Category Archives: Corona Virus

Fed Chair Jerome Powell calls out massive US health spending, says Americans are 'getting nothing' in return; and What are Pete Buttigieg’s Plan for Health care? More on the Coronavirus and health care costs.

Josepj Zeballos-Roig reported that Federal Reserve Chair Jerome Powell said at a Senate hearing on Wednesday that Americans were “getting nothing” in return for what the US spends on healthcare.

“The outcomes are perfectly average for a first-world nation, but we spend 6% to 7% of GDP more than other countries,” he said. “So, it’s about the delivery. That’s a lot of money that you are effectively spending and getting nothing.”

Studies have indicated that the US spends far more on healthcare than other developed countries, only to achieve worse outcomes.

One study published last year in a medical journal estimated that nearly a quarter of the US’s $3.6 trillion health spending was wasteful.

Why the heck is this true??

The United States is one of the highest spenders on healthcare for its citizens, but it has very little to show for it, Federal Reserve Chairman Jerome Powell said on Wednesday.

Powell made the brutal comments during a Senate Banking Committee hearing on monetary policy.

Republican Sen. Ben Sasse of Nebraska asked the Fed chair to weigh in on the effect of healthcare spending on the economy, and Powell said the US was spending at far higher levels without much to show for it.

“The outcomes are perfectly average for a first-world nation, but we spend 6% to 7% of GDP more than other countries,” he said. “So, it’s about the delivery. That’s a lot of money that you are effectively spending and getting nothing.”

The Fed chair added that developed countries had been more successful in delivering quality healthcare for much less to their citizens.

“It’s not that these benefits are fabulously generous — they’re just what people get in Western economies,” Powell said.

It’s not the first time Powell has weighed in on the rising price tag of healthcare in America. In a 2018 interview with Yahoo Finance, he warned that it could hurt the country’s economy in the future.

“It’s no secret: It’s been true for a long time that with our uniquely expensive healthcare delivery system and the aging of our population, we’ve been on an unsustainable fiscal path for a long time,” the Fed chair said.

US health spending grew by 4.6% in 2018, reaching over $3.6 trillion, according to the Centers for Medicare and Medicaid Services. And it has been swelling for decades.

The US spent about $10,000 per person for healthcare in 2017, about twice as much as other developed countries, according to the nonpartisan Kaiser Family Foundation. But it has ranked poorly in health outcomes, particularly on infant mortality and deaths from preventable causes under age 75.

One study published in the Journal of the American Medical Association last year estimated that nearly a quarter of that spending — up to $935 billion a year— was wasteful, with failures of care delivery and coordination eating up most of the nation’s mismanaged health expenditures.

How do we change this and will a government run system solve these problems?

‘A godsend to my old industry’: A former insurance executive says Pete Buttigieg’s healthcare plan would keep huge profits for insurers and bankrupt Americans

I thought that as Pete Buttigieg is surging in the polls that we should look at his health care strategies. Joseph Zeballos-Roig further reported that Wendell Potter, a former insurance executive, ripped into Pete Buttigieg’s health plan in an interview with Business Insider.

Potter said he believes the plan is a “godsend” for the insurance industry and will allow it to maintain its grip over American healthcare.

“They’d be happy as clams on the Pete Buttigieg health plan,” he told Business Insider.

The Buttigieg campaign defended the plan in statement and noted the insurance industry has also spent millions attacking it.

A former insurance executive says Mayor Pete Buttigieg’s proposed healthcare plan would be “a godsend” for insurers and allow it to exert outsize power in the debate around healthcare reform.

Wendell Potter, President of Medicare for All, an advocacy organization, tweeted on Tuesday that Buttigieg’s effort to continue attacking a proposal to insure everyone in the US in the Democratic primary would massively benefit the health industry.

“This will thrill my old pals in the insurance industry, as Pete’s plan preserves the very system that makes them huge profits while bankrupting & killing millions,” Potter wrote.

He resigned from his position as a senior communications executive at Cigna in 2008 and went on to testify against the insurance industry in Congress.

In an interview with Business Insider, the former healthcare executive said he believed Buttigieg’s plan would be a “godsend” for the industry in a system designed to maximize profits at the expense of consumers.

“They’d be happy as clams on the Pete Buttigieg health plan,” he said. “It doesn’t change much.”

Potter criticized a mandate in the proposal compelling people to carry health insurance which could saddle people with multi-thousand-dollar fines at the end of the year, given a provision to cap premiums at 8.5% of income. It resembles the least popular part of the Affordable Care Act that Congress repealed under the 2017 Republican tax law.

The former Cigna executive has sought to generate support for universal healthcare, and met with the Sanders and Warren presidential campaigns. But he doesn’t plan on endorsing a candidate in the competitive primary.

The Buttigieg health plan mirrors the one that former Vice President Joe Biden unveiled last year, another moderate. Both candidates have faced off against Sens. Bernie Sanders and Elizabeth Warren’s support to create a single-payer system in the US, which would cost over $30 trillion over a decade.

Buttigieg’s $1.5 billion health proposal is a middle-of-the-road approach. It would create a government-managed plan for people who want it while allowing others to maintain their private insurance. He’s touted it as a “glide path” towards universal health coverage.

What the heck does that mean?

In a statement to Business Insider, Sean Savett, a spokesperson for the Buttigieg campaign, defended the plan and noted insurers have also spent millions of dollars slamming it.

“Pete’s ‘Medicare for All Who Want It’ plan would make some of the boldest, most progressive changes to our health care system in decades in order to achieve universal coverage for all Americans,” Savett said. “It has also been attacked by the health insurance industry because it would create competition and force insurers to lower costs and improve care or lose customers — so that claim doesn’t hold up.”

