Medicare Essentials You and Your Health

Who Controls Your Health Care?

Who Controls Your Health Care?

Not Your Doctor, That’s for Sure


health care reform

Image: © mokee81

The American healthcare system is in turmoil. The government, insurance companies, and pharmaceutical companies are stirring the pot while doctors and patients sweat it out in the hot water.

Patients may not exactly see it that way, but the truth is that doctors don’t have much control of the system either. Few solo practices exist these days thanks to the big business of medicine. It simply costs too much to run an office these days. Instead, hospital systems buy them out, and administrators call the shots.

Simply look at the government’s requirement that doctors use electronic health records (EHR). According to, the average EHR system costs $15,000 to $70,000 per provider and that is only to install and initiate the system. Addition costs include annual maintenance and licensing fees which range from $4,000 to $8,000 per provider. Now add the costs of rental property, support staff salaries and all that comes with managing a business and things get even more complicated. It is no wonder that many practices have turned to larger networks to manage the overhead.

A recent report from the Annals of Internal Medicine shows the added burden of those EHRs. Healthcare providers spend twice the time documenting in the EHR than they do on actual patient care. The administrative burden of using an EHR often results in work that needs to be done on personal time, leading to increasing levels of physician burnout. Doctors are being driven away from meaningful patient care to complete tasks that have not been shown to improve patient outcomes.

What has gone wrong with our healthcare system? Why are doctors scrambling to deliver quality care? Why are patients struggling to access that care? Who is really running the show?

The Role of Government

The United States often claims to have the best healthcare system in the world. Sadly, that has not proven to be true. According to a 2014 study by the Commonwealth Fund, the United States ranks only 11th in health care for developed countries! Great Britain and Switzerland ranked #1 and #2, respectively, Canada #10. Interestingly, all ten countries that led the United States had universal healthcare systems.

Why doesn’t the United States hop on that bandwagon? When 2016 presidential candidate Senator Bernie Sanders promoted Medicare for All, people balked. They did not want to pay the taxes needed to pay for a single-payer system. People also balked back in the 1980s when President Reagan tried to expand coverage with the Medicare Catastrophic Coverage Act of 1988. The act was repealed in 1990. Again, too many taxes.

What will cost us more? Taxes or a failing healthcare system?

As it stands, America runs on capitalism and market competition, even when it comes to health care. Private insurance companies and pharmaceutical companies set the costs. Hospital administrators follow suit.

The government offers Medicare coverage but subcontracts its Medicare Advantage plans out to private insurance companies. Medicare Part D plans, the prescription drug benefit, are also run by private insurers. The government essentially shifts the power to big business.

Big Pharma

Businesses like to turn a profit and they usually do so at any cost. Just ask former Turing Pharmaceuticals CEO Martin Shkreli or current Mylan Pharmaceuticals CEO Heather Bresch.

Shkreli increased the cost of Daraprim (pyramethamine), an anti-parasitic drug used to treat toxoplasmosis. The infection is often acquired in people with HIV/AIDS. Overnight the cost rose from $13.50 to $750 per pill, an increase of more than 5,500 fold!

Bresch saw an increase in her salary from $2.5 to $19 million from 2007 to 2016 while the price of the Epipen rose from $100 to $600 for a two-pack during the same period. The drug is used to treat life-threatening allergic reactions with more than 3 million EpiPens prescribed every year. The drug with its injection device costs under $30 to make.

With increasing awareness of an opioid epidemic (the CDC reports that 78 people die from an overdose every day), the price of naloxone, a drug used to reverse an opioid overdose, has increased 17-fold over the past two years. Amphastar Pharmaceuticals, the largest maker of the generic drug, is now being investigated for price gouging.

Why do they do it?

Because they can.

It doesn’t matter that people’s lives were at stake. Profits won over patient safety and medical need. What matters to Big Pharma is that there is no government regulation over how much they can charge. In fact, there are actually laws in place that prevent federal interference. How can a government protect its citizens if it does not step in when it counts?

Private Insurance Companies

Private insurers also look to improve their profit margins. Aetna, Anthem, Cigna, Humana, and United HealthGroup are the five leading health insurers in the United States and mergers are on the horizon. Aetna is looking to merge with Humana and Anthem with Cigna. The Department of Justice is looking to challenge these mergers from the perspective that they may create local monopolies. With monopolies come decreased market competition. That means price hikes all around.

Aetna went so far as to threaten withdrawal from Obamacare exchanges if the government prevented its merger with Humana. Specifically, they said that if the merger proceeded, they would expand Obamacare plans to five other states but if it failed to pass, they would withdraw from five states they already had contracts with for 2017.

Whether or not you agree with Obamacare, this is unacceptable. A private company should not be threatening the federal government with an ultimatum. Yet there is nothing to prevent this from happening. This is the culture of capitalism. Profits at any cost. Don’t even get me started on the ongoing investigations for rampant overcharging by Medicare Advantage plans.

The Solution?

The debate over universal health care wages on.

Until then, we have to work with what we have.

Whether you are in favor of big or small government, laws need to be enacted that allow the government to challenge the practices of these large companies. Without it, there is no chance for cost containment. The government also needs to stop putting increased burdens, both administrative and financial, on doctors so they can focus on what matters most — patient care. We need to turn the business of medicine upside down. Instead of prioritizing Big Pharma and insurance companies, our country needs to prioritize its citizens.

We need healthcare reform now.

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