This document discusses issues with the US healthcare system, including high costs, lack of access to care, and medical errors. It notes that the US spends significantly more on healthcare than other developed nations, but does not achieve better health outcomes. Reasons proposed for the high costs include a shortage of doctors, expensive medical education discouraging new doctors, and inefficiencies in the system. The document advocates for reforms to improve patient safety, access to care, and reduce costs.

1. Oscar Ferreiro
The Broken Swing set
There are somany differentkindsof people inthe world.We have youngandold,malesand
females;we have adrenalinejunkiesandcouchpotatoes;there are familyorientedpeople andlone
wolves.Thislistof antonymscouldgoonand on fordays butdespite all of ourdifferences,we all want
the peace of mindtoknowwe will be able tostay healthy. Nothingelse mattersifthere isno health.
Despite whatdoctorsmighttell you,moneycan’tbuyhealth;despitewhatFacebooksays,likesdon’t
save livesandunfortunatelydespite whatMomsaid,akisswon’tcure all booboos.
All of us needto be healthyin order to enjoy our life.Itmightbe more fulfillingtogoto the
park healthythantogo on an all-inclusivevacationinthe Caribbeanwhilegoingthroughchemotherapy.
So that part iseasyto understand,whowouldratherbe sick?Itis the secondpart that istricky,withso
manydifferentpeople andlifestyleshow couldeveryoneachieve the same goal?Thankfullyforus(?),
we have health insurance.It isthe bestfeelinginthe worldtohave the peace of mindthat if your back
hurts youcan go to the Doctor and get treatedandhealed. If youhave a car crash, you getrushedto the
ER, get the steeringwheel unscrambledfromyourintestinesandafterwardsyouonlyneedtoworry
aboutfeelingbetteragain.Itisso goodto live ina firstworldcountryand getaccess to all these perks,
the onlydownside isthatwe don’tactuallygetthese things.
Americaisthe landof opportunity.Peoplecome here fromall overthe worldinanattemptto
geta betterlife forthemandtheirfamilies. Itisnot easy cominghere and still people literallyrisktheir
livesto get theirAmerican Dream. Everythingseemstoworkoutwell,until someonegetssick.Itis
amazingthat inthisFirstworldcountrythere are so manyproblemstryingtokeepeveryonehealthy.
Accordingto the investigationby DavidA.Squires fromThe CommonwealthFund,“ExplainingHigh
HealthCare Spending inthe UnitedStates:AnInternational Comparisonof Supply,Utilization,Prices,
and Quality,”the US spendssignificantlymore inhealthcare thananyof the othertwelve developed
countriesusedinthe study(Australia,Canada,Denmark,France,Germany,Japan,the Netherlands,New
Zealand,Norway,Sweden,Switzerland,the UnitedKingdom, andthe UnitedStates).The increased
healthcare spendingdidnotcorrelate tobetterhealthcare service.The higherspendingisnota
reflectionof awealthierorand oldersociety.

2. One wouldguessthatwithall that investmentwe wouldbe gettingsome bangfromourbuck,
truth is, we are onlygettingbanged. AccordingtoanUNICEF reportaboutChildren’swellness“An
overviewof childwell-beinginrichcountries”, the USis the last place among twenty-one developed
countriesin children’shealthand safety. If we lookat the previousgraph,we are spendingwaymore in
healthcare thanthe numberone countryinthe list,Sweden.Where isall thatmoneygoing?Certainly
not intohealthierfood,since the USleadsthe way in obesityas well with an astounding 28% ofthe
populationbeingobese and a 35% ofthe populationbeingoverweight,accordingto the CDC.
Definitelyall obese womenwantthatextratummyto be onlya foodbabysince havinga childinthe US
isa luxuryif the woman’sinsurance doesn’tcoverit.Accordingtoaninvestigationdone bythe New
York Times, the cost of having a baby inthe US is $9,775 for a natural birth and $15,041 if she gets a C-
section.Those numbersare the quantityagreeduponbythe insurance companies,thereforeif the poor
soul has noinsurance these numbersare ajoke comparedto whatshe will be actuallycharged.
Certainlyforthose amountspeopleinothercountriesmightthinkthatourhospitalshave beds
made out of gold or at leastanabove than average experience duringthose times,sorrytodisappoint
all the Swedesbutwe don’tgetevenclose tothat. Despite all the issues, the Americanpeople are
insurance junkies.We knowwho isto blame forthese outrageoushospital billsbutwe justcan’tafford
to boycottthe system.We are aware of the harm the insurance companiesare makingtoourhealthcare
systembutit seemstoolate tofightagainstthemnow.As soonas theytell youinopenenrollmentall
the thingsthat couldeventuallyhappentoyou,youwanttoget all the insurance available.Evenwhen
youare twenty-year-oldrunningmarathons,youwanttobe insuredincase youget a heartattack or
Parkinson’s.
So,allowme to take my magic wandoutof my cloakand letustravel to our perfectAmerica
where McDonald’ssellsthe tastiestBigSalad andpoliticiansgetminimumwage.Whoshouldwe putin
our perfectlyreformedprisonfordoingall thisdamage toourhealthcare?Well,Iguesswe all live in
prisonnow.All Americansare toblame formakingthismonsterandcontinuingtofeedit. There are
three groups responsible forthis catastrophe, the Doctors, the Insurersand the Patients. We are all
part of thisparasiticinfection we can’tcure because itistooexpensive togoto the doctor and geta
prescription.
So muchblame to put,let’sstart withhow doctorsdestroypeople’slives.I’vealwayshadthe
ideathat noone can go throughso muchclassesabouthow people die withoutbecominganarcissistic
psychopath.Doctorshave mostof the powerto endthisaberrationof system, buttheydon’t do
anythingaboutit.Anypersonwhohas visitedadoctor’soffice oran ER can testifytothe lackof
empathythese people have.Mostdoctorswon’tevensee apatientfortwentyminutes.Mostof them
make youfeel like justmore paperworktodoat the endof the day. The difference betweenan
expensive office visitanda satisfyingoffice visitis not the price tag; it is how well you get treated.
Life wouldbe somuch betterif doctorsimprovedtheirmethodsduringoffice visitsand
treatments.The processsomeone usuallygoesthroughwhenfeelingsickis:Firstgeta doctor,go to
theiroffice,gettreatment,payandgetcured.Soundseasyenough?Well,itisnot.Everypartof this
processisbroken. Starting with the shortage of doctors available which make it almost impossible to
get an appointmentright away whenyou fell pain. Accordingto a reportpreparedforthe Association
of AmericanMedical Colleges in2015, bythe year2025 the shortage of doctorswill rise to somewhere

