What’s Next in America’s Health Care? (Part 2 of 2)

This column is a continuation of last month’s post on American healthcare issues. If you missed it, see the previous post in my Blog.

Last month we discussed five topics, which I described as the “big-picture items.”

As a healthcare consultant, I frequently hear about these concerns from my clients because they create barriers to accessing and obtaining good healthcare. All of us can help in fixing these issues. The first step to resolution is becoming informed and looking at the source of the problem or issue.
 
The topics that I addressed last month are:

1. We have a shortage of physicians, but why?  
2. Physician office settings look different
3. Patients are getting care via apps and other technology
4. Hospital errors are the third leading causes of death in the U.S.
5. Poor work-life balance impacts our health

 
To continue, this month includes four more topics:
6.  If you are rich, you will get better healthcare and more likely live longer
            The following factors about longevity were found in the study results of 2016, published in the Journal of American Medical Association (JAMA) (http://jamanetwork.com/journals/jama/article-abstract/2513561):
 
1. Higher income is associated with greater longevity: The richest 1% live almost 15 years longer than the poorest 1% in America.
2. Inequality in life expectancy increases over time
3. There is more inconsistency and variation in life expectancy with the lower income population compared to the wealthy population
4. Geographic differences impact longevity and is correlated with health behaviors, education, and other characteristics of the area.
 
            As far as access and the ability to afford healthcare, the differences between the rich and poor are apparent to us. Meanwhile, as average consumers, we know about the obstacles – such as waiting for the approval of an MRI. We continue to watch premiums and co-pays go up as coverage goes down. We cannot point the finger at other countries about having the long waits for medical care; it is happening in this country. As of this year, it takes 29 days (on average) to secure an appointment with a family care physician, up from 19.5 days in 2014. For some specialties, the delays are as long a 32-day wait to see a dermatologist, and a 21-day delay at the typical cardiologist’s office (2017 survey done by Merritt Hawkins, a company for healthcare staffing).
            Meanwhile in areas of the country such as northern California, concierge medicine is becoming a popular approach to healthcare for those who can afford it. These private medical practices, with consumers paying out-of-pocket, can avoid the fiasco of the healthcare/insurance system and obtain high quality healthcare. This medical system operates more like a luxury hotel and includes lots of time and attention, as well as convenience and access to the best of care. Although way out of the price range for most Americans, these wealthier consumers note that their concierge healthcare bill is “cheaper than the annual gardener’s bill at our mansions” (https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html?_r=0). Physicians in these private medical businesses do admit that they struggle with the ethical issues of providing elite treatment for a wealthy few, while millions of American struggle to afford basic care.
            What can we do? Healthcare is a major battle in our political arena right now. As consumers, we must become informed; our lives (literally) depend on it and the future of our next generations.
 
7. Food Deserts Do Exist in Our Country
            Citizens in this country don’t like to accept the fact that we actually have people in America who go hungry. We prefer the term, “nutritionally deprived” to hunger – perhaps it makes us feel better. The term Food Deserts is also controversial. But the USDA (U.S. Department of Agriculture) estimates that 3.5 million people who live in urban neighborhoods and rural towns have limited access to fresh, affordable, healthy food. As a result, this population of people relies on processed foods, fast foods, and often shopping in convenience stores, instead of grocery stores. Our poorer citizens in this country, due to their poor nutrition, are suffering from chronic conditions such as diabetes, heart disease, cancer, bone diseases, dental complications and obesity. As previously noted, the death rate of poor people is higher. Fortunately, nonprofits are beginning to bring in healthier foods to these communities, helping to start community gardens and trying to encourage grocery store chains to move into these areas. Some farm markets are accepting food stamps. Locally, People’s Place has a free weekly farmer’s market to assist our poorer citizens obtain healthier food. But it is not enough; more incentives and public health measures are needed. Locally there are over 50 food banks if you want to help out; here is the website (search by zip code): http://www.foodbanknyc.org/get-help/
 