In recent months, the health industry has spearheaded a multimillion-dollar effort to throttle proposals for Medicare for All.

It often lumps modest attempts at reform — such as Buttigieg’s plan — alongside universal healthcare and industry groups warn it could lead to a “one size fits all” system with hospital closures and longer wait times to receive medical care.

Still, the effectiveness of a public option depends on its strength. It would likely still shake up the healthcare system and empower the government to negotiate with providers for lower costs.

Larry Levitt, executive vice president for the Kaiser Family Foundation, said to the New York Times last year: “The political appeal of the public option is it preserves the choice of private insurance. But the better it works, then the less likely it is to actually preserve a private insurance market.”

The glaring question continues to be how will the $1.6 billion be paid?

John Legend calls Pete Buttigieg’s ‘Medicare for All Who Want It’ plan a ‘trap’

Further, we had Eliza Relman of the BusinessInsider report that John Legend took issue with former Mayor Pete Buttigieg’s healthcare-reform proposal in a series of tweets on Thursday, saying the 2020 candidate’s plan doesn’t go far enough to protect Americans.

As if John Legend is someone whose evaluation on health care should be valued!

Buttigieg’s “Medicare for All Who Want It” plan would essentially add a public option to Obamacare. 

“It’s a trap for progressives to try to talk about healthcare as some sort of free market like they’re talking about TVs or cell phones,” Legend tweeted. “Healthcare is a necessity and there’s very little choice when you’re actually sick. You need treatment and you need it to not bankrupt you.”

Critics of a public option, including those who favor “Medicare for All,” say it wouldn’t adequately rein in healthcare costs and would leave the insurance industry with significant influence over Americans’ healthcare coverage.  

John Legend took issue with former Mayor Pete Buttigieg’s healthcare-reform proposal in a series of tweets on Thursday in which he said the 2020 candidate’s plan didn’t go far enough to protect Americans.

“This myth of freedom and choice sounds wonderful til you realize your boss has the freedom and choice to fire you from this union job,” the singer wrote, retweeting Buttigieg’s message promoting his “Medicare for All Who Want It” plan for union workers. 

Buttigieg’s plan, like the one proposed by former Vice President Joe Biden, would essentially add a public option to Obamacare, opening up Medicare for those who don’t have or want private insurance. Critics of a public option, including those who favor “Medicare for All,” say it wouldn’t adequately rein in healthcare costs and would leave the insurance industry with significant influence over Americans’ healthcare coverage.  

“It’s a trap for progressives to try to talk about healthcare as some sort of free market like they’re talking about TVs or cell phones,” Legend said. “Healthcare is a necessity and there’s very little choice when you’re actually sick. You need treatment and you need it to not bankrupt you.”

He added, “And the so-called ‘market’ for healthcare is so opaque, there are few if any perfectly informed consumers. And no one can predict what healthcare they’ll need in the future.” 

Spokespeople for Buttigieg’s campaign didn’t immediately respond to a request for comment. 

Health Insurance Premiums Continue to Increase. What Can You Do?

MoneyWise noted that according to the Kaiser Family Foundation’s annual employer benefits survey, the average annual health insurance premium for family coverage for employer-sponsored health plans was over $20,000 in 2019. That’s the first time premiums have reached the milestone. Premiums were 5% higher than the year before.

Meanwhile, a 2018 report from the National Association of Insurance Commissioners noted that the health insurance industry was continuing its “tremendous growth trend,” going from a profit margin of 2.4% in 2017 to 3.3% in 2018.

The numbers haven’t come in yet for 2019, but insurers in 2019 have posted record profits, and many individuals and families have experienced climbing health insurance premiums in recent years.

Why health insurance premiums are climbing

While a number of factors contribute to the rising cost, Melissa Thomasson, department chair and professor of economics at Miami University in Oxford, Ohio, has identified two main reasons for rising health insurance premiums: consolidation and billing.

Consolidation

Thomasson says that the increasing consolidation of health care is the main driver of rising premiums.

“People can look around, and they see physicians’ practices being purchased by hospitals. Well, every time that happens, those bills increase,” Thomasson says.

This is what you likely learned in high school economics class. “When competition is lowered, prices go up,” Thomasson says. “As hospitals merge, they have less competition and more leverage with the insurers, and the discounts get lower. Consolidation forces health care prices to go up.”

Billing

The second factor is “surprise billing,” Thomasson says. Every health care bill may seem like a surprise, given how you often don’t know what you’ll be charged. But Thomasson says that it’s becoming more common for consumers to receive extremely large bills for out-of-network care — even though they thought they were receiving care within their health insurance network.

“It doesn’t always occur to you to ask, ‘How much will it cost for somebody to read that X-ray?’” Thomasson says.

What you can do about rising health insurance premiums

Often, when you ask experts what can be done about rising insurance premiums, the answer is “not much.” But there are a few strategies you can use to try to tame your costs.

Tinker with your health insurance plan

Keep your plan, but talk to your insurance agent or the insurer directly about making changes.

Choosing a higher deductible and higher copays will lower your premium, says Matt Oves, an employee benefits account manager at Sahouri Insurance, an independent insurance brokerage located in Tysons Corner, Virginia.

“If you are healthy and do not anticipate any major health concerns, it may be smart to select a plan with higher deductibles,” Oves says.

However, it may not be a good idea if you often go to the doctor, or you anticipate needing to see a physician frequently in the near future. If you’re paying a smaller monthly premium but you’re shelling out higher copays two or three times a month throughout the year, you might wish you had kept your premium as it was.

