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A friend is admitted to the hospital. He was experiencing shortness of breath and chest pains extending down his arms. Obviously the signs of a heart attack or an impending one. Doctors do a complete work up on him. He's diagnosed with mitral valve stenosis and needs a valve replacement [maybe 2]. One problem is his kidneys aren't functioning properly, a possible complication of his diabetes, which is causing some concern to the doctors.

Anyways, there's a lot of discussion amongst the doctors, and it's decided his condition isn't urgent. So he's sent home to recover, under a nurse's monitoring, until his kidney function improves, and his condition can be further evaluated.

So now that I've set the stage, you can pretty much forget everything I just mentioned, because it's what comes next that is so disturbing.

Upon my friend's release, he's prescribed a number of medications, one of which is a blood thinner, Lovenox, although the name of drug is irrelevant. The problem is when his wife goes to the pharmacy to pick up the prescription, she learns their health insurance doesn't cover that drug, and it will cost $1,000.

Taken aback slightly, and not having the $1,000, she contacts the doctor to see if there is a generic version, or a substitute drug he can prescribe that is covered. But instead of getting a different prescription, the doctor simply states, "oh, he doesn't really need it anyways."

WHAT THE ..............! HE DOESN'T NEED IT! THEN WHY PRESCRIBE IT TO HIM IN THE FIRST PLACE? WERE YOU TRYING TO RIP MY FRIEND OFF, OR JUST HIS INSURANCE COMPANY? WHAT OTHER PRESCRIPTIONS DOESN'T HE NEED? AND WHAT ABOUT EVERYTHING ELSE YOU'VE SAID? HOW MUCH OF THAT CAN WE BELIEVE?

No wonder Americans pay twice as much for health care than everyone else in the world, and have worse outcomes. No good can come from prescribing unneeded medications, and ordering unnecessary tests and procedures. But that is the US health care system.

It's called fee-for-service medicine, and it is the single biggest driver of increasing health care costs, and decreasing quality of care. In the US, doctors don't get paid for doing nothing. Doctor don't get kickbacks paid for not prescribing medications. They get paid for doing just the opposite. They get paid when they prescribe medications, and for ordering and performing tests and procedures, whether they're needed or not. In the US patient care comes secondary to profits.

Contrary to what some people might have you believe, health care is not a commodity like other commodities. We only get one chance at life. You can't trade yours in for a new one, like you can a car. You can't simply return a defective/malfunctioning heart, and install a replacement, like it's a kitchen appliance. And a ruptured artery doesn't yield the same result as a busted waterline in your home.

Increased competition, and shifting more of the burden of health care onto individuals and businesses is not the answer to our problems. Until we recognize that, the quality of health care in the US will continue to degrade, and health care costs will continue to soar, until no one, that is except for the very rich and of course our elected representatives, will be able to afford health care, good or bad.

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