Healthcare Vs. Illness Care: The Affordability Issue
The purpose of this article is to explain the disparity between Healthcare Management and Disease Management, and to show why this is the reason for rising health insurance costs due to the wrong focus by doctors and patients.
Our healthcare system focuses on managing disease (illness care) rather than prevention and wellness (true health care). I think this is one of the reasons why the cost of health insurance keeps increasing.
I notice several problems:
- Many people don’t know that some diseases are avoidable.
- Some people are in denial about their health and they just think they are prone to being unhealthy.
- The system of healthcare is not focused on prevention as much as it should be.
- Some medications are costly because the pharmaceutical industry is mostly unregulated.
I’ll discuss each of these issues in detail.
Health management is not taught in our schools. People grow up without any knowledge of how to take care of themselves and how to lead a healthy life. Doctors should offer patients some form of education so they know how to live a healthier life, instead of just treating illnesses after they occur.
I notice some people make themselves sick with the way they live. Then they go to doctors to treat their problems with medications that sometimes have worse side effects. I don’t see any effort with trying to figure out what is causing their problems in the first place.
The answers exist. I know, because I read up on health-related journals and I learn how to lead a healthy life. People think I'm 10 years younger than I am. I suppose this has something to do with my diet and exercise, in addition to a healthy lifestyle (non-smoking, etc.)
Being in Denial About Reasons for Sickness
Denial causes people to avoid doing what’s right. I once told a friend he would get cancer because he always ate carcinogens. He liked to barbeque his means every day. He was in denial and continued to do this until he developed colon cancer and needed to have a portion of his colon removed.
The problem is not always the patient’s fault. The healthcare system is messed up. It rewards doctors for doing procedures, not for teaching patients how to live longer. It is totally up to us to educate ourselves.
Doctors get paid for performing services, not for helping patients get healthy. I had an interesting discussion with my doctor once about this.
I’ll tell you this brief story:
After I started eating more vegetarian dishes, my cholesterol and triglycerides came down tremendously. My doctor said it must be due to my changed diet. I asked him why he doesn’t tell his patients to eat that way when they need to improve their blood counts.
His frustration was obvious when he answered, “Because they don’t listen. They find it too difficult and would rather just have me prescribe a medication.”
I was shocked, and I realized the insurance companies have to pay for this. That’s why the premiums keep going higher.
Illness Management and Prevention: A Failed System
If a patient has a heart attack, a doctor can make $1500 for surgery to add a stent.
If the same doctor takes 45 minutes to discuss with the patient how to get healthy so that they can avoid future heart attacks, that doctor may get paid only $15 for the service.1
According to the Institute of Medicine, a 2011 study showed that 30% of healthcare spending is wasted and does not improve health. This is roughly $750 billion annually.2
Bypass surgery just solves the immediate problem. Future costs for more surgeries will most likely occur, raising the cost of insurance even further.
If a patient is not educated on the proper lifestyle to avoid heart attacks, they will most likely end up with more stents or more bypass surgeries, until they die.
Going from Sick Care to Health Care
The Preventive Medicine Research Institute did a survey that found heart disease is reversible. Blockages in arteries that end up requiring stents actually clear up when one changes their lifestyle and eats heart-healthy foods.3
I once spoke with someone I met at a party who had a triple bypass. She said she would soon need another. I asked her if she knew about the research that found how a plant based diet could help reverse heart disease. She said it is too difficult for her to avoid red meat and delicious fatty foods.
I was stunned. She would rather go under the knife. Unfortunately there are many people like that.
Why Drug Prices Are Out of Control
Most health insurance includes coverage for medications prescribed by a doctor, usually with a deductible. Medicare Part D also pays for prescribed medications. However, they are divided into tier groups. Tiers 1 and 2 usually have zero or low co-pays. However, drugs in the higher tiers can end up costing thousands of dollars.
The influence of the pharmaceutical lobbyists caused the Affordable Care Act (Obamacare) to leave the pharmaceutical industry unregulated. This left Medicare powerless to negotiate for better drug prices.4
I wonder if many of these costs can be avoided altogether, especially if patients take the time to read up on the side effects and ask questions.
I love to do my own research, so whenever I experience something strange happening after starting a new medication prescribed for an ailment, I study the data on the drug to determine if it might be the cause of it.
I would usually discover that many of my problems were a result of medication side effects. How many patients actually do his or her research in this manner? They expect their doctor is taking proper care of them, but, in my experience, I see that the doctors don’t have time to do their own research. They just trust the drug companies. In addition, they have no idea about costs to the patient.
Leading a healthy life is more affordable when you focus on getting healthcare before you need illness care. You’ll be happier for it.
I think it’s important to discuss health issues with your doctor. Never take things for granted. Don’t accept what your doctor prescribes without asking about side effects and if healthier alternatives are available.
Of course there is always the possibility that one will succumb to a genetic disease that is prone to occur because of an inherited gene. Nevertheless, many people can be healthier than they presently are. It just takes the willingness to learn how to lead a healthy life and put it into action.
The healthcare industry still needs improvement, but you can do your part in making it affordable.
- Escape Fire: The Fight to Rescue American Healthcare | Wikipedia
Annie Lowrey, Study of U.S. Health Care System Finds Both Waste and Opportunity to Improve. (2012/10/11). The New York Times
- Halt heart disease with a plant-based, oil-free diet. (Sept 2014). Harvard Medical School Health Publishing
- Caitlin Owens, Why Prescription Drugs Aren’t Part of Obamacare. (2016/03/24). Morning Consult.
© 2017 Glenn Stok