8. The Cost of Aging
            A. Caregiver cost dilemma: As many of us have experienced with our parents, people are living longer, and require more care as they age. Many people prefer not to “end up in a nursing home.” But the reality of being able to stay in your own home and receive care is limited. At this point in time, you either have to be wealthy or be on the opposite end of the scale – people can receive long-term care in the home if all their assets are depleted. According to the Centers of Medicare and Medicaid (CMS), ten percent of the seniors in this country qualify for Medicaid (in addition to Medicare) because they “ran out of money.” But if you fall in the middle of those two extremes, the options are limited. In our area alone, the bills for home care aides for 24/7 care amount to approximately $14,600/month. If care includes a mix of registered nursing services, you can add approximately $4,000 more to that figure – at a monthly cost of $18,000.  The following website provides a cost-of-care calculator:
(https://www.payingforseniorcare.com/longtermcare/costs.html#cocc). Although there is long-term care insurance, it is costly and is also subject to change, just like we are experiencing with healthcare insurance. It is best to research this option in order to determine if it is worthwhile. Thus, as with the suggestions in #6, we need to become informed about healthcare reforms.
             B. The cost of Alzheimer's:
            The Alzheimer’s Association predicts that the disease will cost the U.S. $1.2 trillion overall by 2050. Right now one in nine Americans has the disease and that figure increases to 32 percent for Americans over the age of 85 (http://www.alz.org/downloads/Facts_Figures_2014.pdf). We just discussed the cost of caregivers for the elderly, but if you add in Alzheimer’s to the formula, it is even more costly. In 2014, the bill for the healthcare of Alzheimer’s patients was $150 billion. That doesn’t count for the 15 million Americans who fall into the category of unpaid caregivers (spouses, adult children, other family members and friends); and 65% of those unpaid caregivers are women. Obviously these caregivers make many sacrifices, which results in physical and emotional stress, strained family relationships and financial hardships. More women are giving up their careers and jobs, resulting in a loss of income and often, healthcare coverage. If you want to work on an important cause in this country become involved with the Alzheimer’s Association: http://www.alz.org/downloads/Facts_Figures_2014.pdf
 
9. As the Climate Changes, So Does Our Health
            Regardless of your politics or what you believe is the cause of climate change, it is happening. We are experiencing extreme weather systems, rising sea levels, rising temperatures, and increasing carbon dioxide measurements. It is certainly not new; our earth has experienced climate changes before (http://www.humanosphere.org/global-health/2016/01/guest-post-10-global-health-issues-to-follow-in-2016/). People are dying from air pollution. The World Health Organization estimates that globally 7 million premature deaths are related to air pollution, with MIT News estimating 200,000 deaths occurring annually in the U.S. Respiratory troubles, particularly asthma, are on the rise and this especially impacts children and the elderly. Fortunately, many faith-based organizations, instead of getting caught up in the politics or the reasons, are not denying climate change and are recognizing the importance of “environmental stewardship.” There is a resulting intersection of religion and public health. To name a few general issues, climate changes have a negative impact on our health as the changes are effecting our water supply, agricultural yield, our ocean life, the safety of our earth (droughts, fires), infrastructure, the spread of infectious disease, and respiratory conditions. “As climate change threatens communities in the U.S. and throughout the world, public health and faith-based groups are relying on each other to create a safer, healthier environment” (http://thenationshealth.aphapublications.org/content/47/5/1.1.full).
 
            We have continuously changing healthcare issues in our nation. The healthcare system has become complex and it requires savvier consumers. This means that consumers need to be informed by reading about hospital systems, community health, and national health – even global health. On an individual level, consider the benefits of developing good communication skills to talk with your providers, understanding the new technologies, becoming informed about the politics that impact healthcare, making plans and considering the cost of good healthcare in the future as you age – and finally, it helps to become involved in one’s community health issues. Choose a topic and help to be part of the solution for your country.