3. between45,000 and 90,000 physicians.The areasthatwill be impactedthe mostare primaryand
surgical physicians.Thisisespeciallyscarybecause ittakesalot of yearsto train a doctor, soif society
wantsto avoidthisproblemfromgetting bigger,itshouldstarttoact now.
It makessense thatstudentsgetscaredto go intothe medical field;itisa longand painful
process.Studentsplanningtogointothe medical fieldshouldstartbefore college,takingasmanyAP
classesinhighschool as theycan and gettingintoaverygood school witha comprehensive Pre-Med
program.These studentsneedtoexcel inthese classesinordertogetat leasta 3.5 GPA in orderto even
getconsideredforMedical School. Accordingtothe AAMCin 2013 48,000 people appliedtoMedical
School and onlyaroundhalf of them,20,055, gotin. The psychological stressthishasonpeople is
intense,addtothat the average debtmedical studentsgetismore than$150,000. No wondertheytry
to cram as much appointmentsinadayas possible.
So,what issocietysupposedtodoinorder to helpalleviate the shortage of doctors?Itis
actuallya goodthingthat physiciansgetsomuch education.Evenwithall that educationalotof doctors
still manage tomessitup. It isnot the physiciansfault,sometimes.The Institute of Medicinewrote a
reportTo Err IsHuman:Building a SaferHealth System back in2000 where itanalyzeddeathsrelatedto
medical errors. The report mentionedthat somewhere between44,000 and 98,000 people die in
hospitalsfrom medical errors. These errors cost between$17 billionand$29 billioneachyear. This
reportfoundthat mostof these errors can be attributedtoa faultysystem. The reportmakesemphasis
inhavinga designatedauthoritycompletelyresponsible of patientsafety.The agencyshouldrequireall
healthcare organizationstoreportany mistakes.Itshouldbe mandatorytoreportany mistakesthat
leadto deathandvoluntaryto reportminimal mistakesthatdidnoharm butcould have hadriskier
consequences. Mostofthe concerns addressedby the report were answered by the Clinton
administrationmost importantly, the creationof the Agencyfor Healthcare Research and Quality. This
agencyfocusesinpreventionof medical errorandresearchonthose errors.The toolsare there inorder
to try and make a saferhealthcare system;people justneedtolearnhow touse these toolsmore
effectively.
In the article Howhealthcare killed my father by DavidGoldhill,he tellsthe sadstoryof how his
dad waskilledbyaneglectinthe hospital.He explainshisdaddiedof a bacterial infectionhe caughtin
the hospital whentryingtogethelpforan unrelatedthing.Inhisessayhe states howDr. Peter
Provonost triedto reduce the fatal hospital borne infectionsby persuadingdoctors to be more
attentive to simple thingslike hand washing. Followingthe listreducedinfectionrate bytwothirdson
the firstthree months.Later,hospital executivesstartedcomplainingaboutthe listandtheyremovedit.
It isscary to thinkthat hospitalsbelieve doctorswashingtheirhandsismore of a problemthanthe
deathof 200,000 patientsperyear.
Talkingabouthavinga saferenvironmentforpatientsanddoctorsinorderto improve health
care iseasiersaidthandone.How couldsomeone measurehow effective isahealthcare institution?If
someone were tomeasure howefficientisacar factory that personwouldjustneedtosee how many
cars the factoryis able toproduce and how manyit doesproduce.Most industrieshave pretty
straightforwardwaysof measuringhowefficientlyitisoperating.Healthindustryisdifferent.If hospitals
were treatedlike anyotherfactory,hospitalsanddoctorsfocusingoncancerand cardiacproblems
wouldneedto close andwe wouldhave an overpopulationof plasticsurgeonsanddermatologists.
Measuringthe efficiencyina medical settinghas too many variables,which makes it almost

4. impossible toaccurately measure. It wouldbe terrible totryto measure the efficiencyof ahospital
basedon howmanypeople recover.Recoverynotonlydependsonthe doctor,itdependsonthe type of
sickness,the technologyavailabletotreatit andthe patients’responsibility.Itwouldnotbe fairfora
doctor workingina lowincome areawere people mightgotothe doctor whensufferinganillnessbut
won’tgo fora followuportheywon’thave moneytobuy the medicationsprescribed.
So howshouldwe keepastandardqualitycontrol inhospitals? Itisalmost impossible.Itwould
not helpto ask physicianshow many procedureshave beendone successfullybecause all doctors will
be afraid to performrisky but life-savingoperations.The onlywaytohelpcontrol how doctorsdo their
jobis to make sure all patient’srecordsare updatedandavailable toall of the individual’sdoctors.A
goodway for normal people tomake sure theyare gettingthe adequate treatmentfortheirillnessisto
lookfora secondopinionandjudge whatversionof the storytheylike better.
So,secondopinionsthatshouldmake everythingeasierandbetter.Itdoesnot. One ofthe main
problemswith healthcare and somethingthat raises all the pricesfor healthinsurance is inefficiency
in the system. Describedin Perverseincentivesin Health care byJohn C.Goodman,“There is no
systematicrewardforexcellenceandnopenaltyformediocrity.” Everythingabouthealthcare is
inefficientandthisinefficiencyisactuallyencouraged.The healthindustrybleedspeopleslowlyinways
some people don’tevennotice,forexample,gettingasecondopinion.If the healthproviderswere
controlledinsome waypeople wouldnotlookforsecondopinionsasfrequently.
Imagine Mr. Smith,he isdiagnosedwithstage one lungcancerafterchainsmokingforforty
yearsstraight.Mr. Smithfeelsindestructible one packaday isnot that much,hisdad smokedwaymore
than himand he diedpeacefullysleepingafterhis95th
birthday. How couldMr. Smithhave cancer with
that ancestry?Since he didn’t believe ithe probably didn’thave it, that doctor must have gotten his
degree inUniversityof Phoenix.Mr.Smith went to another doctor. The new doctor told himhe did
not have cancer; it was just pneumonia. Mr. Smithdoeslike that story;therefore,itmustbe true.So,
Mr. Smithgoesthroughwiththe pneumoniatreatment.He buysall hismeds,getsall hisX-raysdone,
getblooddrainedasif he were feedingavampire buffet,etc.He finallyfinisheshistreatmentandhas
not improved.He goesagaintohisdoctor and tellshimhisproblem, the doctorchecksall hisanalysis
and findsoutmaybe itis notpneumonia,maybe itis pulmonary arterial hypertension.So,Dr.Smart
sendshimto geta biopsy,anultrasoundandmore bloodtests.Mr. Smithgetsall hisanalysisandstarts
hismedications.He still isnotgettingbetter andgoesto Dr. Smart again.Thistime he getsa
bronchoscopyandDr. Smart can see the problemclearas day,lungcancer stage three.
By now, Mr. Smithhas investedmore time and money than what he would like around $700
per month. Andthe worstis yetto come,accordingto a studymade byPamelaM. McMahon et.al Lung
CancerTreatmentcosts,including patient responsibility,by stageof diseaseand treatmentmodality,
1992-2003, Mr. Smithwouldprobablyhave topaysomethingbetween$10,000 to $17,000 dollarsthe
monthhe is officiallydiagnoseddependingonthe treatmenthe isgetting.Afterdiagnosishe would
incurcosts between$2,000 and $9,000 dependingonwhetherhe isgettingchemotherapyorradiation.
If he getsa surgery,he will have topay around$20,000. Most of these expenseswill be coveredto
some point by his insurance or Medicare but Mr. Smith is still responsible forsome of these expenses
or a percentage of them.
There are somany thingsthatwentwrongwithMr. Smith,sadly,thatstoryis repeatedeveryday
by thousandsof Americans.IfMr. Smithhad followedthe firstdoctor’s diagnosis,he couldhave