Consider a health savings account (HSA) or flexible spending account (FSA)

This is one strategy that I have suggested to my family. Oves suggests taking advantage of an HSA or FSA if you can. Some people with high-deductible health insurance plans, as defined by the government, qualify for health savings accounts. Each year, you decide how much to contribute to your HSA, and that money is usually not subject to federal income tax. If you don’t use the money, it rolls over to the next year. That will help cover out-of-pocket costs. There are also investment options for HSA funds, providing an added bonus to those with high-deductible plans.

Flexible spending accounts are similar to HSAs, but the money doesn’t roll over to the next year and the account is owned by the employer. FSA contributions are deducted from your salary with pre-tax dollars. The employee usually receives a debit card to use for qualified health expenses. If you qualify for both an HSA and an FSA, you’ll likely find more flexibility and benefit from an HSA.

Look into a short-term health insurance plan

Adam Hyers, who owns Hyers and Associates, Inc., an insurance agency in Columbus, Ohio, says that many of his healthy clients have enrolled in short-term insurance plans that can last 12 months or longer.

“These policies now look much like what insurance plans did pre-ACA and can cover the insured for unknown, catastrophic types of issues. In many cases, premiums for short-term plans can be half as much as ACA-type policies,” Hyers says.

However, Hyers cautions, “short-term plans aren’t the solution for everyone as they don’t cover preexisting conditions, but they are a good option for those who just want to cover a bigger event that could happen throughout the year.”

In other words, it’s a stop-gap solution if you need a health plan while you look for a plan you can afford, you’re between jobs or you need coverage in case of an emergency.

Stay healthy

Eating your fruits and vegetables, exercising and not doing unhealthy activities, like smoking, can help lower your insurance costs today and over time. Obesity and other conditions can increase your costs over time. Using your preventative health insurance every once in a while, can help keep your health care costs lower in the future.

“Get routine checkups to catch health problems early and avoid paying for complex surgeries later,” Oves says.

Think of your body as a car. If you never change the oil because it’s expensive, eventually you’ll destroy your engine and be out far more money. If you don’t get an annual physical, you may pay for it later in a big way.

Talk to your representatives

Call your senator. Call your member of Congress. Thomasson recommends this if you’re looking for health care premium relief in the long run. If you feel that the government should be working to bring health care prices to more manageable levels — for you and your employer — then make your voice heard.

Your wages may be paying for insurance premiums

Thomasson notes that if your wages haven’t risen much lately, it may be due to your employer-provided health plan. “If your employer is paying for your higher and higher premiums, then you’re receiving compensation for that. And that’s the raise that your employer can’t give you,” Thomasson says.

There’s the chicken-and-egg irony in all of this. Your health plan is getting more expensive, which keeps your employer from offering you a higher salary, which makes your health plan even harder to pay for.

While it may be challenging to combat rising insurance premiums, knowing your options and taking small actions can help save you money today and in the future. While you may not be able to lower your premium, you can make changes to help offset the costs, or even inspire change in your workplace or community by understanding how insurance premiums work.

And now more on the Corona virus, or COVID-19!

More than 1,700 healthcare workers in Wuhan have gotten the coronavirus. A study found that 29% of infections were in medical staff.

Holly Secon reported that as the new coronavirus, now known as COVID-19, continues to spread, hundreds of healthcare workers are getting sick.

China’s National Health Commission announced Friday that 1,716 health workers had contracted the new virus. Six have died.

One study found that nearly a third of the patients involved were healthcare workers.

Healthcare workers on the front lines of the coronavirus outbreak are getting sick by the hundreds.

China’s National Health Commission said on Friday that 1,716 healthcare workers nationwide had been infected by the virus. Of that total, 87.5% are in the Hubei province, where the outbreak began.

In addition, Chinese authorities confirmed for the first time that six healthcare workers have died. That includes doctor Li Wenliang, who was censored by Chinese authorities after warning colleagues about the new virus.

The South China Morning Post Tuesday that at least 500 healthcare workers in Wuhan hospitals had contracted the virus, and approximately 600 more cases were suspected, but the official numbers reveal that the risk to medical staff is even more dire.

Research published last week in the Journal of the American Medical Association found that of 138 total patients studied, 29% were healthcare workers. In one case, a patient admitted to a hospital in Wuhan infected at least 10 medical workers and four other patients.

Together, these reports highlight a concerning threat both to the individuals working to curb this outbreak and to Wuhan’s already overstressed healthcare system.

Healthcare workers at risk

The coronavirus has infected more than 64,000 people and killed nearly 1,400. It has spread to 25 countries beyond China.

Healthcare workers are particularly vulnerable for a handful of reasons. First, the coronavirus is highly contagious, and medical staff members are exposed to more viral particles than the general public. Second, they’re facing shortages of supplies as the tide of patients rises. Third, a combination of stress and long hours could make their immune systems more vulnerable than normal. 

A lack of data and information about the new coronavirus is a fourth challenge. Gastrointestinal symptoms, for example, were not initially recognized as potential early indicators. That’s the reason one Wuhan patient infected 10 medical workers: The person came into the hospital with abdominal issues but was placed in a surgical ward, since the symptoms didn’t match known coronavirus red flags. Four other patients in the ward then caught the virus, too.

The threat to hospital staff isn’t limited to China: Two of four new coronavirus cases in the UK are healthcare workers, officials announced Monday.

“We are now working urgently to identify all patients and other healthcare workers who may have come into close contact, and at this stage we believe this to be a relatively small number,” Yvonne Doyle, medical director of Public Health England, said in a statement. 

