Health Care Paradox: Red Tape, Lobbies, Political Posturing . . . and Sick People

August 2nd, 2012
in Op Ed, syndication

Written by Michael Kulla (pictured)

There’s broad consensus that health Care needs a makeover, in spite of an unrelenting barrage of disinformation characterizing present reforms as michael-kullaSMALLrisky and unworkable – the moral equivalent of Stalinist collective farming.  There can be no levity on this weighty issue while the (political) blitzkrieg goes on unabated.

At the beginning of the 21st century, America was unquestionably the most powerful, innovative and richest nation in the world, paradoxically though, not the healthiest compared to other developed countries.  While we can boast the best-educated doctors and nurses, the best equipped hospitals and leaders in medical research, sadly we have squandered our treasure.  The basic shortcomings of our health system cover a wide spectrum – coverage, quality and cost.

Follow up:

Our Health Care System is a Failure …

A former patient of mine contracted diabetes, a disease that modern medicine can manage.  If she lived in Canada, France, Italy, Germany, Britain, Japan, Sweden, etc. she would have been given the standard treatment for diabetes and she could have  lived a normal life span.  Once sick, her health insurance coverage was dropped, and she lacked the resources to pay for doctors and drugs to treat her.  She died at 31.  She didn’t die from diabetes per se, but from lack of access to health care.

On Sept. 11, 2001 some 3,000 innocent people were attacked and killed.  We’ve spent staggering sums of money tom prevent this from happening again.  But the same year, and every year since, more than 22,000 Americans (and numbers growing each year) die from lack of health coverage and hundreds of thousands more go bankrupt from treatment they cannot pay for.  There are 46 million with no healthcare and another 40 million have only minimum coverage.  Never does this scenario occur in any other developed country.

… Costly, Inefficient …

American health care is unhealthy.  Costs are rising three times the rate of inflation. The U.S. spends $8,500 per person on health care; Britain under $3,500.  Administrative costs in the U.S. are 20 to 30 percent of the total cost and just 5 percent in Canada and Britain.

Our health-care system suffers even more from inefficiency than from lack of funds.  Gobs of money is wasted on bureaucracy, unnecessary tests, overpriced prescription drugs, fraudulent billing from vendors, etc.  U.S. companies are increasingly less able to afford health coverage for employees.

Every developed country but the U.S. provides care to anyone who gets sick, pre-existing conditions notwithstanding, and most provide longer life expectancy, lower infant mortality and better recovery rates from major diseases than we do — and they spend far less on health care.

… And Morally Deficient

The landmark Affordable Health Care Act, misleadingly labeled as “Obamacare” was actually compromised legislation passed by both bodies of Congress.   How can we have an honest conversation about the salutary features and ones that may warrant a makeover in the current adversarial climate?

Efforts to change the American system get derailed by sloganeering about “big government” – socialized medicine verses “free enterprise,” even though no one can quite define what it means.  The essential moral question, should health care delivery be a sacred right, gets lost in the shuffle.

A Health Care System for the Benefit of Corporations …

Contrary to conventional belief, most developed countries manage health care without adopting “socialized medicine.”  Other wealthy democracies could show us how to build a health system that fits our needs.  A potpourri of options is available.  Let’s face it, though, our health system is highly resistant to change.  Vested interests – insurance and pharmaceutical companies, as well as hospital chains, have blocked attempts to restructure it for the benefit of care holders.  Other industrialized nations with vested interests like Switzerland and Taiwan have overcome political hurdles and reformed their care systems.

… Supported by the Close-minded, Trite and Frivolous

Another barrier to reform is American Exceptionalism taken to extremes.  Notice that presidents (and other politicians) take every opportunity to laud America as “the best.”  To vacillate on this is “unpatriotic.”  The real “patriot” evaluates the situation in toto (good, bad or whatever) and reacts with an open mind.  The bogeyman isn’t that it is socialism per se, but that it is foreign.

Individual Care has Given Way to Medical Business Oligarchy

I have witnessed a profound change in my field — psychology.  Its honed skills and art and science, in effect the accumulated expertise, has been pushed aside for time-limited robo-therapy.  Adding insult to injury, patients pay more, doctors get less, paperwork is overflowing and insurance company telephone prompts are unending with often no human to talk with.  The foregoing landscape results in poorer and more costly services in the long run.  In contrast, insurance industry profits over the past few years are zooming.  Most therapists try to maintain good practice standards in spite of this onslaught.