5. worked to get rid of the cancer soonerand cheaper. If Dr. Smart had beena betterdoctorhe may have
caught the cancer the previousdoctordiagnosed.Bythe endof the day,there isa dyingmanwhowould
not listen,afaileddoctorandthousandsof dollarsindebtthatcouldhave beenavoidedhadMr. Smith
feltthe firstdoctor’sopinionwasgoodenough.People don’tusuallydoubtwhattheirfoodsaysit
contains.People don’tgogettingsecondopinionsonwhethertheirmilkisreally2% andnotfat free.
People trustinservicesthathave strictsetsof qualitycontrol. Havingpeople lookfor second opinions
so oftenshows that people don’ttrust the systemor theirdoctors. Accordingto a studyby Johns
Hopkins,outof 6,000 cancer patients1-2% of themreceivedawrongsecondopinion.
Anotherproblemwiththisprocessisall the stepsneededinordertogeta diagnosis.Mr.Smith
had to go to back andforth to the doctor inorderto get hisanalysisandhisblooddrawn. The more he
came back, the more the office wouldcharge him. He wouldhave togo as manytimesasthey
“thought”he needed.The wrongdiagnosisonlyhelpedthe doctor’soffice. Duringfollow up
appointmentshe wouldgototell the doctortreatmentwasnotworkingandthe doctorwouldjust take
anotherguessandkeephimcoming,bleedinghimliterallyandmetaphorically.The storyMr. Smith
wentthrough,manypeople gothroughitand there islittle someone candoor is willingtodoin order
to make thisprocessmore efficient.Whybe efficientwhenyoucanbe rich?
One of the mainproblemshighlightedbythe report To Err is Human wasthe lackof sharing
amongdoctors. Thisisa seriousproblemthatnotonlyinvolvesthe doctorsbutthe whole system. When
someone goesto the doctor, his medical history isrecorded by that doctor, but there is no database
where anyone can go check. That is one of the downsidesof havingpersonalizedattention.If aperson
decidesorhas to change doctors,he has to start hisprofile againandhe mightnot remember
everythingthathappenedinhismedical life.Some detailsmaybe importanttorememberif he gets
treatedforsome disease.Thisisespeciallyscarywhenyouthinkaboutoldpeople whocanhardly
remembertheirkids’names. The normal way of gettinga patient’smedical historyis to ask the patient
or the family.Most people are notdoctors;the informationgainedbyaskingaroundforsomeone’s
medical historywillnotbe objective.Some peoplemightthinktheireyelashesgotirritatedandthatisa
meaningful symptombutmayignore the giantlumpoozingliquidoutof theirabdomen.
In order to get bettermedical advice,it wouldbe useful to have a national database, where
doctors can update your medical history and it is available to any doctor in any part of the country,
maybe eveninternational. Imagine Mr.Snow livesinFloridaandgoesskiingtoDenver, he livesin
Floridaandobviouslydoesnothave muchpractice andendsup inthe dangerouspart of the mountain
where he fallsandendsupunconscious.He ishurriedtoa hospital buttheyhave noideaof hismedical
historyandthe guyis almostdead.How will the ERdoctors know that he isallergictoIodine?If there
was a national Database, all questionswouldbe answeredandphysicianswouldtake smallerrisks.
Godmanexplainsin PerverseIncentivesin Health care that despite technologybeingsoreadilyavailable,
electronicmedical recordswerefoundonlyatone infouror five hospitals.Ireallyhope foreveryone’s
sake that those numbersrose since the time the article waswritten.
Individual attentionis a must whentalking about a patient’shealth.Everyone’sbodyis
differentandalthoughtheymayreactthe same to differentbiologicalthreats,notall bodiesare
identical.There isnowayof removingthe individualattentionfrommedicine.Atleastnow,there isno
trust worthywayof tellingacomputeryoursymptomsandthe computergivingyouadiagnosis.
Whoevertriestoinputtheirsymptomsinacomputerwill endupwitha cancer diagnosis. Partof the old

6. charm of medicine washaving a family doctor that wouldtreat grandma, the children,momand pop.
That image is gettingharder and harder to get. Now,withsomany differentspecialistsitishardto end
up withthe same trusteddoctoreveryone wentto.The kidsgetseen bya pediatrician,grandmagets
the geriatriccare; dad goesto the urologist,cardiologistandgastroenterologist;Momhas the OB/GYN,
dermatologist,oncologistandneurologist.The doctor’smayknow eachotherbuttheyare not
constantlybeingupdatedoneveryone’shealth.
Withso many specialistsone wouldthinktheyare gettingthe besttreatmentforeverypartof
theirbody,sometimesitisnotthe case. People oftenthinkaswell thatdoctorswithofficesfull of
gadgetsare betterandendup payingmore justto geta machine to do a simple task.Technologyisa
double edgedsword.Sometimestechnologywillhelpsave livesbyimprovingthe methodsof treatinga
disease orperformingasurgery. Infact,most of the time technologyandmedicine gohandinhand,we
have everything:prostheticlimbs,genetherapy,stemcell treatmentsmicrosurgeriesandmanyothers.
TechnologyhelpsDoctors give a better diagnosisand offerits patientsa betterprognosis. For
example,before,people wouldneedtogo to surgery in order to discoverwhat was causing their
abdominal pain; now, these people can get a CT scan or an ultrasound. Whengoingintosurgery
patientswouldexperience manymore risksthanjustgoingto the CT scan. So,technologyisgoodright?
Debatable. Withsomanyscreeningtests,doctorsfeel the needtoapplyall of themto theirpatients,
justin case theymisssomething. A CTscan cost somewhere between$600-3,000 and sometimesitis
not coveredbyinsurance.Itwouldreallyhurttopay$3000 and endupbeingdiagnosedwithgastritis.I
don’tknowaboutyou,but if I get charged$3000 fora single diagnosistest,theybettertellme I’mdying
tomorrow(soI don’thave to pay that bill).
It isa fact that an advancingbiotechnological fieldiscorrelatedtoanincrease inlife expectancy
and a decrease indeathsbystroke,cancerand cardiac issues(CDC). Contrastingwithour decrease of
illnessisour increase in overmedication. Accordingtoan ABC Newsarticle by SharynAlfonsi and
CourtneyHutchison,47%of all Americansare takingat leastone prescriptiondrug (2006) whereas38%
of people in1994 were takingprescriptionmedications.Withsomanypeople poppingpillslike Tic-Tacs,
the othercitizensof the worldmustthinkAmericansgetthemforfree;inrealitythatisfar fromthe
truth.
If Mr. Chuck getsfrequentheartburn,he couldbe prescribedNexium, apopulardrugaimedat
treatingacidreflux.Mr.Chuck goesto hislocal Walgreensandasksfor Nexium,the ladyatthe counter
ringshimout, $215. Mr. Chuck feelsa fire burninginside of him,not sure whetherit’s the acid reflux
after that Chipotle he had for lunch or the outrageousprice he has to pay to getrid of it. Later that day
(completelyrealistically),Mr.Chuckfindshimself inthe Netherlands.He goesouttoeat some
Andijviestamppot andhisacidreflux startsactingupagain.He findsouthe forgotto bringhis Nexiumso
he goesto the pharmacyand asksfor Nexium.Readytostartchoppingoff hisarm andleg,he hearsthe
bill,$23. What happenedwithMr.Chuck? Isthe Netherlandsaplace where peopledrinkNexiumandit
isso cheapdue tohigh demand? IsMr. Chuck sohandsome he scoredalmostfree medicine?SorryMr.
Chuck,you’re justanothersymptomof the messeduphealthcare systeminthe US,andyou’re ugly.
Pharmaceutical companieslove the US.Theyare similartothose drug addictswhogo to their
grandmaswitha lame excuse andask formoneyfordrugs and the poor,blind,deaf,baldgrandma
(Americans),justcan’tresistandgive themthe wholepurse.Pharmaceutical companieswill charge the
US almost tentimes more for prescriptiondrugs than other developedcountries.How cantheydo