At the Good Samaritan Hospital in San Jose, California, meanwhile, five employees were sent home and told to self-isolate for about two weeks after they came into contact with a patient later confirmed to have coronavirus.

Infection among healthcare workers has been a problem during outbreaks of other coronaviruses as well, including SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Around 20% of people who got SARS were medical workers. One highly contagious patient — a “super-spreader” — infected 50 doctors and nurses.

“We’ve seen this before with MERS, we’ve seen this before in SARS,” Mike Ryan, the executive director of the World Health Organization’s Health Emergencies Program, said in a press conference on Friday. “If you look at the percentage of overall cases, although it’s a tragic situation for the health workers … it is a lower percentage than has occurred in other coronavirus outbreaks.” 

Overwhelmed by the coronavirus outbreak 

In Wuhan, where nearly 20,000 cases have been documented, hospitals have reported running out of beds, testing kits, and protective gear.

Chinese authorities sent 10,000 additional medical workers and more protective gear to the hospitals in the city and rapidly built two new hospitals there as well. Hotels, sports centers, exhibition spaces, and other local venues are also serving as temporary treatment centers.

But a doctor at one major hospital in China — who was kept anonymous due to fears about losing his job — told the South China Morning Post that curbing the outbreak and treating patients is exponentially more difficult when healthcare workers are getting sick. 

“Just a very rough estimate, 100 nurses and doctors can look after 100 ordinary beds and 16 ICU beds,” he said. “If they are sick, not only do they occupy 100 beds, but the staff taking care of 100 beds are gone. That means a hospital loses the capacity of 200 beds. That is why the authorities have to keep sending medics over to Wuhan, not only because there are not enough beds, but because of a lack of health doctors and nurses to take care of the sick beds.”

Hospitals and healthcare workers in other countries are preparing

In the US, which has confirmed 15 cases, many hospitals are preparing for potential coronavirus cases. 

“A lot of our patients are from many different countries and travel,” Kim Leslie, an emergency-department nursing director at Swedish Hospital in Chicago, previously told Business Insider. “The likelihood of us coming across it is high, so we’re trying to have a plan for what to do.”

Health authorities worldwide recommend standard preventative measures for healthcare providers: hand-washing, avoiding touching one’s face, and wearing a surgical mask when around sick patients.

The Central Hospital of Wuhan via Weibo/Reuters

The US Centers for Disease Control and Prevention also recommends that hospital staff put potentially infected patients in an airborne infection isolation room, wear eye protection, and immediately notify the CDC about any person under investigation.

Plus, US hospitals are already facing a bad flu season. At least 22 million people have gotten the flu since October 1, 2019, and 12,000 have died.

“It’s really hard because so much of US screening is relying on travel history, but it shows the importance of following the standard procedure of basic infection control practices,” Saskia Popescu, an epidemiologist specializing in infection prevention, told Business Insider, adding, “if you could put a mask on everyone who had a cough and fever, that would be huge.”

My Millennial Doctor Peers Think They're Walking Into a Crisis Regarding Health Care, Doctors Need to Understand Health Care and Buttagieg’s Health Care Plan, Corona Virus and Kobe.

Dr. Daniel E. Choi announced that ”Hey man, just wanted you to be one of the first to know that I put in my 90-day resignation notice at the hospital. Planning to pursue exec MBA…”

I did a double take at this shocking text from an orthopedic surgery colleague who was also a close friend. What? He was quitting?

We had just slaved through 5 years of orthopedic surgery residency, 1 year of fellowship, and just passed our oral boards. We were now supposed to be living the dream. All of that delayed gratification: throwing away our 20s holed up in the library, taking call endlessly on weekends and holidays. We did it for the ultimate privilege of being attending surgeons for our patients one day.

I called him right away and he confirmed my suspicions about why he quit. As an employed physician in a hospital system, he felt that he was sadly just becoming a cog in the machine, a “provider” generating relative value units. Administrators who had never done a day of residency or even stepped foot in his clinic wanted to provide “guidance” on how he should practice medicine. Overall, he felt that medicine was a sinking ship on which doctors were losing autonomy quickly and that this was a path leading straight to burnout.

I felt I had to let the Twitterverse know.

This tweet went viral and it was clear that I was on to something. I had struck a nerve with many of my physician colleagues. Surprisingly, many physicians empathized with my friend and didn’t blame him for looking elsewhere in finding a fulfilling career. Some physicians even thought he was doing the right thing.

I was getting really curious. I followed up with a Twitter poll: “Physicians, are you actively making plans for early retirement or considering how to possibly exit medicine in the near future?” Sixty-five percent of physicians who replied were considering an early exit from medicine.

This poll result was consistent with my own observation that early retirement online physician groups are burgeoning. Physician Side Gigs on Facebook, which seeks to help “physicians interested in pursuing opportunities outside of traditional clinical medicine…as a way to supplement or even replace their clinical income,” has over 50,000 members. Another Facebook group, Physicians on FIRE, aims to help physicians reach “Financial Independence. Retire Early” and has over 4000 members.

It is difficult to determine whether these physicians seeking early retirement are just wishfully complaining or actually planning an exit strategy. Many physicians answering the Twitter poll clarified that they loved treating and helping their patients but that the system had just become too difficult to deal with. Did this many physicians really want to leave the practice of medicine? What does that mean for our impending physician shortage? Why do so many of us feel the urge to get out?

Many discussions with disenchanted physicians ensued after that poll. In these discussions, I have found several common reasons that have pushed my colleagues to leave medicine.

