The elephant in the operating theater
US Medical costs are out of control. But rather than dealing with that, voters will be faced with political policy decisions based on whether the govt should pay for it.
While politicians have had a field day talking up a good game on the campaign trail, now that things should be back to business again, how about we start to empower people to take control of their bodies and their health again? In this article I deep dive why the elephant in the room of high medical costs in the USA isn’t healthy for anyone.
The other day, I had to fill a prescription at the local drug store. I had my doctor call in the prescription, and I called them to make sure they had it. “Sure, we have it. Come in and pick it up in about an hour”. OK, I thought. I’ll schedule that with my normal local errands.
The prescription was for an antibiotic, Azithromycin. Commonly called a Z-Pak. This is an extremely common drug. Normal retail price on this is about $35 but with insurance, I paid $15 for it. The thing is my monthly insurance premium is about $1,100 for a family of 3 here in Arizona. We’ll unpack this a bit later in this article, but the story continues...
So I get to the drug store. There are about 8 people waiting in line in front of me. Each time a customer goes to get their prescription, the process takes about 12 minutes. I actually timed this because I couldn’t believe just how inefficient it was. Eventually I get to the counter and the lady is there. “Oh, I remember you - I spoke to you on the phone”, she said. Felt nice that someone remembered me. Then she says, “About your script, it is going to take another hour.”. WTF, I thought? It has already been 5 hours since this was called in, 3 hours since I called to confirm and was told to come in 1 hour later. What would happen if this was Domino’s Pizza? Would I get it for free, because they promise to deliver in 30 minutes or less?
Nope. You get what you get, and you don’t have a fit. Fine, so I wander around the store for a bit, go sit in my car and check my emails on my phone. Listen to a podcast. Eventually an hour is up, and I go back only to stand in line another 30 minutes while waiting for the other customers to get served. Then I get there, and she (again) serves me, and says, “Hold on a minute”. Then she comes back and says it is still not done yet. I give her one of those disappointed stares. Then she says, “Hang on...”. She goes over to one of the pharamcists and manages to kick them into gear and them a bag with my Z-Pak emerges. I pay with my credit card for the $15 which goes through in 3 seconds, and eventually I get to leave.
This whole process took about 7 hours in total. As a customer, I’m pissed that I’ve missed something I had planned to do later, it is now after 5PM and I can’t complete my errands that day. It was not a pleasant experience.
Now I’m going to A-B compare this to how I normally get prescription drugs. About 3 hours from our house is the border of the USA & Mexico, specifically the medical tourism town of Los Algodones, Mexico. You drive there, pay $6 to park all day on the US side of the border, walk into Mexico (there isn’t any border control going into Mexico) and then you get to choose one of the 50 or so Mexican Farmacias all wanting your business. You go in, order a Z-Pak and the lady there who speaks perfect English asks, “How many do you want?”. When I question the price, it is $2.99 each. I can pay with a credit card too. While you are there, you can get pretty much anything you need at pennies on the dollar to the US price. When I was talking with my dentist there about this, I asked “Doesn’t the US Customs & Border Patrol stop this?”. He said, “Nope, because as long as it isn’t some Class A narcotic, they don’t care. Just don’t try and buy more than 6 month’s supply at once”. And that is 100% true. I get back in line to go through immigration to get back to the USA, and I’m with dozens of senior citizens from the US and Canada who are all down there getting their prescriptions filled for about 1/12th of the price of the US pharmacy.
So to compare this, a 7 hour process in the USA for $15 + $1,100 medical insurance premium, in which at least 6 people “touched” the prescription, vs. driving 3 hours to Mexico, 30 minutes to get the Z-Pak for $2.99 and walk back through immigration, back to the car and drive back 3 hours home. About the same total amount of time.
I have been thinking about this for a long time now. I analyze our family’s budget and expense line items with laser precision. The largest cost line item each month is medical insurance. It is more than most family’s mortgage payment in Arizona. Sure, if you work for an employer they pay for it, but that doesn’t mean you are not paying. If you got the money that they paid for this, you’d likely see a $20,000 pay rise in your salary since that is the average cost that an employer has to pay for your family’s insurance. They pay more than the individual does, but they do it because it is part of the enslavement process and the “golden handcuffs” that they wish to use to keep their employees from leaving.
Why are we so stupid to be paying such a large amount of money to the medical industry for what can only be described as the most inefficient business practices? Is it that the doctors get paid a lot? Not really. If you consider the level of costs that they had to fund for the education to become licensed to practice medicine, they are not making out like bandits here. We are actually rewarding over-burdened regulations along with an industry of rich billionaires that make mega-wealth from what we individuals consider to be the most important expense we can make.