7. that? There isno agencythat helpsregulate drugpricesinthe US.In the CNN article by NadiaKounang
Why Pharmaceuticalsarecheaperabroad, she explainsthatinothermarketsthere are few
organizationsincharge of buyingdrugsso if theythinkthe pricesare outrageous,theycanorganize and
do somethingaboutit.Inthe US, there are many more buyers,the insurance companies,itisharderto
geteveryone torebel andtheyreallycan’tgetmuchdone.There ismore competitionamongall these
companies.Amidthe tumultuoussituationthe onlybenefitsare forthe Pharmaceutical companies.If
youadd to thisthe fact that the largestbuyer,Medicare,isnotable tonegotiate withpharmaceuticals,
youget a joke of a system.
There ismore thanone problemwithpharmaceutical companies. Notonlydo they overcharge
for the drugs theyoffer,but they don’t investthe moneyin developingdrugsthat are becomingmore
and more necessary.Part of these forgottendrugdevelopmentsare antibiotics.Since the 70’speople
startedusingmore antibioticsthantheyshould.The thingwithantibioticsisthatthe more people use it
the lesseffective itis.As more andmore people useditworldwide,bacteriabecame more resistantto
it.Now,it isbecominganalarmingsituationthe amountof people whodie fromasimple bacterial
infectionthattenyearsagocouldbe easilymanagedandcured.The rise inprescriptiondrugpricesis
attributedtothe companies’needtoinvestinresearchanddevelopmentof new medications.Every
drug that goesintothe marketisa multibilliondollarinvestment,notcountingthe onesthatattempt
and fail.
Pharmaceutical companiesindeedinvesttheirmoneyin R&D for new drugs,profitable dugs.
Insteadof investingindrugsthatcure diseaseslike vaccinesorantibiotics,pharmaceutical companies
investtheirR&Dmoneyindrugsthat treat chronicdiseases.Bigcompanieslike PfizerandEli Lillyhave
not done researchinantibioticssince the 90’sandinsteadhave focusedondrugslike Lipitor adrug that
ismeantto be usedforthe rest of the poorsoul’slife (retail price ~$200 per50 tablets).Antibiotics
shouldnotbe used for extendedperiodsof time;some antibioticsare ascheap as $50 for a full
treatment.Talkingnumbers,itmakessense whypharmaceutical companiesinvesttheirmoneyinsome
drugsand not others.Whenthe PfizerCEOgetssickwithMRSA and can’t be curedit mightmake more
sense toinvestinnewantibiotics.
Recently,anewsheadline causedoutrage amongpeople.AndrewPollackforThe NewYork
Timesreported that Daraprim, a 62-year-old drug went from $13.50 a tabletto $750. Thisdrug isused
to helptreata parasiticinfectioninpeople withcompromisedimmune systems(littlekids,AIDS,
Cancer).The move made by CEO of TuringPharmaceuticals,MarinShkreli.EvenwhenMr.Shkreli was
paintedinthe mediaasthe big Scrooge,he isnot the firstone to implementsucha move.Recently,
Pharmaceutical companiesare takingabandonedolddrugsandturningtheminto“specialized
treatments.”Suchisthe case withCycloserine,anantibioticusedtotreatdrug resistanttuberculosis.
AfterbeingacquiredbyRodelis Therapeutics,the packof 30 pillswentfrom$500 (prettyexpensive)to
$10,800 (Ouch!).There are somany examplesof thissuddenraise thatagroup of congressinvestigated
the fact that so genericsmedicineswere suddenlyrisingfromone daytothe next.Ourhealthcare
systemgetsconstantlyaffectedbythisunfoundedandsuddenprice changes.
Thislack of price transparencyisnot onlyinprescriptiondrugs. Goingtothe doctor isalmostas
frustratingasplayingwitha spoiledbratwhodoesn’tlike tolose,theyjustmake upstories.There isa
seriousand scary lack of transparency inthe healthcare industry. We live in a country where we can
go to Best Buy and check the price of a TV, thengo home and order it from Amazon or Groupon

8. because it’s cheaper.We can do thisprocesswitheverythingfromcars,TV’s,groceriesandabsolutely
everything,exceptourhealth.Althoughitisa fact that whenyouhave a heartattack you can’t justgo
windowshoppingforhospitalsorambulances,still peoplecan’t know whattheyare chargedfor a
consultationora test.People associate costwithqualitywhenthere isreallynocorrelation.
Thislack or price transparencynotonlygoesagainstcommonsense,itgoesagainstall aspects
of capitalismandfreedom.People are notable to look for the best value when talkingabout their
healthand are stuck paying whateverthey want to charge themfor. Hospitalswouldoftenmake
separate chargesforsomethingthatpeople wouldconsiderthe same thing.Forexample,If Mr. Badluck
has to go geta colonoscopy,he mightnotonlybe chargedforgettinga camerainsertedintohismost
private parts,he will alsogetchargedfor the Doctor’sfee,nursesfee,facilitiesfee,floorfee,bedfee,
windowfee,etc.Mr.Badluckcould have gone to anotherfacilitytogethisworkdone but he didnot
knowany better.
Luckily for consumers,Insurance companiesare having mercy on us and some of them are
starting to come out with tools to helpwith price comparisons. They are not completelyaccurate and
mostare basedon whatpeople inthe areaspendonaverage.Accordingtothe CommonwealthFundin
itsarticle QualityMatters afterinvestigatingaprimarycare practice,theyfoundsome endoscopieswere
pricedat $1000 while otherswere $4000 or $6000. The poorguy charged$6000 musthave come in a
suitmade out of goldto be chargedsix timesmore thanotherpatientsinthe same place.
Havingprice transparencyinthe healthcare fieldwouldbe one of the mostimportant
improvements.There wouldbe some competitionand bettercompetitionmeans betterprices. People
will be able tolookforthe bestvalue andmostof themwould stoprelyingonpayingmore forlessthan
perfecthealthcare.Doctorsand facilitieswouldneedtostepuptheirgame since they can be
scrutinizedmore easily. There are 9000 medical bill codesbutnotone of themiscuring the patient
(Sweet).
As previouslymentionedthere isnoprice transparencybecause of the fluctuationsindata
acquired. How isit possible for an insurance company to estimate the out of pocketcosts if they don’t
have an idea how much theyare goingto be charged for the procedure they are subjectedto?
Insurance companiesdon’tknowwhatthe doctorisin the moodfor prescribingthe patient.Evenif the
patientactuallyhas flu,ifthe doctor wants to make sure he can evenorder a biopsyor whatever he
pleasesand the patient will have to do it and the insurance company, ifhe has one,will have to try to
cover it. If the patientdoesn’tfollowthe doctor’sordershe won’thave hisprescriptionandhe will not
gethealthy.
Michael E. Porterand ThomasH. Lee wrote the article Thestrategy thatwill fix health care.In
thisarticle Porterand Lee explaina Utopianidea of what healthcare should become.In theirperfect
little world,people wouldgo to IntegratedPractice Units(IPU’s).In these unitsseveral medical and
not medical personnel will work togetherwith each patientand not only treat a disease but its
complications.Theywill be patientcenteredandpatientswill receive nice littlephone callstosee how
theyare doing.Thissoundslike aperfectideaif we hadunlimitedtime oratleastunlimiteddoctors.
These doctorswouldhave tobe fluent inseveral fieldsof medicine.Everyone shouldalsohave time
aftereach patienttodeliberatewhatthe nextstepshouldbe.Thisarticle hasthe bestunattainable
solutionbecause doctorsdon’tgrowontrees.