Medication prices would collapse in response to competitive pressures. Instead, prescription drug prices in America remain excruciatingly high, the result of Medicare Prescription Drug Act that forces Americans to subsidize overpriced drugs. The cost of the drug act was later (revised) to over $1 trillion, or three times greater than what Congress was led to believe. This act, written and lobbied through Congress by the drug industry nearly a decade ago, prohibits Medicare from using its enormous purchasing power to lower prices.

In Mexico, shelves are stocked with just about every popular American prescription drug but no prescription is required. Most prices are fractions of what they cost here. Certainly, there are medications that require close physician supervision and they should remain on prescription-only status, but affordability is essential.

Once a brand drug comes off patent generic equivalents emerge. They cost far more than they need to because of Federal Drug Administration regulations and drug company maneuvers. On average, Americans are paying substantially more at drug stores than ethical compounding pharmacies could sell them for.

Medicare is facing insolvency. A major reason is that too many older people are getting sick.  Diseases of aging are preventable via a wide variety of lifestyle alterations. Government needs to be much more proactive in this area. One example is the needed promotion of vitamin D supplementation. Evidence supports the huge role that vitamin D plays in preventing almost every killer disease of aging.

A Dialogue about Morality, Rationality, Cost and Effectiveness

America’s health care anomalies are so numerous it’s not possible to fit them, as well as exciting new cost-saving initiatives, into one article. Americans deserve to be healthier and happier, and their needs must take top priority. For this to happen a rational dialogue without prejudice must ensue.

The primary issue for any health care system is a moral one.  Should it be an essential safeguard of human life and dignity, an obligation for society to ensure it as we guarantee the right to prayer, education, voting, etc., or should we let Americans die for lack of access to health care?  Settle this point and we can bring about fundamental change drawing from many systems in the world that are fairer, cheaper and more effective than ours.


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About the Author

Michael Kulla is from Pleasant Valley, NY and is a New York State licensed psychologist.

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  1. C. T. Smith says :

    What a load of fecal matter!
    The "friend" had diabetes and no insurance(her choice)and died at an early age idea what.
    Obamacare passed in Congress as a result of some of the most deplorable tactics imaginable. But fortunately we were able to know what it contained by reading it AFTER it passed.
    Get real,Doc.

  2. Frank Li (Member) Email says :

    What a great description of problems! What's your solution? A rational dialogue? Good luck!

    America's problems are deep & structural. It's the political system, stupid! Unless that's addressed, fundamentally as I suggested, avoid anything "affordable", because it's just a give-away!

  3. Dennis Roubal says :

    Health care is going to be a bigger and bigger problem. The costs are escalating faster than incomes. Real reforms are difficult for the same reason nothing else, important to most people, gets done. Lobbying. Big money buys politicians. Politicians do what big money wants. The only way to stop this is to stop voting for Dems and Repubs. They are all captive. They always get elected, so big money supports them and owns them from day one. Until the public figures this out and stops voting for those two parties; no change.

  4. Miles hoffman says :

    In this time of debate over "Obamacare", too many people who read articles like this react (because they disagree), or they cheer (because the favor Obamacare). To be out front, I tend to react, but when I react, I do research (I'm a retired analyst).

    I've read and reread Mr. Kullas article and I find it humorous in that he's a psychologist because he sounds schizophrenic. I can't decide what he is advocating: we spend too much, but we spend too much on 9/11; the "Medical Business Oligarchy" seems at fault, but "prices would collapse... (under) competitive pressures", etc. The only thing Mr. Kulla seems to be advocating is more dialog, and dialog hasn't worked, so let's research.

    I pulled data from the Centers for Medicare and Medicaid Services ("") website's research section summarizing total national healthcare expenditures (forthwith referred to as "TNHC$") over the last 6 decades.

    Mr. Kulla does point out the critical dilemma, "... should health care delivery be a sacred right...". He doesn't seem to realize that question has already been answered.

