Summary: Economist Ed Dolan points to an amazing example of our mad health care system at work. It is one of the least discussed of America’s most serious problems.
This week I had a cardiovascular workup at a hospital. I got a physical exam, blood tests. chest x-ray, and treadmill EKG. The results were fine. While there I admired the surroundings. The good American big city hospitals (not those that treat the poor) are among our most opulent buildings, exceeded only by plutocrats’ mansions and corporate HQs. They are like American temples.
Even more impressive is modern medical technology. It makes the medical tech of my childhood look like antiques. All the instruments — blood pressure, x-ray, treadmill EKG — were computer controlled. With the hospital’s information systems automated, most of the receptionists’ desks were empty. I electronically received all of the test results within 24 hours, along with explanations,
It was all quite amazing. But this all raises a strange question. Why have these marvels not greatly improved American’s health and lifetimes? That is a complex question, with no obvious answer.
But there is another question, even more important. Economist Ed Dolan discusses it in a report at the Niskanen Center. We pay so much more (a fantastic 18% of GDP — two or three times what our peer nations’ spend. For that we get few or no extra benefits. America groans under the expensive of our mad health care system. It comprises the largest share of the massive government liability that so terrifies conservatives.
Where does the money go? For a small but illustrative example, he points to a recent study with some amazing results.
by Fred Schulte and Elizabeth Luca
at the Kaiser Health News website.
“The cups of urine travel by express mail to the Comprehensive Pain Specialists lab in an industrial park in Brentwood, Tenn., not far from Nashville. Most days bring more than 700 of the little sealed cups from clinics across 10 states, wrapped in red-tagged waste bags. The network treats about 48,000 people each month, and many will be tested for drugs.
“Gloved lab techs keep busy inside the cavernous facility, piping smaller urine samples into tubes. First there are tests to detect opiates that patients have been prescribed by CPS doctors. A second set identifies a wide range of drugs, both legal and illegal, in the urine. The doctors’ orders are displayed on computer screens and tracked by electronic medical records. Test results go back to the clinics in four to five days. The urine ends up stored for a month inside a massive walk-in refrigerator.
“The high-tech testing lab’s raw material has become liquid gold for the doctors who own Comprehensive Pain Specialists. This testing process, driven by the nation’s epidemic of painkiller addiction, generates profits across the doctor-owned network of 54 clinics, the largest pain-treatment practice in the Southeast. Medicare paid the company at least $11 million for urine and related tests in 2014, when five of its professionals stood among the nation’s top billers. One nurse practitioner at the company’s clinic in Cleveland, Tenn., single-handedly generated $1.1 million in Medicare billings for urine tests that year, according to Medicare records. …
“Kaiser Health News, with assistance from researchers at the Mayo Clinic, analyzed available billing data from Medicare and private insurance billing nationwide, and found that spending on urine screens and related genetic tests quadrupled from 2011 to 2014 to an estimated $8.5 billion a year — more than the entire budget of the Environmental Protection Agency. The federal government paid providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined.
“Yet there are virtually no national standards regarding who gets tested, for which drugs and how often. Medicare has spent tens of millions of dollars on tests to detect drugs that presented minimal abuse danger for most patients, according to arguments made by government lawyers in court cases that challenge the standing orders to test patients for drugs. Payments have surged for urine tests for street drugs such as cocaine, PCP and ecstasy, which seldom have been detected in tests done on pain patients. In fact, court records show some of those tests showed up positive just 1% of the time.
“Urine testing has become particularly lucrative for doctors who operate their own labs. In 2014 and 2015, Medicare paid $1 million or more for drug-related tests billed by health professionals at more than 50 pain management practices across the U.S. At a dozen practices, Medicare billings were twice that high.
“Thirty-one pain practitioners received 80% or more of their Medicare income just from urine testing, which a federal official called a ‘red flag’ that may signal overuse and could lead to a federal investigation. ‘We’re focused on the fact that many physicians are making more money on testing than treating patients,’ said Jason Mehta, an assistant U.S. attorney in Jacksonville, Fla. ‘It is troubling to see providers test everyone for every class of drugs every time they come in.’ …
‘It Was Almost A License To Steal’
“Tests to detect drugs in urine can be basic and cheap. Doctors have long used testing cups with strips that change color when drugs are present. The cups cost less than $10 each, and a strip can detect 10 types of drugs or more at once and display the results in minutes.