9. Doesit reallymake sense fordoctorstoscan for absolutelyeveryillnessandcharge youforit? It
doesmake sense giventhe contextinwhichwe livein. Physiciansare constantlybeingsued for
malpractices. Some of those malpracticesare real andsome are justout there tomake someone afast
payout.Thissituationislike Godzillavs.KingKong,doctorsvslawyers,maythe bestmoney-grabberwin.
A wayto avoidall the costs relatedtothissuperfluouswouldbe tohelp maintaineveryone accountable
of theirrole ina patient’shealth.Doctorsshouldbe able to keepdigital records of appointmentsand
proceduresdone on the patient. Andthey could call patientsto make sure they are keepingtheirend
of the bargain. These little detailsare cost-effective solutions because theyrequire barelyany
investmentand the fruits could be astonishing.
Everyone relatedtothe healthindustryisata catch 22. Doctors have to give goodincome
towardsthe hospitalsandhave to complywithmanyregulationstherefore theytendtobe overly
cautious.Doctorswouldusuallyrecommendunnecessarytestsinordertoavoidlegal problemslater.
Patientswho get exposedto so many tests eventuallyfindsomethingwrongwith theirhealth that
shouldbe treated.Healthinsurance companieshave topayforall these testsanddrugs afterthe person
isdiagnosed.Andhealthinsurancecompanieshave tosomehow come upwithnumbersof how much
the processis goingtocost for everysingle person.Even if theygetthe approximate costforsomeone,
that cost will varydependingonabsolutelyeverything,since pricesfluctuate amongthe same clinicwith
the same doctors.
Even wheninsurance companies carry so much of the blame for having thiscomplicated and
inefficientsysteminplace,theyare also the onesstuck with the hardest part of the system,making
sense of it.They are the oneswhohave to figure outwhat,when,how,andwhoto insure.The
insurance companieshave toarrange all those datapointsand make themintosomethingtheycansell
to people.Theyhave tosell itina waythat people mightfeel peace of mindof havingitwithoutreally
havingit.Most people blame the healthinsurance providersforall this mess;inrealitytheyare not
responsible forthatmuch.
Insurance companieshave tostartby definingwhat aninsurable eventis.AsGoodhillexplains,
“…But healthinsurance isdifferentfromeveryothertype of insurance.Healthinsurance isthe
primarypaymentmechanismnotjust forexpensesthatare unexpectedandlarge,butfornearly
all health-care expenses.We’ve becomesousedtohealthinsurance thatwe don’trealize how
absurdthat it is.”
Andhe isright. Before,insurance companieswouldhelppeopleoutincase theyfacedan
emergencyandhadnot savedforit. Insurance companies were to helpin the last resort. That could
keepsituationsstablesince office visitsshouldnotbe soexpensive astoneedhelptopaythem.Drugs
shouldnotbe as expensive astoneedsomeone else toover80% of the price. People like tobe
comfortable,and insurance companieslike to sell and make profits,so they sold comfort. Insteadof
payingthe doctor,the insurance companywouldtake care of it.Thinkinglike adoctor, itis easierto
charge largeramountsof moneyto thisbigcompanywithofficesinthe topfloorsof a skyscraper,thanit
isto the single motherof two.Thatcomplicatesthingsbecause Doctorswillcharge more andpeople
withor withoutinsurance willhave topaywhatevertheyare chargedfor.
Insurance companieshave tofigure outwhatshouldbe covered. Asdescribedbythe article by
Lawrence H. Mirel, We call it Insurance:

10. “The general definitionof an"insurableevent" -- fromtrafficaccidentstotornadoes -- is
somethingthat,first,isveryunlikelytohappen;second,will come withoutwarning;andthird,is
not somethingthe personwhoisinsuredeverwantstohappen.Thatdefinitionappliestosuch
catastrophichealtheventsasseriousillnessorinjury.Butit doesnot apply toroutine health
maintenance.”
Well,guesswhatwe are usingitfor? Routine healthmaintenance (salvation?). Accordingto
Mirel,This model isnot the most lovedor evenefficientmodel forinsurance. Currenthealthcare
plansare a Frankensteinmonsterof whatshouldbe insured.Consumersandhealthprovidersaskfor
regular(notmedicallynecessary) eventstobe covered,whilethe insurance companies justmade
calculationsforthe medicallynecessaryprocedures.Thissituationissimilar toinvitingafew friendsover
for a relaxingbarbecue andatthe time of the social gathering,everyonebringstheircousins,friends,
parentsand petsandyou onlygotfive poundsof brisketanda 12-pack of beer.
Insurable eventsin healthcare are no longerjust catastrophic emergencysituations.
Legislatorsmandate that evennot necessaryproceduresbe coveredto some extent(Mirel). This
article wasmade a fewyearsbackand insurance haschangedsince then.One of the possible solutions
that he proposedwastwodifferenttiersforhealthcare costs.One tierwouldbe the catastrophicillness
and the otherwouldbe the healthmaintenance.
At mygirlfriend’sjobshe hasthe optiontodothis. She can get a separate insurance in case she
gets a chronic illnesssuchas cancer or Alzheimer’sandshe can getthe regular insurance that covers
for drugs and office visits. In hercase I advisedhertotake the highdeductible healthinsurance plan
(HDHP) and opena Healthsavingsaccount(HSA).Thisplanworksbetterforherbecause she hates
doctorsand hatestakingmedicine tofeel better. Incase of a critical healthproblemshe iscoveredby
the critical illnessinsurance. Thisinsurance workswiththe highdeductiblehealthplan,incase she falls
ill,the HDHP will helpcoverthe hospitalbillsandthe Critical illnessinsurance,willhelpcoveranyother
expensesrelatedwithmissingworkorproceduresnotcoveredbythe HDHP.When a medical
emergencyhappensitisexpensivesothe deductiblegetscoveredeasilyincase of an emergency. By
gettingthe HDHP her paymentsper check decrease,givingherthe opportunity to save that money
into an HSA. The advantage of the HSA isthat the moneyispre-tax anditkeepsonsavingoverthe
years,whenshe isold and saggyshe can still use ittobuy arthritismedicineif she hasnotusedit.
JohnC. Goodman wrote anarticle inwhichhe explainsthe powerthatshouldbe givento
patientsinorderto make a betterhealthinsurance system. Inhisarticle he points out that for every
dollar spentin health,patientsonly pay one fourth. That minimal amountdoesnotpraise the
consumerswhenmakingsmartspendingorpunishthemforbeingstupid.He pointsoutthe advantages
of havinga highdeductiblehealthplanalongwithaMedical savingsaccount.Withthe moneyonthe
patient’sside comesthe power.Byhavingahighdeductibleplanwithlow premiumshealthinsuranceis
made more attainable forpeople whoare currentlyuninsuredbecausetheycan’taffordthe current
premiums.
The HSA is alsoa huge advantage forpeople because itallows themtouse the moneytheyhave
savedinsteadof owingmoneytheyhave notyetearned. Byspending“liquid”cashinstead,inflation is
avoided.Amountssavedintothisaccountare pre-tax whichisanotheradvantage becausepeople end
up gettingmore value foreverydollartheyspendfromthataccountinsteadof outof pocketcosts.
Goodmanprojects