    In 1960, 48% of TNHC$ were paid out of pocket. Over the next 5 decades, the percentages were 33%, 23%, 19%, 15% and 12%, respectively. In 1960, 21% was paid by private health insurance, which jumped to 32% in 1990 and has stabilized there.

    According to "CMS" footnotes, Medicare and Medicaid became effective July 1966., so the 1960 percentage of TNHC$ was a miniscule 6% and was apparently spending by the Dept. of Defense. CMS's "other" category amounted to 16% of TNHC$ and cannot be isolated further; however it appears most was(IS) government spending. So in 1960, the government controlled somewhere between 6% & 22% of TNHC$.

    By 2010, the government controlled a minimum of 39% of TNHC$ and perhaps 49%. So yes Mr. Kulla, our government believes health care delivery is a sacred right.

    This is one of the real cruxes of the problem - there's no more personal responsibility with regard to health care spending because someone else is doing "all" the paying. No one spends your dollars as wisely as you do!

    Mr. Kulla mentions the U.S. spends $8,500 per person on health care, a figure almost exactly out of the CMS data (it's figure is $8,402, but that was 2010), so I think it's important to also look at the per beneficiary cost.

    CMS says Medicare spends $10,600 per enrollee vs private health insurance's $4,000 per enrollee spending. Comparative Medicaid figures are not given but enrollment levels are growing faster with slightly less dollars spent, so Medicaid appears to spend less per enrollee.

    Mr. Kulla also states that "Administrative costs in the U.S. are 20 to 30 percent of total cost" but the CMS data support a figure of only 10% (which is still worse than other nations?) and other sources show even less.

    Nonetheless, regardless of the administrative costs, it sure seems that the government is NOT spending our health care dollars as wisely as does the insurance industry. And Mr. Kulla, as does Obama, supports greater government control of health care dollars. Go figure!

    By "picking on" the prescription drug industry, Mr. Kulla seems to want to lay much of the blame on them; however, this industry accounts for only about 10% of TNHC$ spending whereas hospitals represent 30% and doctors 20%.

    To try to be succinct, the AMA controls the number of medical schools and thus the number of doctors. It has been very restrictive with regards to increasing the number of either of these, so as many have pointed out, the AMA and doctors are simply a big union that restricts competition. Less supply, aka less competition, and the higher something costs. Why doesn't Mr. Kulla discuss this?

    As "a side note", the number of lawyers per capital has skyrocketed compared to the number of doctors per capita. So for lawyers, there's more supply, aka more competition, and they're competing for the right to sue the doctors and the hospitals (which is why those hospitals and doctors order so many tests, it's called "cover your ass").... but I digress (or do I?).

    As for the drug industry, I do think it gets a bad wrap, perhaps not undeservingly, but for the wrong reason. The drug industry should be blamed for focusing on "blockbuster drugs" and abandoning much other research (to the biotech industry) - and looking for blockbusters is a hit or miss business, and mostly miss at that. However, most of the blame here should probably be laid at the door of the FDA, which has slowed the drug approval process as well as made it even more difficult and costly to comply, in essence, forcing the drug industry to seek blockbuster drugs..

    And the other major crux of the health care problem might imply the drug industry is at fault but in reality it's demographics. Mr. Kulla rightly points out that "Medicare is facing insolvency. A major reason is that too many older people are getting sick."

    But the reality is that the health care industry, and especially the drug industry, has been succeeding in extending longevity. There are simply more old people now, and they continue to get older. And old people consume more drugs. In fact, "aged care" facilities (nursing homes, home health care, retirement communities, were just 4.8% of TNHC$ in 1960 but have grown to 13.2%.

    I've seen a lot of people throw out numbers like 70% of our health care spending is spent on people in the last 6 to 12 months of their lives. I can't confirm numbers but suffice it to say, the real moral dilemma we face in health care is not access to health care or not, but access to health care at what cost... and WHOs cost?

    In my humble opinion, when our forefathers set out to create a country where people could pursue "life, liberty and the pursuit of happiness", NONE of our forefathers meant that these things were a sacred right. If you wanted them, then you pursued the means to obtain them. That is, you work hard or smart to earn them. They were not sacred rights, and neither is health care.



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