Meanwhile the value for money here is low. The longevity of a US Male on average in the USA as of 2018 was 79.3 years. The same longevity in Europe is closer to 82. We are living about 3-5% shorter lifespans than our friends across the pond, yet we are paying 10x the cost of health care than they are.
And yet, when politicians talk about health care, they only talk about health insurance and who pays. Single payer, Medicare, pre-existing condition coverage, etc. It is all about coverage. The problem has nothing to do with coverage. I guarantee that if your costs were 10x less than you are currently paying, you’d probably gladly pay all of it out of your pocket if you could.
I’ve spoken about this a lot, but I classify health care into 3 categories - Preventative, Elective and Adverse/Chronic. There’s a big difference in the first 2 categories and it can be summed up with one word - CHOICE.
Let’s say you want to go to the gym. You have choices. There are likely many that are in a 10 mile range from your home. Some are smaller boutique facilities with personal trainers, others are “BigBox” gyms that have more equipment, and are cheaper. You can choose which suits your use-case and budget and join the one best suited to your needs. The pricing is forced down by the free-market. Price discovery determined a $20-$50 a month cost of a gym membership here, not some government protected industry. And you can change your mind (within the terms of your membership contract) anytime you want.
If you want to buy vitamins, you have the choice to go to specialty stores and buy from them, or you can get them on Amazon. You can research the supplier, efficacy and costs on the Internet. You can read reviews from others and you can make your choice from that information.
Now let’s say you need some medical procedure done. Maybe it is a hip replacement, or some dental work, or something like that. If you were to shop around for pricing, good luck. This second category of elective surgery is lumped in with the last category of Adverse/Chronic care because it happens to occur at the same medical facility - a hospital. But over time, more outpatient facilities have popped up for these things, and some smaller private hospitals offer a very competitive pricing model. But you also have the choice to be a medical tourist and go to a country that may treat you and your wallet better. That’s what I did for a total shoulder replacement. The outcome was amazing, and the cost of the entire surgical team, procedure, prosthetic and 3 nights of hospital stay was less than my deductible for my medical insurance in the USA. And with that said, they wouldn’t cover me in the USA for the procedure because it was a pre-existing condition.
I price quoted the cost in the USA at $125K and paid $9K. 12 times less than the US cost, by having it done in Guadalajara, Mexico - a 2.5 hour flight south of where I live.
But I spent a lot of time researching, and I had CHOICE. So many of my friends who have some lingering medical condition and are just dealing with it, don’t understand that they also have choices. Often their medical condition degrades to the point where they no longer have a choice and then they fall into the third category - Adverse/Chronic.
In this category, you find yourself a victim to life. Whether it be a biological failure in your body or some external event (ie. car accident, etc.) that causes you to be admitted through an Emergency Room visit to a hospital. At this point, you have no choice. You are hoping that the facility that was close enough to you, in order to get care that will save your life is covered under your insurance. And you have to pay the deductible which could be up to $10,000 of the first part out of your pocket. If the care is ongoing, that $10K is your annual cost on top of your medical insurance premiums that you have to fund out of pocket. And then there are all the BS fees that the insurance company won’t pay, but eventually fall on your lap somehow.
There is NO CHOICE when you are lying on a stretcher, unconscious here. You get what you get, and you don’t have a fit.
This is where it doesn’t make sense for me. Consider how many times in your life you have had to go to the doctor, hospital, etc. I’m not sure what the average number of times people have to engage with the medical industry, but I’m going to punt at 200 times per person. Sure, some people have chronic issues and need to routinely visit medical practitioners. I’m sure they would prefer not to be in that situation.
Others may be younger, need little medical intervention and live a health life of diet & exercise. I’m sure all of us would like to be in this situation.
But let’s say 200 times. Now consider of all the times you had to see a doctor, what percentage of those times did you have choice? Choice as to who to visit, choice as to getting a procedure, done, etc? How many times as a percentage did you have control of the situation? I’m going to go with 90% of the time.
The number of times that we have car accidents, heart attacks, etc. as a percentage of the total time we engage with the medical industry, is a minor, minor percentage. And yet for most people in the world, they give up their control to their insurance plan, VA plan, Medicare, etc. to tell them when they can get care. They don’t take any responsibility to themselves to realize they have total control other than this 10% or so when they don’t.
And our medical industry know this. Because if you create a controlled environment - a “Nanny State” as I like to call it, then you can remove choice from the equation.
Now I am not talking about some public, government run health care. I’m not talking politically here. I’m talking about allowing the free market to participate in 90% of your engagement with the medical industry. You choose who to see, what drugs to buy, what preventative care plan you have, who and where your elective procedures are done. You probably do this with dental care now anyway. By having a good plan for proper dental hygiene and proper brushing & flossing, you probably avoid a lot of dental visits. But when you do need to get that implant done, or whatever your care need is, you have a choice. You are not told who to go to - you choose.