11. “…if the combinationof catastrophicinsurance andMedical SavingsAccountswere extended
universally(includingreplacingMedicare andMedicaid).Total administrativesavingsare
estimated(basedon1990 figures) tobe as highas $33 billionayear;inaddition,more prudent
spendingbypatientswouldproduce savingsof uptoan estimated$147 billionayear.After
factoringinextracosts of $12 billionayear due to institutingtax fairness, nettotal cost savings
come to $168 billion—ornearlyone-fourthoftotal annual healthcare spendinginthis
country.”
Talking about pre-tax dollars,the largesttax break in the federal tax code comesfrom health
insurance.People donotlike it.The IRS letsgoof $250 billionperyearinhealthinsurance tax breaks.
Thistax breakisan incentiveforemployerstoprovide healthinsuranceplans.Obviously,the systemis
not perfectbecause some people are notable toaffordhealthplanswiththeircurrentwagesandthey
getno tax break;people withmore availableincome will are able togetbetterhealthcare plansandin
returnget a largeramountof moneyintheirtaxes. Since healthcare getsa discount“across the board”
the pricesfor health care inflate and people whowere barely able to pay for these services,can’t
anymore.
The Affordable Care act tries to helpalleviate the tax break problem.Firstof all, it appliesa
tax to “luxurious” plans.This allowsforpeople whopaymore inhealthcare alsocontribute tohelpthe
burdencarriedbylessfortunate people. The secondattemptat making a betterhealthcare systemis
to implementtax creditsto people gettingtheir insurance through the market place. Tax creditsallow
people toreceive moneyontheirtax returnbasedonhow much theyspent.Forexample,if someone
buyshealthinsurance throughthe marketplace theywill be subsidizedforcertainamountdepending
on theirincome.If the insurance isstill more expensive thanthe subsidizedamount,theygettax credits
(moneyback).There isanothermethodtodecrease the tax liabilityof aperson/family,tax deductions.
Tax deductionsdecreasethe amountof taxedincome.Thismethodisusedinmortgage,if a person’s
income is$50,000, and he/she ispayingamortgage,part of that mortgage is $5000 ininterestperyear.
Those $5000 are deductedfromthe person’sincome,soinsteadof havinganincome of $50,000 it islike
he/she hasan income of $45,000 instead, makinghimpartof anothertax bracket.
I’msure the people comingupwiththe numbersforthe ACA wentthrougha lotof trouble and
came upwiththe bestpossible solutions. Still,itseemscounterintuitive tomake the marketplace plans
a tax credit insteadof a tax deduction. Firstof all,tax deductionsare usuallysetonexpensesthat
wouldbe done regardlessof the tax code;there isno avoidingthe interestonamortgage paymentas
there isno avoidinghavingtobuyhealthinsurance.There isafine foruninsuredpeoplesotheyhave to
getsome kindof insurance plan.Taxdeductionsare betterbecause theyenable people togo intoa
lowertax bracket and most of the people whoare able to go into a lowerclass bracket are the people
in middle and lowerclasseswhere every dollarcounts. People earninghigherpaychecksgetbarelyany
difference if theypay$10,000 ininsurance or$100 but for people withlowerincomesitdoeschange
howmuch income theygettaxedon.Anotherdisadvantageof Tax creditisthat a similarthingtothe tax
breakwill happen,if everyonegetsadiscount,noone getsa discount.Healthinsurance willbe subject
to a higherinflation.
People’slivesare constantlybeingaffectedbyhealthcare inwaysthatshouldnotbe affected.
Someone sufferingfromacritical illnessthe lastthingtheywantistobe worryingaboutkeepingtheir
job. Some work placesofferbetter insurance plans than others and sometimespeople workingin

12. those places have to struggle in order to keeptheir insurance. It istheirchoice afterall to stay inthat
place but whatislife withouthealth?The currenthealthinsurance system, favorscertainpeople
workinginbetterplaceswithbetterlifeinsurance.Itislike the healthinsurance tax break,the people
whohave more,justkeepgettingmore. Healthisnot a privilege,itis a right and as such it shouldbe
protected.No one should have tostanda menopausal bossinordertokeeptheirhealthinsurance and
therefore theirhealth.
Healthinsurance plansare tiedwithemploymentbecause of twomainreasons.The firstreason
isthe tax break;employersare encouragedtooffertheir employees’ healthcare thankstothe tax
break.Andthe secondreasonhealthcare is usuallyprovidedbyemployersisdue toGroupinsurance
discounts.Insurance companieswouldgive a better rate per persondependingonhow much people
are coveredby the group policy, thisis because the more people the betterstatisticsactuarial have to
workwith.For example, fourpeoplegoandgeta groupinsurance policy if one of themgeta chronic
illnessthe otherthree have tohelppayforhisexpenses.Whenyouhave the same situationbutinstead
of havingfourpeople youhave 200, thenthe cost of one gettingsickisdividedby200. Thisis why 95%
of insurance policiesare employersponsoredgrouppoliciesand only 5% are individual policies.98%
of companieswith 200 or more employeesoffer healthinsurance while only50% of companieswith
lessthan 10 employeesdo (Sweet).
Before ACA,peoplecouldbe deniedcoverage basedonpreexistingconditions.Thatpeople
wouldusuallygetstuckina jobjustto maintaintheirhealthinsurance,otherwisetheywouldgetno
coverage. Viewingitas a businessmodel,itis a good businessmodel to denycoverage. Insurance
companieswould waste money insteadof earningit. From a logical perspective itdoes not make
sense to prepare for an emergencyifthe personis already in one.From the humanitarian side,it is
our duty as fellowhumanbeingsto take care of the people who needit the most. Today,insurance
cannot be deniedandpremiumsare notallowedtogoupif a persongetsthatkindof condition.The law
protectspregnantwomen,forexample,if theyenrolledinacertainplanand lateronfoundout they
were pregnant,the premiumsshouldstaythe same andtheyhave the chance to enterintoa Special
Enrollmentperiodinordertochange theirinsurance plan.
Trying to give everyone healthinsurance is a noble cause but we have to questionourselves,
what good does it reallymake to give everyone a broken system? No one intheirrightmindwould
give theirkidsabrokenswingsetto play,itisdangerousforthe kidsandit will endupbreakingeven
more. AsMr. Godhill explains,“unlesswe fix the problemsatthe foundationof ourhealthsystem—
largelyproblemsof incentives—ourreformswon’tdomuchgood,andmay do harm”. What
government,insurance companies,healthcare providersandconsumersshouldhave done firstwasfix
the current system,easiersaidthandone.Itmakesno sense toinsure peoplewhocanbarelypayfor
theirgas witha highdeductibleplanandnosavingsaccount,what gooddoesthat dofor them.
Americanshave the fake ideathatsomethingmightbe “free.” Nothinginthis life isfree,everythingis
included.People thinkthatjustbecause theyhave Medicare orMedicaidtheirexpensesare free.Those
people don’tnotice all thatis paidbythemand the rest of the citizens.
In the article The BiggestSecret in Health Care byHolmanW. Jenkins,Jr,Jenkins goestodrastic
extremesproposingtocutthe healthcare tax break completely. He statesthat people don’treally think
about the consequencesoftheirhealth care choicesbecause they think someone else ispayingfor
them. He agreeswiththe fact that the tax breakisharmful because ithelpspeoplewhoneeditthe