Devaluation of Physicians on All Fronts

Devaluation appears to be happening on many fronts, according to my discussions with doctors online. There is the use of the term “provider” to replace “physician,” which more of us are finding offensive.

Mid-level providers who are cheaper for health systems to hire are replacing physicians. Reimbursements from commercial payers are declining. Health policy “experts” unfairly blame rising healthcare costs on physicians and have pushed legislators to find ways to lower physician compensation further. There are fewer physician meeting spaces in hospitals, such as doctors’ lounges or physician dining rooms, which used to serve as important spaces for physicians to commiserate and collaborate.

Overall, I sense great disappointment and anger among physicians about what many perceive to be increasing disregard for the tremendous amount of sacrifice physicians have made to complete their training. Physicians increasingly regret all of that time away from family or dropping their personal interests and hobbies during medical school and residency.Most shocking to me, however, is that physicians who speak out about such devaluation are often labeled “greedy doctors” by health policy “experts,” the press, and even fellow physicians (usually in the later stages of their career).

Loss of Autonomy and Independent Physician Opportunities

Personally, I’ve always wanted to be my own boss and I knew fairly early on in training that I wanted to enter private practice. I thought private practice would allow me to insulate myself from many of the forces that pushed my orthopedic surgery colleague to quit.

Mine is not the popular path, however, as the number of millennial physicians who are entering private practice has rapidly declined over the past decade. According to Medscape’s Residents Salary & Debt Report 2019, 22% of residents say they anticipate becoming either a practice owner or partner. According to a survey by the Physicians Foundation and Merritt Hawkins, only 31.4% of physicians identified as independent practice owners or partners in 2018. In 2012, independent physicians made up 48.5% of all doctors.

The survey even revealed that 58% of doctors do not think that hospital employment is a positive trend and concluded that “many physicians are dubious about the employed practice model even though they have chosen to participate in it, perhaps fearing that employment by hospitals will lead to a loss of clinical and administrative autonomy.”

I used to wonder why more of my millennial physician colleagues did not choose private practice as a career path and why so many were choosing hospital-based employment. A line I saw on Twitter sums it up: “Private practice is no longer about profitability. It’s about financial sustainability.” With greater consolidation within healthcare, independent doctors have lost much of their leverage when trying to negotiate fair rates with commercial payers.

In addition, the costs of purchasing an electronic health record and running a staff to deal with authorization and billing issues have made private practice extremely difficult. If more private practice opportunities existed, I am sure that my millennial colleagues would absolutely take them to maintain their independence. However, such independent practice opportunities continue to diminish, and millennial physicians may be pressured to take the only available positions: hospital employment with possible restrictions on autonomy.

Is Your Career Worth Your Own Life?

On average, one doctor a day in the United States ends his or her own life. Physicians commit suicide at a rate twice that of the general population, and over 1 million patients will lose their doctors to suicide every year. Pamela Wible, MD, who studied 1363 physician suicides, points out that “assembly-line medicine kills doctors” and that “pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients.”

Just a couple of months ago, my fellowship director forwarded me an email about a young orthopedic surgeon who had committed suicide, Thomas Fishler. He was known to be a brilliant surgeon whom colleagues and patients loved, and is survived by his young daughter. My fellowship director included in his email, “I know you have an awareness of the risks that those in our profession often face.”

Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

Physician suicide is heartbreaking and screams crisis. What is driving brilliant doctors to the edge? I believe it’s further evidence of compounding external pressures that are making the practice of medicine increasingly intolerable. Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

I get chills as I push the thought quickly out of my mind: Am I being subjected to this risk? All physicians have their tough days but I have never been anywhere close to being suicidal. But seriously—is it really worth it if I am at even a small risk of becoming that miserable?

Is There an Impending Crisis?

The average millennial physician completes training, looks around, and sees his or her profession in complete shambles. Burnout is rampant. Doctors are committing suicide daily. Many seem to be miserable over their lack of autonomy and loss of standing. The physician starts to take a hard look at the career they are about to embark on and begins to have serious doubts. Then the physician remembers that student loan debt. The average medical student loan debt in 2018, according to AAMC , was $198,000. There’s really no way out at this point; even if your job is going to make you miserable, you are going to push through because you’re on the hook.

And this is where I start to get seriously worried. We will have an entire generation of graduating physicians who will be subjected to forces that have never been present in medicine before. And these forces are actively causing distress and misery among some of my colleagues.

I know that my millennial colleagues have tremendous resilience and grit, as every generation of physicians has in the past. But how long will they put their heads down and fight against these ominous forces before they decide that they’ve had enough and jump ship just like my orthopedic colleague did?

Hope in Advocacy to Avert Crisis

Don’t get me wrong—practicing medicine is still the greatest privilege, and I know that every one of my millennial physician colleagues loves their patients dearly. I am honored that my patients entrust me to take away their pain and suffering in the operating room. I’ve studied and trained for 14 years to become an attending orthopedic spine surgeon; I’m not giving up this privilege that easily. And neither are most millennial physicians.

Millennials may be viewed as entitled, but many of us see that as comfort in advocating for themselves and questioning the status quo.” I believe that millennial physicians will not quietly accept the current state of affairs.

I see many impassioned millennial physician advocates becoming active in organizations like the Medical Society of the State of New York or the American Medical Association. These organizations already do excellent advocacy work, and I predict that millennial physicians will become a powerful force within such organizations to protect their profession. Through a unified voice, organized medicine is truly our strongest hope in enacting systemic changes that can prevent further physician demoralization and burnout.

We’re not giving up just yet. The crisis can be averted. Our patients and profession depend on it.

