While everyone looks at social security Medicare, Medicaid and frighteningly blames it on baby boomer retirement, sounds the warning bell about insolvency in just a few years, it’s as if they have all missed the forest for the trees. The biggest threat facing entitlement programs is gargantuan healthcare costs brought on by a broken medical system no longer willing or capable of providing quality care to the sickest of people, to those who need it most. Instead we have care based solely on ability to pay, hospitals and practitioners so skittish about giving care for fear they won’t get their money decisions center around how many days and what kind of care the above mentioned programs will cover rather than need. Often actions amounting to mere Band-Aids placed on larger health problems until they become extremely serious, many times life threatening before the person gets the care they should have gotten to begin with, if they ever do. This revolving door healthcare practiced by every insurance company but most egregious in entitlement programs like Medicare and Medicaid, forces doctors to justify keeping a patient in the hospital for observation, additional testing or because their fragile health, complicated medical history necessitates caution, usually resulting in the patient returning not to their doctor but back to the ER, where they routinely charge 5 dollars for an Aspirin never mind testing, blood work and other services. Situations that could both be avoided not to mention cost less if the patient remained admitted and the procedures fell under that category in place of the ER, the most expensive part of the hospital.

And it goes beyond people who have no primary care physician, persons using the ER for that function, even people in financially strapped institutions, care facilities, nursing homes. People can have primary care doctors, utilize a number of nurse practitioners, health clinics and still wind up receiving a lesser standard of care, having to go to the ER to find someone who can diagnose what’s wrong with them. Primary care doctors who will overdose amounts of medications, miss key warning signs and in children miss major elements that could point to something serious, like one toddlers ankle giving out as he tries to run. A pediatrician who asked if a 2.5 year old knew his colors, knowing the child did not attend preschool, another who diagnosed a baby with failure to thrive because of his mildly fluctuating weight even though his mother and aunt are the same way today as adults. Someone who saw their primary care doctor the day before and is calling an ambulance today because they are too weak to perform basic functions, to drive themselves to the hospital; example man goes to see primary care doctor complaining of nausea, hasn’t drank or eaten anything in 12 hours, can’t keep water down, the man is also diabetic and incidentally found out from the hospital he eventually landed in his insulin dosage was way too high. Rather than tell him to go to the hospital to be admitted, hydrated, monitored doctor sends him home with anti-nausea meds he turns out to be allergic to.

Once at the hospital don’t count on it being the salvation it’s supposed to be, aside from teaching facilities that use willing patients as guinea pigs, the number of residents and med students in any hospital seeming to be 9 year olds they just made doctors, hospital born infections, people on your floor with the same name getting a different procedure or set of tests that could be mixed up, even experienced doctors will run batteries of tests only to be flummoxed, not by a rare disease likely to be featured on a medical mystery show, but by something simple. Returning to our nauseated man who can’t keep food down, he was hospitalized 4 times hydrated and sent home before on his 5th visit he got sick again as they were preparing to release him, and after looking at his appendix, gallbladder, intestinal tract, stomach 2 psych exams, a prescription for anti-psychotic medication based on the theory he was having psycho sematic symptoms stemming being upset he could not control his diabetes, he was finally properly diagnosed with severe acid reflux, given a prescription and had no further problems. Another case, 90-year-old woman brought into the ER extremely weak and unable to function with a history of bronchitis and pneumonia diagnosed with the former, sent home with antibiotics told to return if their fever spiked. And of course it did the person was admitted stayed days in the hospital and was transferred to a physical rehabilitation center to regain baseline strength prior to going home. Unfortunately being admitted on the second visit meant twice the ER costs to both Medicare and the elderly woman. Our nauseated man now has 4 times the ER billing, admittance fees.

In addition to bizarre unrelated tests costing millions if not billions in unnecessary billing to insurance companies, stripping the pockets of healthcare consumers, like the psych exam preformed on our gentleman with a legitimate physical ailment, other problems that plague hospitals, doctors and the entitlement program insured, include physicians who will come into a patient’s room rattle off a dozen things from test results to medications, to instructions without stopping to make sure they understand what they are being told, often meaning the patient doesn’t learn what their diagnosis is finding out from nursing home staff, when their primary doctor reviews the chart at a later appointment or yearly physical. Individuals find themselves dealing with doctors who won’t slow down and answer questions, for older patients they don’t make sure caregivers, loved ones are there to also hear what is happening, understand instructions, after care procedures, precautions, even in dealing with people possessing cognitive impairments. Keeping in mind said doctors and medical personnel may be delivering devastating news or informing them of a life altering, if not life threatening, diagnosis. Persons today can have a whole team of doctors supposedly providing them care but over and over what routinely transpires is patients getting confusing, conflicting information, instructions, restrictions from each specialist they see; heart doctor saying one thing, kidney doctor saying this primary care doctor saying something else, no one really working together, keeping track of procedures, medications, results. In fact researchers looking at our healthcare system, ways to make it more effective found numerous testimonials of just that; a team of doctors gathered around their bed, not making much sense, leaving the patient befuddled and bewildered.