13. least.Medicare isthe perfectexampleof the mentalityof babyboomers,someone else will be there to
take the fall for them.Hopefullywithnew generationscomesnew mentalitiesandif we cansurvive the
babyboomerswe mightbe able to do somethingtohelpthe brokensystem.
Now,31% of the populationiscoveredby Publichealthinsurance,18% are coveredbyMedicare
and 23% by Medicaid,some are dual eligible andcoveredbyboth.Takingintoaccountprivate and
publicinsurance, one thirdof the people don’tfile any claims while 10% ofthe people use more than
60% of the health care expenditures(Sweet). Makesyouwonderwhatthat10% is doingwiththeir
lives. IFthat10% of the populationwouldstopmakingsomanyclaims,the insurance expenditure
shouldgodown,therefore makinginsurance more affordable forthe restof the people.
There is a well-knownanalogythat relates to this overusage of insurance by some,the
tragedy of the commons. Basically,whatthe analogyexplainsisthatthere isa lake witha limited
amountof fish.Thisamountof fishisenoughtofeedeveryone inthe towncomfortably.Sometimes
people don’trespectthatcapon the fishtheyshouldgetandendup fishingmore thantheyshould.
Evenby justfishingone more fishthantheirquota,theyendupdisturbingeverything.Firstof all,the re
islessfishavailable andsecond,peoplewhosee theirneighborsfishingmore thantheyshouldand
gettingawaywithit,endup fishingmore forthemselves.The happyendingof the storyisthat everyone
dieshungry. Whenpeople feel the freedomtotake as many as theycan of somethingtheywill. The
onlywayto avoida tragedyof the commonhealthplan,isto be betterenforcers.Create asystemwhere
people donotneedtofile somanyclaimsand the onestheydoneedto file actuallyhelpthemget
better.
In order to try and make this messbetter,insurance agenciestry to control prices as much as
they can. Reforms are constantly beingmade in order to maintain costs low but that isnot a
sustainable approach.Itisnotthe same to buyone cheapshirteveryweekbecause itkeepsripping
apart than to buya good qualityshirtthatisa little more expensivebutlastslonger.The easierandless
reliable fixistocontrol howmuch youspendinsteadonfocusinginwhatyouspend.The government
and the insurance companieshave triedforyearstokeeppriceslow withnoevidence of success.The
priceskeeprisingalongwithcosts.Beingcostefficientinsteadof price efficientisamore reliable wayof
keepinginsuranceagenciesinblacknumbers.
Recently,Insurance companiesare tryingnew methodsinordertokeeppeople fromspending
so muchmoneyat doctor’sofficesandhospital visits.Insurance companiesalongwith government
have triedto helppeople avoidgoingto the doctor by livinghealthierlifestyles.Governmenthastried
by changingschool lunchestohealthieralternativesandbystartingprogramslike Let’sMove with
Michelle Obama.These are attemptstohelpthe “lessfortunate”make betterhealthchoices.If the kids
don’thave otherchoice theywill eatthe nastysaladinsteadof the nastynuggets,at leastthe saladis
healthier.Bylivinghealthierlives,peoplecanavoidgoingtothe doctorfor ailmentssuchasdiabetes,
heartproblems,andobesityrelatedissues.
On the other hand, Insurance companiesare “Rewarding” theirconsumers for healthy
choices.If a persongoesto geta regularcheck-upeverysix monthsof ayear,the insurance company
sendsthema giftcard. If the personenrollsinagymand goescertaintimespermonth,theygetanother
giftcard. Whentheyenroll inwellnessplans,theygetmore money.Thesenew strategieshave been
aroundfor a little time andresultsare still unclearbutmyguesswouldbe thatthisstrategywill really
helpimprove the patients’health,the healthcare systemandbringdowncosts. Anotherperkinsurance

14. companiesare startingto offerare “Videooffice visits.”Forsimple consultationsthere isachoice tojust
talkto a doctorovera videocall.Thatisthe greatestideaever.
Absolutelynoone wants to spend theirmorning in a doctor’s office readingold magazines.
Whenina Doctor’soffice there are a ton of people sickerthatcouldspreadtheirdiseasetoother
people.Peoplenolongerspendtheirtime sittinginawaitingroom. Onthe otherhand,it isalsobetter
for doctors.Theydo nothave the overheadcoststhata clinichas.They are able to treat people faster
and more efficiently.Peoplewhoreallyneedattentioncangetitwithoutgettinginthe wayof people
whojusthave the flu.
Everyone isstartingtolookat the problemandtryingtocome upwithsolutions. Mostpeople
now agree that in order for themto live healthierand happierlivestheymust preventdiseasesrather
than cure them. On the article Howhealthcarekilled my father, Goodhill states“Medical care,of course,
ismerelyone componentof ouroverall health.Nutrition,exercise,education,emotionalsecurity,our
natural environment,andpublicsafetymaynow be more importantthancare inproducingfurther
advancesinlongevityandqualityof life.”Mostof the ailmentspeople suffernow are preventable.
Accordingto thisgraph from2008 WHO statisticsmostof the deathscome frompreventable/age
relateddisease
Althoughscientistspreviouslydiscovered thatsome chronicdiseasesare hereditary,recent
studieshave shownthateveningeneticdiseases,mostcanbe preventedif takingthe rightmeasures.
For example,diabeteshasbeenprovedtobe hereditarybutthe onsetcanbe delayedorcompletely
avoidedbylivingahealthierlife.Ahealthierlife meanseatinghealthierfoodssuch as fruits vegetables
and proteinsinstead of carbohydrates. A healthierlifestyle alsomeansan active lifestyle;peoplewith
type 2 diabetestend to be overweightand sedentary.