“After noticing that some labs were levying huge charges for these simple urine screens, the Centers for Medicare & Medicaid Services moved in April 2010 to limit these billings. To circumvent the new rules, some doctors scrapped cup testing in favor of specialized — and much costlier — tests performed on machines they installed in their facilities. These machines had one major advantage over the cups: Each test for each drug could be billed individually under Medicare rules.
“‘It was almost a license to steal. You had such a lucrative possibility, it was very tempting to sell as many [tests] as you can,’ said Charles Root, a longtime lab industry consultant whose company, CodeMap, has tracked the rise of testing labs in doctors’ offices. …
There is likewise little scientific justification for many of these new types of drug testing that have made their way onto doctors’ order sheets and laboratory menus.
Many pain patients on opioids are routinely tested for phencyclidine, an illegal, hallucinogenic drug also known as PCP, or angel dust, Medicare records show. Yet urine tests have rarely detected the drug. Millennium, the San Diego-based company that once topped Medicare billings for urine tests, found PCP in fewer than 1% of all patient samples, according to federal court filings. …
Government officials have criticized the explosive growth in testing for some prescription drugs, notably a class of tranquilizers known as tricyclic antidepressants. Medicare paid more than $45 million in 2014 for more than 200,000 people to be tested for tricyclic drugs, often multiple times. Medicare was billed for 644,495 tests for one tricyclic drug, amitriptyline, up from 6,173 tests five years earlier.
The Department of Justice argued in a 2012 whistleblower case that these tests often couldn’t be justified because of “low abuse potential” of the drugs and a “lack of abuse history for the vast majority of patients.”
——————– See the full report here. ——————–
“If God didn’t want them sheared, he would not have made them sheep.”
— Calvera, bandit leader in the movie “The Magnificent Seven” (1960).
This is a tiny example of the extractive US health care system at work. It works much like the extractive defense industry and extractive Wall Street financial sector. These sector’s immense profits gives them the political power to resist reform. Both Democrats and Republicans love them. It is America’s “grifter economy.”
Little can be done to fix America without tackling these leaches. It can be done only by a broad citizen coalition that looks beyond the divisive issues that today keep us weak.
Being sheep is a choice, not a destiny.
For More Information
- Hidden truths about American health care.
- The core truth about our health care system — It’s quite mad.
- What does the health care debate reveal about us, and our future?
- Why do so many new-born babies die unnecessarily in America, the City on a Hill?
- Single payer healthcare is coming to America. It’s inevitable.
A new book explaining this vital issue.
Crisis in U.S. Health Care: Corporate Power vs. The Common Good by Dr. John Geyman (professor emeritus of family medicine at the U of Washington School of Medicine). See his website, with bio and articles about health care. From the publisher…
“The debate over U.S. health care — where to go next to rein in costs and improve access to quality health care — has become bitterly partisan, with distorted rhetoric largely uninformed by history, evidence, or health policy science. Based on present trends, our expensive dysfunctional system threatens patients, families, the government, and taxpayers with future bankruptcy.
“This book takes a 60-year view of our health care system, from 1956 to 2016, from the perspective of a family physician who has lived through these years as a practitioner in two rural communities, a professor and administrator of family medicine in medical schools, a journal editor for 30 years, and a researcher and writer on health care for more than four decades. There has been a complete transformation of health care and medical practice over that time from physicians in solo or small group practice and community hospitals to an enormous, largely corporatized industry that has left behind many of the traditions of personalized health care.
“This is an objective, non-partisan look at the major trends changing U. S. health care over these years, ranging from increasing technology and uncontrollable costs to depersonalization and changing ethics in medicine and health care. This book points out some of the highs — and lows — of these changes over the years, which may surprise some readers. It also compares the three basic alternatives for health care reform currently being debated.”