Doctors who speak poor or thickly accented English also greatly hamper care for everyone, but again seem to disproportionately effect Medicare and Medicaid recipients. Possibly because a majority of older Americans are on aforementioned programs and the ones in need of specialists, extremely varied kinds of care; many can be hard or hearing, making it challenging to process information. Add an unusual accent someone has never heard before, unusual pronunciations of words and it’s a recipe for medical disasters, people overdosing on their medications, misunderstanding food and drink restrictions, mixing over the counter and prescription medications in adverse, potentially lethal, combinations. Further veterans forced to interact with someone clearly not from here can compound problems when their doctor sounds like one of the enemy they used to fight over there; they can’t absorb what they are being told if the look or voice of their medical professional triggers a flashback or even mild PTSD episode. Other Americans are simply put off by the whole package presented by a doctor clearly not born here; from little things like wearing socks and sandals rather than shoes at odd times of the year, to turbans or any strange dress, a perplexing accent. Today wondering if your doctor, medical professional could be a terrorist; it’s not prejudicial per say but causes some to feel uneasy, uncomfortable undressing for an exam, tentative about bringing up health concerns, as bedside manners differ widely by culture. If you feel like your doctor doesn’t understand you, doesn’t want to, likewise if the doctor doesn’t understand his or her American patients, misses social cues that they are trying to bring up something sensitive or embarrassing, is utterly confused by the visit, it creates a poor doctor patient relationship translating into poor care, creating a domino effect into everything from a shorter lifespan to emanate death. Oh and not forgetting exorbitant costs stemming from delayed care due to someone not broaching an issue, not following instructions that worsened their condition, refusing to go to their doctor owing to who that doctor is, how they behave in the eyes of the consumer.

Because medicine can be 90% about relationships and 10% about actual medicine, fixing the entitlement healthcare cost problem goes leaps and bounds beyond everyone having a primary care doctor, age and medical history appropriate preventative tests and procedures, healthy lifestyle choices like exercise, not smoking, limiting alcohol. It means having a primary care doctor you feel comfortable with, someone who makes you feel at ease and with whom you can freely discuss care issues. It means having physicians, nurse practitioners, medical professionals all, from large hospitals to family clinics, who are competent and confident in what they do, who know when to send someone to the hospital to be admitted, who know when something needs to be put in the hands of a specialist at an actual hospital and not just handled by the local clinic. Eliminating the scenario above where the man went to his primary care doctor not having eaten or drank in 12 hours and was sent home rather than sent to the hospital for admittance, an action that when coordinated by a doctor, nurse, nurse practitioner, comes down to no processing through the ER and bypasses huge amounts of extra fees. In the hospital it means again professionals excellent at what they do, who are not easily confused by symptoms, who when someone returns for a second or third visit, especially within days or weeks, complaining of the same problem, they dig deeper, who know that you admit an elderly person who has lost baseline function, particularly if they came in via the ER to both diminish cost and monitor care. Again eliminating both a completely unrelated and inappropriate test for the man above and saving money not one but two ways A- not having a useless test preformed at the average mental health professional rate of $150 an hour and B- not causing the man to avoid seeking medical attention for physical issues based on treatment received, that only leads to more costs when a problem can no longer be ignored.

Teams of doctors must communicate clearly with each other and the patient; restrictions and instructions should be reviewed by all doctors on a case before they are given to the patient hospital nursing staff, caregivers, making sure everyone is on the same page. Doctors who speak English as a second language need to have interpreters or other aids there to make sure they are clearly understood, aren’t unintentionally ignoring confusion or persons wanting to ask a question. They also need to be fluent in customs and social cues so that they don’t miss their patient trying to tell them something. Specific fields of medicine such as mental health and psychiatry would be better practiced for these doctors in neighborhood pockets of the particular nationality, taken back to their home country or to any area that sees many persons of the nationality and therefore houses people less unnerved by the package presented, people who have less difficulty breaking down an otherwise unfamiliar accent. While it may sound discriminatory on the surface, doing so produces a twofold positive effect; people of that nationality can have a mental health professional they feel more comfortable talking to because they share the same original social structures, common experiences from their home country, possibly common experiences in assimilating into American society. On the flipside, typical American people of all ages have a better shot at getting an American psychiatrist, psychologist, counselor they will bond with, open up to sooner and neither patient nor doctor are frustrated by an inability to understand each other, waste precious extra time building that relationship solely because of the origins of the medical professional.

As always in discussing cost reduction of anything waste and fraud become part of the discussion waste and fraud that cost Medicaid, Medicare, the government and tax payers billions, contributing to the dreaded insolvency of said programs. Efforts to prevent double billing for medications, tests, procedures should be increased 10 fold as opposed to being left to the patient, who just got out of the hospital, just had major surgery, who is on the lookout for complications, may have bigger health concerns based on what they learned while in the hospital, a layman or woman who is unlikely to know billing codes, medical terminology and really doesn’t possess the stamina to spend anywhere for 45 minutes to 2-3 hours on the phone with a department seemingly built to give you the run around, are completely uncooperative to anyone even hinting they might have been overcharged for something. Closer inspection and oversight of medical billing also curbs billing for procedures never done; case in point, man with feminine sounding name charged for a pap smear, an absolute anatomical impossibility said gentleman had to fight and fight to have removed from his bill. And that’s only because he has the wherewithal to notice it. Fraud is the other huge issue; it seems like every few months the news is reporting a new scam against Medicare, Medicaid social security, sometimes taking years to reveal themselves and 2-3 years of investigation and undercover work to stop while the unscrupulous rob the most vulnerable, fleecing tax payers, the government on the way to doing so. Meanwhile Washington bureaucrats and tea party reformers want to force fundamental overhauls to all so-called entitlement programs that don’t have to be and don’t really address the core malfunctions. The real truth is healthcare costs are destroying entitlement programs and it’s not treatment for obesity related illnesses, how many baby boomers retired within a given year, even the last decade, it’s how much money is wasted in incompetence and inattention across all medical fields, in every part of the healthcare process.