America’s healthiest and unhealthiest states

Cortney Moore noted that when it comes down to the popular saying that “health is wealth,” the states that have high revenue streams and median household incomes also have populations that are wellness-focused. Particularly, the states with the healthiest people are concentrated in the northern half of the U.S. and West Coast, according to America’s Health Rankings annual report conducted by the United Health Foundation.

The United Health Foundation analyzed the 50 states on five core categories, including model behaviors, community and environmental factors, public policies for health care and preventative care, clinical care and the overall health outcomes that result from the previous four.

America’s Health Rankings used a composite index of over 30 metrics to create its annual snapshot of statewide healthy populations, which ultimately helped the organization determine the healthiest to the unhealthiest.

Moreover, the report cited the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” in addition to individual genetic predispositions to disease.

The healthiest state is Vermont, which has moved up from 20th place in 1990 to first place in 2019, according to America’s Health Rankings data. In the past 15 years, the state has decreased its air pollution by 47 percent – with fine particles per cubic meter going down from 9.7 to 5.1 micrograms. Additionally, Vermont’s disparity in health status decreased from 49 percent to 17.4 percent in the past year. Other strengths the report noted include low incidences of chlamydia, violent crime and the percentage of uninsured residents.

For the 2019 fiscal year, with the exception to the month of December (which data has yet to be released for at the time of publication), the state of Vermont made over $955 million in revenue from general funds, according to the Agency of Administration. More than $113 million came from health care taxes and assessments that were collected between January 2019 and November 2019.

The median household income in Vermont is $60,076, according to data from the U.S. Census Bureau, which is close to the national median of $61,937. Moreover, average employee health care premium contributions for a family in the state is said to be $4,996, according to independent researchers at the Commonwealth Fund.

When it comes down to those who have government-funded health insurance plans, the Centers for Medicare and Medicaid Services do not have up-to-date figures since it is collected on a quinquennial basis. However, the agency found that Vermont reported a little over $5.7 million in 2015 for health care expenditures, as noted in an infographic by the Kaiser Family Foundation.

Outside the Green Mountain State, the other states that rounded out America’s Health Rankings top 10 are Massachusetts, Hawaii, Connecticut, Utah, New Hampshire, Minnesota, New Jersey, Washington and Colorado.

The unhealthiest state is Mississippi, which has maintained close to 50th place from 1990 to 2019, according to America’s Health Rankings data. Since 1993, low birthweight in Mississippi increased from 9.6 percent to 21 percent of live births. In the past five years, premature death increased by seven percent from 10,354 to 11,043 years lost to people who died before age 75. Premature mortality has increased on a national scale in addition to diabetes and obesity. Other challenges the report noted include a high cardiovascular death rate and percentage of children in poverty.

For the fiscal year of 2019, the state of Mississippi made $166 million in revenue collections, according to the Mississippi Legislative Budget Office, which surpassed the state’s estimate by $30.5 million.

The median household income in Mississippi is $43,567, according to data from the U.S. Census, which is $18,370 less than the national median. Average employee health care premium contributions for a family in the state is $5,133, according to the Commonwealth Fund, which is only $137 more than the premiums employees in Vermont are paying. But, when coupled with Mississippi’s lower median income, the cost of health coverage is substantial.

Mississippi also surpassed Vermont in spending on government-funded health insurance plans. The Centers for Medicare and Medicaid Services found that Mississippi reported over $21.5 million in 2015 for health care expenditures.

The other states that rounded out America’s Health Rankings bottom 10 were primarily in the South, including, South Carolina, Kentucky, Tennessee, West Virginia, Oklahoma, Alabama, Arkansas and Louisiana. Indiana was the only Midwestern state to land on the lower one-fifth of the unhealthiest states list.

On a national scale, American health is a mixed bag. Since 2012, smoking among adults has decreased from 24 percent to 16.1 percent, however, obesity among adults increased to 30.9 percent from 11 percent while diabetes among adults increased to 15 percent from 9.5 percent.

In the past three years, drug-related deaths have increased by 37 percent from 14 to 19.2 deaths per 100,000 people. When compared to America’s Health Rankings data from 2007, that is a 104 percent increase.

Environmental conditions have improved as air pollution decreased by 36 percent since 2003 and violent crime decreased by 50 percent since 1993. In the past four years, frequent mental distress increased from 11 percent to 13 percent, which has resulted in an increase of mental health providers, according to the report.

Infant mortality has decreased by 43 percent from 10.2 to 5.8 deaths per 1,000 live births in the past 29 years. However, low birth weight has increased by four percent from eight to 8.3 percent in the past three years, which also happens to be a 19 percent increase from 1993.

The average American spends more than $11,000 per year on health care and accounted for 17.7 percent of the U.S. GDP, according to estimates from the Centers for Medicare and Medicaid Services. With spending projected to grow at an average rate of 5.5 percent per year, the U.S. will reach nearly $6 trillion in health care spending by 2027.

Buttigieg’s health care plan would save money while Warren and Sanders plans would cost trillions, analysis finds

Associate Editor Adriana Belmont reported that Health care has been a contentious topic among the Democratic presidential candidates: Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) support Medicare for All while Mayor Pete Buttigieg (D-IN) and former Vice President Joe Biden offer alternatives to universal health care.

A new analysis from the Committee for a Responsible Federal Budget (CRFB) took a look at the different plans and found that while each proposal would reduce the number of uninsured Americans, the least costly would be Buttigieg’s plan.

“Mayor Buttigieg’s plan would reduce deficits by $450 billion,” according to CFRB, adding that the policy would also “increase gross spending by $2.85 trillion, reduce costs by $1.2 trillion, and raise $2.1 trillion through direct and additional offsets.”