I use the dental analogy here for choice because it is something people understand. When the dentist quotes you $5,000 for a dental procedure, you have the right to say NO and to shop around for other quotes. You could do what we do, and to drive 3 hours to Los Algodones, Mexico and pay 25% of the US quoted price there. We’ve done that routinely for all of my family member’s dental needs, but even that seems to be a bridge too far for many.
Why? Because our society has been raised in a “Nanny State” where few people take any form of active participation and responsibility for their bodies. They feed it with so-called “food” that they know is bad for them. They smoke, they take recreational drugs, and they don’t have any form of regimen for preventative health care. They panic because they think their health is out of their control. Meanwhile the US medical industry is lurking in the shadows knowing this, and manipulating the playing field by ensuring that you don’t enact any form of active choice in your health. You just go to the hospital. It becomes habit after a while. Meanwhile you keep 6-10 people employed while they process your paperwork, claim, etc. and don’t engage in providing any form of health care - just administration. The doctors are not getting financially rewarded at a level they are entitled, and the greedy lawyers and insurance companies are making out like bandits.
But we are happy to keep that going because they are publicly traded companies that provide us with greater 401K value in our stock portfolio and as long as we don’t see all this money flushing down the drain because our employer pays for it on our behalf, well it is out of sight, out of mind, to us.
This is pathetic. Meanwhile once you get on the “I’m not responsible” train, it is heading off to heavier regulations, low grade outcomes, inefficiency, cost-cutting for greedier shareholders to keep more profits, government cartel deals with “big pharma” or some other lobbyist, and your choices keep disappearing. Yet for 90% of the time that you could have managed the choice, you elected not to. You just went with “what my insurance will pay” like some child walking in the darkness.
It is your body. 90% of the time, you have the choice for medical intervention. And 100% of the time, you have the choice as to the food you eat, the things you put in your body and the likely reaction you will have to those things. This is YOUR choice. Not some insurance company, government or counter party.
If you don’t fight to retain that choice, it will be taken from you. The food you eat will be laced with addictive substances to ensure that you have to keep eating them. The costs of the food will only be affordable if you buy artificial produced food substitutes by agronomics and chemical invention. The power of taste is constantly diluted so you have to eat more, get fatter and your performance is just dwindling. It is a slippery slope - once you start on that downward spiral, it is super hard to fight to get back out of it.
You must realize that 90% of the time, you do have choices. If you believe you don’t, do some critical thinking. If you think that you have to get that operation done in the USA, you don’t. The quality of care outside of the USA is typically as good (and in some cases better), and for a much lower cost. My own personal experience was 1/12th of the price of the US equivalent.
Now with that said, let me tell you what I think does work really well in the USA. Emergency medicine and high-end procedures, often with cutting edge creativity and invention, is more likely to be an option in the USA. Why? Because the budgets available due to this 12x cost factor that is abundant here has a portion of that returned back to R&D which means anything that is predictable and inventive allows the natural problem-solving skills of the American culture to thrive.
But how many times do you engage with that level of medicine? The thing is that we give up our control all too easily because we are a herd of followers. We don’t critically think about what we are doing. We are too busy being stressed out and working ourselves to death to realize that this is a part of our longevity that we are not respecting. We don’t intervene when needed with proper trade-off analysis of options. No one wants to take the road less traveled here. They will just follow the herd into the “Nanny State” of Medical care, giving up control of their own bodies to their politician of choice and not to their own choices.
I understand that we need a safety-net for those that can’t afford to have choices. But rather than just accepting that as the end-point, we don’t question why they can’t afford to have choices. Our medical industry would prefer not to promote that line of questioning, or it could disturb the income flow. I’ve worked in large biotechnology corporations before, from startup to operating, and I’ve helped startup medical claims processing companies that today are making hundreds of millions in revenue being a cog in the wheel of dysfunction while their very own patients are dying of drug addiction and falling into being victims to something they could have controlled earlier on. When it suits certain parts of the medical field to call alternative medicine “quacks” or “whack-jobs”, because it could threaten their own business model, we have a problem. Considering that most pharmaceutical products came from embracing things that are commonly found in nature, and creating synthetic versions of it, or how to scale that into a drug. Nature is the answer to most of our issues, and yet unless it comes from someone with a “DR” in front of their names, we don’t tend to pay any attention.
So this is why we our bodies are constrained. It is one thing to constrain our minds by restricting the information that can come to us. Or to constrain our finances by extorting us for money all the time. But when it comes to YOUR body, you have choices. And until you start to think outside of the proverbial box, you will be further constrained by a lack of choices, and often this is only seen when it is too late.