An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

According to U.S. law, the same product cannot be on the market as both a prescription and an over-the-counter product.

The surprising result is that today there is generally far less careful scrutiny of new devices than of new drugs, even though most drugs can be stopped in an

instant if problems emerge and many devices are permanently implanted in the body.

She concluded that the pathway error might be fixed with an immune modulator called tumor necrosis factor (TNF), which was known to also be involved in the body’s natural defense against cancers. While clinical studies in the 1980s had determined that TNF

was too toxic to give directly to patients, there was fortunately already a drug on the market that stimulated its production: bacillus Calmette-Guérin (BCG), a vaccine against tuberculosis that was so old it had long been generic. It was very safe.

“If the March of Dimes was operating according to today’s foundation models, we’d have iron lungs in five different colors controlled by iPhone apps, but we wouldn’t have a cheap polio vaccine,”

Growing health systems often effectively protect their market by controlling electronic medical records (EMR), a tool originally intended to improve

communication between hospitals and physicians: the idea of digital record keeping in healthcare was considered so beneficial that the American Recovery and Reinvestment Act of 2009 included $19 billion in incentives to develop and deploy the technology, “one of the largest publicly funded infrastructure investments the nation has ever made in such a short time period, in health care or any other field.”

commercially insured patients were leaving town to avoid the conglomerate’s high charges, the response, he says, was that Sutter said it would consider lowering the charges for elective services to gain back the business, but not for emergencies—since patients in extremis couldn’t travel.

Some of the increased cost is borne by insurers, but patients also encounter larger bills. According to the terms of Ms. Debold’s policy, X-rays done in a physician’s office required only a $25 co-pay, or $50 at a radiologist’s office. But services performed in a hospital require her to pay the first $2,000, a deductible. That’s why she received a bill for $500.

one in five Americans had medical debt on their credit record, impacting their ability to get a mortgage or buy a car.

Connecticut’s Office of the Healthcare Advocate said that getting billed for what patients had anticipated would be a free screening colonoscopy has generated more consumer complaints than any other ACA provision.

Is the practice owned by a hospital or licensed as a surgery center?

Will you refer me only to other physicians in my insurance network, or explain why in advance if you can’t?

If I need blood work or radiology testing, can you send me to an in-network lab?

In Your Doctor’s Office Here are some questions every doctor or healthcare provider should be able to answer for you at a doctor’s appointment: 1. How much will this test/surgery/exam cost?

How will this test/surgery/exam change my treatment? If the answer is “It won’t, but it might be good to know,” take a pass.

But most problems—coughs, back pain, a rash—can be treated by waiting to see if they resolve themselves. The value of so-called watchful waiting is taught in medical school, but it is terrifically underused in American medicine because it isn’t at all profitable.

(1) Price transparency should be mandated: “The difficulty in obtaining the cost or price of medical care should end. These should be very easy to obtain. Doctors are as ignorant as patients as to these prices and hospitals should teach doctors and patients these prices, not hide them.”

Hospitals in your network should also be required to guarantee that all doctors who treat you are in your insurance network. State regulators should insist that this be written into insurance contracts, and your company HR representatives should insist on this during annual policy negotiations. The hospital has contracts with emergency room doctors, anesthesiologists, pathologists, and radiologists. It has up-front bargaining power to ensure they join networks if they want to work under the hospital’s roof.

support. If you’re