15. Accordingto the AmericanDiabetesAssociation,the costof diabetesfor2012 was$245 billion,
a 41% increase from2007. People Diagnosedwithdiabetesusuallyspendabout$8000, 2.3 timeshigher
expensesthanpeople withoutdiabetes.Of all thatmoney62.4% iscoveredbygovernmentinsurance,
34.4% byprivate insurance and3.2% by the uninsured.Thatsalad at McDonalds doesn’tseemthat
expensive now,doesit?
Notonlylife changingchoicesare importantwhendiscussingpreventionv.treatment.A single
momentcan change someone’slife. Take for example AIDS.No life changing choices,like givingup
cheesecake,are required.Most of the time preventionofAIDS is a tensecond choice. The price of a
whole box of condomswhichwouldprotectsomeoneagainstSTI’s(includingHIV) is lessthan$20. The
annual cost of HIV care in2009 was $367,134 accordingto the CDC, that ismore 18,000 boxesof
condoms.Inthe case of HIV,people inthe 80’sstarted becomingaware of the dangersof HIV and a new
era startedgivingrise toa decrease ininfectionsthankstoprevention.
Some things are harder to preventand people justhave to accept them and be preparedfor
them,like aging. People become oldthere isnowayarounditand age bringsproblems.Myfather
usuallysaysthatoldage arriveswhensomeone startsusingneverandalways;“Ihad neverfeltlike this,
I alwaysusedtobe able todo (blank).”Probablythe 10% of people spendingtwothirdsof the health
expendituresare overthe age of 65. Earlierhealthchoicescatchupwithpeople.
Agingcitizenstendtobe coveredbyMedicare,thereforewe all payforthem.Eldercitizensare
not easyto take care of.Even with the support of society,elderpeople have the most struggle to deal
with. Firstof all, theyare the oneswhotendto get sicker;whentheygetsicktheysufferfromchronic
diseasesandlastof all,theydonot have the advantage of beingable towork to affordtheirhealth
expenses.Some luckypeoplehave aretirementtheyhave beensaving theirwholelifethatmaycat as a
cushionforall the tough times.Mostof ushave the ideaof a retirementinsunnyFloridaplayinggolf.No
one reallyimaginesspendingtheirretirementtime andmoneyinahospital bedeatinggelatin.
Elderlypeople have a lot of medical expensesthey needtocover. The most commonis
prescriptionmedication,accordingtothe HealthPolicyInstituteatGeorgetownUniversity,“Three-
quartersof those age 50 to 64 use prescriptiondrugs,comparedto91 percentof those age 80 and
older.”Notonlydotheytake more prescriptiondrugs,theyalsogetchargedmore forthemas described
inthe followingtablesfromGeorgetownUniversity.
Age isnot the onlygap inpricesbetweendifferentdemographicsof people.Anotherclearly
marked difference isbetweenmenandwomen. AccordingtoGeorgetownUniversity, 75% of women
use prescriptiondrugswhileonly56%of malesdo.Not onlythat,theyalsoget prescribedmore kindsof
drugs(11 v. 7 formen) Womenhave more needforroutine medical examslikemen.
Mike Stobbe wrote an article forthe SA ExpressNewsin2007 describingthe differences
betweenwhatwomenpayandmenpay.He explainsthat mentend to spend lessthan $500 while

16. womenusually spend$1200. He alsostatesthat the reasonfor women’sexpensesbeingsohighis
because “Women’scostsare higherbecause womenneedmammograms,cervicalcancervaccine,pap
tests,birthcontrol and pregnancy-relatedservicesthatmendon’t.”Healthcare getsexpensive quickly
regardlessof gender,age orethnicity.
One of the mainissueswe keepgoingbacktois the overdiagnosisthathasbecome the normin
our healthsystem.Whetherit’sthe doctor’sfaultorthe patients’responsibility, people are getting
treatment for diseasestheydon’t evenhave.Rememberwhenglutenfree foodswere all the hype?
People startedassociatingglutenwithhealthyandorganicandstartedbuyingeverythinggluten-free.
Brands tookadvantage of that; foodsthat have alwaysbeenglutenfree startedgettinglabelsconfirming
it.That label costsconsumersdumbenoughtoreadit several dollarsmore forthe same product
withoutthe label.Glutenisasetof proteinsfoundingrainsnaturally,theyare notgoodand theyare
not bad.Some people have adisease calledCeliacdisease.Similartolactose intolerance,celiacdisease
makessome people intoleranttogluten.Suddenlyitwaslike everyone hadCeliac,onlytheydidn’t.
If you look hard enougheveryone will findsome abnormality with their bodies.Overdiagnosis
isa huge expenseinourhealthcare thatcan be remedied.AccordingtoOverkillanarticle byAtul
Gawande forthe NewYorker,there wasa studywhere theyexaminedmore thanamillionMedicare
patientsandaskedthemif theyhadcertaintestsperformedonthem.These testswere testsprovento
not helpatall withcertaindiagnosticssuchas gettingaEEG for a headache.Amazingly,24-42% of the
Medicare patientshadat leastone of those testsdone.Justforreference,anEEG may cost upto $3000
perday.
Sometimespeoplewillgetfedupwiththissystem.Itisa redundantsystemthattakesmore
frompeople thanwhatit usuallygivesthem.Itspeciallyharmspeopleinthe economicaspect.Some are
evenwillingto leave theircountry in order to get the procedurestheywant or need. Term givento
people travelingoutside theirhome countryinordertoget a medical procedure ismedical tourism.
Duringthishealthescapadespatientsusuallygotolessdevelopedcountriestogetcheapertreatment
whichisusuallypaidoutof pocket. It is a riskworth takingforsome people since it’scheaperand
quicker.
For people lookingtoenjoyavacationwhile gettingtheirimplants,there are special travel
agenciesthat will take care of the trip, accommodations, surgeon,hospital and the transportation to
and from the hospital. Some insurance companieshave alsostartedpartnershipswithforeignhospitals
inorder to lowerhealthcosts.Medical schoolswithgoodreputationhave alsostartedpartneringwith
othercountries,sopeople cangetsurgeryinJohnsHopkinscampusSingapore andstill paylessthan
goingto the local emergencyroomonthe corner of the street.
Medical tourism had several disadvantages.The most important disadvantage is that it is
another country! A differentcountrymeansthere are othersetsof rulesandguidelines.The doctors
there have noideaof the individual’smedical history,theymayevenspeakadifferentlanguage.
Anotherriskisthe travel itself,travelingsoonafteramedical procedure cancause complications.the
othergreaterriskof medical travelingisthatthere isno follow up,therefore whenthe grease filled
implantsexplode the prettyblonde will alreadybe at herNebraskahome,farawayfrom the doctor
responsible.

17. Medical tourism is a great risk but for some people itis the onlychoice. Costsinthe US are just
too highforsome people tohandle,theyalsohave towaitlongertogetthe proceduresdone.Inmany
waysit givespeople the opportunitytohave choicestheydon’thave intheircountry.These medical
touristsalsohelpthe local economywhichisaplusno one reallycaresabout.
No one can escape healthcostsbuthealthcan escape froma person.We alwayswantto be
protectedagainstanythingthatcouldhappen.Truthis,we couldhardlybe protected.Healthinsurance
inthe US is a dream,a fake safetynet. It has become so complicatedand regulatedthat it is almost
impossible tountangle. It remindsme of stickinggumina girl’shair.Eventually,nomatterthe time
spentandthe home remediesusedtotryto fix it,we’ll have toendupcuttingthe girl’shair.The sad
part of our sadsystemisthat it isnot hairand it will notgrow byitself so easily.Ittakesaconscious
effortfromeveryone.Itis not the government’sresponsibilitytoimplementnewreforms. It doesno
difference whatreformsare putup;people will findwaystoabuse the system. The onlysolutionisto
change the way people lookathealthcare and healthinsurance.We have tomake sure that everyone is
payingfortheirpart and theyare payinga lot. If I had a Magic wand and I could fixthe Health
insurance system I woulddo justone thing,make everyone responsible forwhat they are paying.If
that doesn’twork,Iwouldjustmake everyone disappearandproblemsolved!

18. Sources:
High Deductibles may cost women. Mike Stobbe
How American Health Care Killed my father. David Goldhill
Perverse Incentives in Health Care. John C. Goodman
The biggest Secret in Health Care. Holman w. Jenkins, Jr.
The Strategy That Will Fix Health Care. Micahel E Porter and Thomas H. Lee
We Call it Insurance. Lawrence H. Mirel
Health care industry notes. Sweet
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raises-protests.html?_r=0
http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/april-may/in-
focus
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/
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opinion
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leases/426166/20150303.html
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/May/1595_S
quires_explaining_high_hlt_care_spending_intl_brief.pdf
http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-
world.html?src=me&ref=general&_r=1
http://www.unicef.org/media/files/ChildPovertyReport.pdf
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Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
http://nccd.cdc.gov/NPAO_DTM/LocationSummary.aspx?statecode=94