Medicare Rife with Fraud, Waste, and Ineptitude
Life Extension (and other media sources) has reported egregious examples of how Medicare expenditures are squandered. In some cases, crooks set up phony clinics, collect millions from Medicare for services never rendered, and then move on to another location before Medicare figures out it is paying bogus claims.
The real money, however, involves lobbying Congress to force Medicare to grossly overpay for the particular service, device, or pharmaceutical a company happens to sell.
One of the fastest growing areas of the disease-care industry is “home healthcare.” It aims to save billions by avoiding costly hospitalizations. Hospitals, of course, learned how to bilk Medicare long ago, and home healthcare providers are no less proficient.
An investigative report by the Wall Street Journal uncovered a ridiculous program in which Medicare paid a $2,200 bonus once a company made ten at-home visits to a particular patient.15 With this kind of incentive, home healthcare companies jumped through hoops to hit the ten-visit mark, even threatening employees with no pay if they failed to figure a way to bill Medicare ten at-home visits for every patient. Remember, for each patient that Medicare paid for ten consecutive visits, an absurd $2,200 taxpayer-funded bonus was kicked back to the home healthcare provider PLUS the cost Medicare had to pay for each at-home visit.
Those who successfully lobby Congress receive windfall profits from Medicare, while those who don’t are so short-changed that many are dropping out of the system. It’s somewhat analogous to the former Soviet Union, where companies favored by the entrenched Communist Party received special status, while those who lacked political connections often could not pay their employees because no money came from Moscow.
One home healthcare company that receives 90% of its revenue payments from Medicare enjoyed revenues of $1.5 billion in 2009, compared to only $88 million in the year 2000. Its stock has gone from less than $1 in 2000 to $60 in 2009.15
Clearly, the way to make money in today’s economy is to find a way to guarantee that the federal government will pay you inflated prices so you don’t have to worry about competing in the free market for consumer dollars.
A Trip to Mexico with My Son
I try to spend time with my children and wound up in Mexico for a few days last summer, where my 13-year-old son was bitten by an insect. He developed a painful reaction that required immediate attention. Fortunately, in Mexico, you don’t need a prescription to buy most drugs. I was able to walk into a pharmacy and purchase a tube of triamcinolone cream at virtually no cost. Within a few hours my son was cured.
In the United States, it is not so easy or affordable. For some ludicrous reason, the FDA mandates that one obtain a doctor’s prescription for topically-applied triamcinolone cream. If this insect bite had occurred in the US, I would have had to find an urgent care medical facility that was open, pay the doctor over $100, and then take the prescription to a pharmacy and wait for it to be filled. My son would have spent many additional hours in pain and I would have spent a lot more money and time.
If I could not locate an urgent care center, a hospital emergency room visit would be the only alternative. The cost to me and my insurance company would have been over $500 for an ER visit as opposed to spending only a few dollars for a tube of triamcinolone cream at a Mexican pharmacy with no prescription.
The Mexican pharmacy, by the way, was overwhelmed with American tourists who were behaving like kids in a candy store. The shelves were stocked with just about every popular American prescription drug, but no prescription was required. Prices for most drugs were a fraction of what they cost in the US.
Prescription Status for Many Drugs Should Be Abolished
There was a time when the public was so ignorant about medical issues that a doctor’s prescription was required for most drugs to be safely and effectively used.
That has changed. An enlightened individual can use the Internet to learn about drugs that lower blood pressure, glucose, and lipids, along with the drug’s side effects. At-home blood pressure devices are more effective in monitoring real-world blood pressure than periodic visits to a doctor’s office. An enlightened patient can precisely individualize dosing of anti-hypertensive medications to bring their blood pressure to optimal levels (below 115/75 mm Hg in most people).
Enlightened individuals, with the help of trained health advisors, can also interpret their own blood test results and choose medications and hormones that can normalize abnormalities that hurried doctors too often overlook. Periodic audits of one’s self-prescribing regimen by a physician would be highly recommended.
There are drugs that require close physician supervision and would remain on prescription-only status.
Naysayers who argue that people will take inappropriate doses or the wrong drug ignore the epidemic of adverse reactions that occur when patients blindly follow physician’s prescribing orders. Look at how many prescriptions doctors wrote for Avandia® long after studies showed sharply higher heart attack and stroke risks.16,17
If doctors were relieved of having to see patients for simple issues (like elevated LDL and triglycerides) they could focus more time on patients who need intensive hands-on treatment.
Accepting Harsh Realities
Medicare’s date with insolvency is a mathematical near-certainty.
There are many reasons for this, but corrupt legislation that precludes a medical free market from developing, along with bureaucratic overregulation, ensures that disease-care expenditures will cripple this nation.
As we proposed in detail in the August 2009 issue of Life Extension Magazine, the cost of prescription drugs would plummet if the FDA did not have such stringent approval requirements for generics.
As proposed today, if patients were empowered to make their own decisions on personal health issues, medical costs would plunge as wasteful visits to doctors’ offices could be reduced.
I suspect most of you reading this recognize that there reaches a point where the words “we cannot afford it” become a harsh reality. Whether one agrees with the solutions suggested in this editorial or not, the simple fact is that Medicare, private insurance, and the private sector cannot afford the costs of today’s broken sick-care system.
For the edification of new members, please know that we at Life Extension have been sounding the alarm bells about the catastrophic consequences of artificially inflated disease-care costs for the past four decades.
The Federal government has responded by launching relentless criminal investigations against me (and others) at the behest of pharmaceutical interests, who don’t want you to know that Americans have been forced to pay $200 for a bottle of valacyclovir (Valtrex®) that costs only $2.10 to make!
For longer life,
P.S. - Generic drug prices fluctuate widely. When more manufacturers obtain FDA approval, prices sometimes drop. When manufacturers cease making certain generics, prices can sharply increase. In January 2011, the Life Extension Pharmacy was able to offer 30 500 mg tablets of valacyclovir for $103, though this price is subject to being increased at any time. When I called a local Walgreens the very same day, they quoted $199.99 for the same amount of valacyclovir.
From an efficacy standpoint, valacyclovir provides relatively mediocre results in those suffering acute herpes or shingles outbreaks. For those seeking natural and more innovative approaches to controlled herpes and shingles attacks, visit the Herpes and Shingles protocol.