Through Buttigieg’s Medicare for All Who Want It plan, everyone would automatically be involved in universal health care coverage for those who are eligible. The policy would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers change for out-of-network care at double what Medicare pays for the same service. At the same time, those who still want to stay on private insurance can do so.

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.

CRFB estimated that the Indiana mayor’s plan would reduce the number of uninsured by between 20 to 30 million “by improving affordability and implementing auto-enrollment as well as retroactively enrolling and charging premiums to those who lack coverage.” 

‘Building on Obamacare’

Joe Biden’s health care plan, described as “building on Obamacare,” has an estimated gross cost of $2.25 trillion and would add $800 billion to deficits over 10 years. The CRFB also found that “it would reduce costs by $450 billion” and “raise $1 trillion through direct and additional offsets.”

Biden’s plan would reduce the number of uninsured by 15 to 20 million Americans and reduce national health expenditures by 1%. 

Some of his biggest revenue drivers in his plan include coverage expansion revenue feedback, which would create a public option, and end deductibility of prescription drug advertising. Additionally, his capital gains tax and “tax at death” would generate $550 billion.

‘Federal health expenditures would increase somewhat more’

Sen. Sanders, one of the original proponents of Medicare for All, has a plan that’s projected to add $13.4 trillion to deficits over a decade at a gross cost of $30.6 trillion. It would also raise $12.5 trillion in revenue through direct offsets and raise another $3 trillion through additional offsets.

His proposals to eliminate medical debt would cost $100 billion and would raise $1.7 trillion by reducing the costs of prescription drugs. To generate more money for the plan, Sanders would establish a 4% income surtax (projected to raise $4 trillion) and 7.5% employer payroll tax (estimated $4 trillion added). One significant cost in his plan, though, is offering universal long-term care — which would cost $29 trillion. 

“The reality is that Medicare for All will save American families thousands of dollars a year because they will no longer be paying premiums, deductibles and co-payments to greedy private health insurance companies,” Warren Gunnels, senior advisor for the Sanders campaign, told Yahoo Finance in a statement.

“If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.”

Overall, between 2021 to 2030, the CFRB estimated that Sanders’ plan would increase national health expenditures by 6%, “meaning that federal health expenditures would increase somewhat more than non-federal health spending would fall.”

‘Magical math’ or ‘the biggest middle class tax cut ever’?

Sen. Warren’s plan closely resembles Sanders’ in terms of cost. She stated her plan would cost $20.5 trillion in federal spending over a decade. CFRB found that the plan “would add $6.1 trillion to deficits over ten years under our central estimate.”

Experts disagree over the cost of Warren’s numbers, with one calling it “magical math” and another referring to Warren’s plan as “the biggest middle class tax cut ever.”

According to CRFB, the plan would increase gross spending by $31.75 trillion, reduce costs by $4.7 trillion, raise $14.2 trillion in revenue through direct offsets, and raise another $6.75 trillion through additional offsets. Her health care plan is estimated to increase costs by about 3%, but “the magnitude of these increases would decline over time.”

A major way to fund the plan would be through tax reform. By essentially eliminating tax breaks with private health insurers and requiring employers to contribute to her Medicare for All, she’s projected to generate an estimated $14.2 trillion. Other means of generating revenue for her plan include her wealth tax and a tax on bonds, stocks, and derivatives.

Both the Warren and Sanders plans would reduce the number of uninsured Americans by 30 to 35 million and “nearly eliminate” average premiums and out-of-pocket costs.

Patients can’t afford for doctors to misunderstand the healthcare business

Caroline Yao reported that When I was in medical school, my teachers started a lot of their stories with the same phrase:

“Back in my day, I still helped patients who couldn’t pay.”

“Back in my day, we didn’t have 100 checklists.”

“Back in my day, I didn’t need permission from insurance companies to do my job.”

“Back in my day, a yelp review couldn’t ruin my reputation.”

It happened so often that I wondered if I had shown up to the medical profession 30 years too late. Had I signed up for a sham fairytale?

I had thought doctors were autonomous, benevolent masters with kind voices and encyclopedic knowledge. After entering the field, I’ve found most young doctors struggle to balance convention versus empowerment, and doing good versus doing well. Doctors are the ugly stepchild of healthcare reform; too privileged to warrant help, but too powerless to do our jobs better.

I performed more than 2,500 surgeries during my residency training, and I am embarrassed to say that I do not know what a single one of my patients paid for their operations.

I later learned at the public hospital, surgeons were reimbursed $35 for each emergency appendectomy performed. Where did all that money go? Why didn’t the doctors question the system, or try to regain some control?

The provider will see you now

Somewhere along the way, my title as a doctor has been reduced to “provider,” and my worth dictated by administrators, insurance companies—and the government. The Hippocratic Oath I earnestly recited upon starting medical school is challenged everyday by a system of perverse incentives, where hospitals are paid more for treating the sick than keeping the patient well.

In 2013, 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine; 81% felt they lacked an understanding of healthcare legislation.

Is the answer that doctors should participate more in determining patient fees and reimbursement schedules? History shows that when doctors controlled payments more directly, graduated systems based on ability to pay were subtle but more ubiquitous. In the era of Aristotle, wealthy physicians did not accept payment, while poorer ones requested them. When 9th-century physician and scholoar Ishaq bin Ali al-Ruhawi wrote the first book of medical ethics, he described physicians as business owners who provided free services during times of patronage from caliphs and sultans. Throughout medieval Europe and during the Ottaman Empire, doctors treated the poor with the help of subsidies from royal courts and churches. Notable physicians such as Sir William Osler, legendary French surgeon and anatomist Guillaume Dupuytren, and physician and founder of Dickinson College, Benjamin Rush also charged rich and poor patients based on a self-made sliding scale.

