative therapy is given whatsoever. It seems obvious that the AMA is willing to misrepresent the scientific research and governmental endorsements that conflict with its own vested interests despite the harm it will cause patients Confessions of a medical heretic by Robert Mendelsohnwho naively follow this ineffective, outdated advice.

 The late renowned medical author Dr. Robert Mendelshon remarked that, “Anyone who has a back surgery without seeing a chiropractor first should also have his head examined.” He characterized the medical profession in his book, Confessions of a Medical Heretic, as the Church of Modern Medicine whose goal is to suppress any and all Protestant treatments, if you will, be it chiropractic, acupuncture, nutritional supplements, homeopathy or whichever non-medical healing art. Everything but drugs and surgery is automatically condemned by the medical priests despite the proof or popularity, keeping American health in the Dark Ages where tradition supersedes progress.

I’d like to continue on Dr. Mendelshon’s theme by writing Confessions of a Chiropractor, telling the unknown story that only a chiropractor could tell.

What the public doesn’t know is this campaign against chiropractors was carefully crafted by the medical PR goon squad that was assembled back in the 1960s to undermine the chiropractic profession’s image, political clout, and scientific development. For the most part, all three goals were accomplished.

 



[1] “Can government deliver ‘affordable health care’?” Macon Telegraph, 10-23-08.

[2] Mark R. Chassin, MD, MPP, MPH; Robert W. Galvin; and the National Roundtable on Health Care Quality, The Urgent Need to Improve Health Care Quality Institute of Medicine National Roundtable on Health Care Quality,  JAMA.  1998;280:1000-1005.

[3] World Health Organization, The World Health Report 2000: Health Systems—Improving Performance, 2000.

 

[4] Conniff, Richard; How to fix: Health care; MSN Money  Feb. 19, 2008.

[5] Pearlstein, Steven, UnitedHealth's Options Scandal Shows Familiar Symptoms, Washington Post, October 18, 2006.

 

[6] Kuttner, R., Market-Based Failure — A Second Opinion on U.S. Health Care Costs, NEJM, Vol 358:549-551 Feb. 7, 2008, Number 6.

 

 

[8] Robin Herman.  Back Surgery.  Washington Post (Health Section), April 18, 1995.

[9] Bigos S. ibid.

96 Widen, M. “Back specialists are discouraging the use of surgery.” American Academy of Pain Medicine, 17th annual meeting, Miami Beach, Fl. Feb. 14-18, 2001.

 

 

 

 

 

 

 

 

 

 

 

 

 

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