Today, governments, universities, religious groups, and philanthropists are essentially modern-day barons who fund healthcare for the indigent through public hospitals, grants, and charitable work.

In the US, some physicians are granted partial and full student debt forgiveness from the government for working in underserved or rural communities. However, the majority of physicians who volunteer at free clinics, teaching hospitals, charities, or medical missions often do so only because their practice is flexible or lucrative enough to allow them both time away from paying jobs and the financial means to offer free services.

While physicians in private practice have autonomy over who they treat and how much they charge, physicians who work in hospital systems are more and more removed from managing the whole patient.

In 1983, 76% of doctors owned their own practice versus only 47% in 2016. Young physicians today are fundamentally unaware of the business side of medicine, and that’s bad news for everyone. As is the fact that medical students and residents are consistently and idealistically mentored to ignore the costs of materials and treatments we recommend.

We are taught to deliver care based on strict scientific evidence: the “gold standard” of care. Said gold standard, however, does not account for price, diminishing returns, convenience, or pain. The treatment that works best for a lab rat in a cage does not always translate to the most appropriate care for a person who has far more complex needs.

The cost of your health

A more pragmatic physician understands that patients who are underinsured, uninsured, or improperly educated will often forgo procedures, clinic visits, and medications when those interventions are too expensive or inconvenient.

Cost-conscious surgeons know that using instruments to tie stitches instead of hand-tying stitches can often result in a 10-fold cost savings without sacrificing quality.

I did not know how prohibitively expensive everyday surgical consumables cost until I went on humanitarian missions abroad and worked with surgical teams that could not afford these luxuries. I learned that hemostatic fabric we used like disposable napkins in the US cost $40 for a post-it sized square. A five-inch silicone band-aid costs $20. Bioengineered skin substitutes cost $10,000 for a palm-sized sheet.

My lack of price-awareness is fairly common. Many doctors have stopped accounting for the cost portion of a cost-benefit analysis.

And where doctors have leaned away from understanding cost, others have stepped in. Hospital administrators, governments, and insurance companies now manage the costs of healthcare. Correspondingly, physician compensation is estimated to be under 10% of total US national healthcare spending today. Overhead, administration, ancillary staff, malpractice insurance, and pharmaceuticals account for the majority of costs. For an appendectomy and associated care in 2018, the Medicare allowable compensation for a surgeon’s work is $394; meanwhile, healthcare watchdog organizations quote $13,000 as the fair price for hospitals to charge a patient and US hospitals bill an average of $31,000.

Most surgeons working in large hospitals are unaware of these numbers. They are therefore unable to tell patients how much they will be billed for a given operation. A surgeon in the 1830s in the company of the likes of Dr. Dupuytren would know these numbers.

Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation.  As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.

By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”

We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.

As China’s Coronavirus Cases Rise, U.S. Agencies Map Out Domestic Containment Plans

Richard Harris reported that China has reported a large surge of cases of the novel coronavirus — upping its count from under 3,000 to over 4,500 as of Tuesday morning. More than 100 deaths have been reported. It is spreading rapidly in many provinces, and sporadic cases have now been reported in 18 other locations outside of China, including Australia, France and Canada.

In the United States, the case count remains at five — all people who had recently returned from Wuhan, China. And at a news conference Tuesday, top U.S. health officials reiterated that the disease — while serious — is not currently a threat to ordinary Americans.

“At this point, Americans should not worry for their own safety,” said Alex Azar, health and human services secretary, at the press briefing Tuesday.

While risk to most Americans remains low, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, noted that “risk is dependent on exposure” and that health care workers or others who know they have been in contact with a person exposed to the virus should take precautions.

The federal government continues to adjust its approach to preventing the disease from taking hold in the U.S. On Monday night, the CDC and the State Department announced that a travel advisory recommending that Americans avoid travel to China when at all possible.

Airport screening is also being expanded from five airports to 20, with the goal of screening all passengers returning from China and letting people know what they should do if they fall ill after they get home.

The CDC is conducting contact investigations of people known to have been in contact with the five patients with confirmed infections, monitoring them for symptoms and testing them if concerning symptoms emerge.

Officials at the CDC are eager to get into China in order to help scientists there answer key questions — such as whether the virus can spread from people who don’t show any symptoms of illness. Azar said at the news conference that he had been pressing his counterpart in China for permission to send investigators.

That plea has been answered, at least to a certain extent. On Tuesday, the World Health Organization announced that it had the green light to send outside experts to China. It was not immediately clear whether that will include scientists from the CDC.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, explained that federal agencies are taking a three-pronged approach to respond to the novel coronavirus: developing and improving diagnostic tests, investigating experimental antiviral drugs, and working to develop a vaccine.

He said if it turns out that the virus can spread from someone who is not showing any symptoms, there would be some changes in the public health response. Similar coronaviruses from past outbreaks — severe acute respiratory syndrome and Middle East respiratory syndrome — did not spread in the absence of symptoms, but that doesn’t mean the new one will behave the same way. Viruses such as measles and influenza can be spread from people who aren’t showing signs of disease.

“Even if there is some asymptomatic transmission, in all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks,” Fauci said. “The driver of outbreaks has always been a symptomatic person.”

And lastly condolences go out to the Bryant family and the other members of the helicopter crash in southern California. Kobe will be sure missed but loss of kids really upsets a father like me the most!