Affordability of Healthcare and the Role of Complementary and Integrative Medicine (CIM)

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Insurance coverage, and government healthcare coverage, for Complementary Medicine, such as the care from a TCM physician, or Licensed Acupuncturist and herbalist, has long been denied and discouraged in the United States, despite the recognition of scientific proof of effectiveness and the very low cost of treatment. As healthcare in this country continues to be less and less affordable, even a complex law such as the Affordable Care Act cannot fully restore this affordability of health and treatment that should be given in a just and humane society. Integration of Complementary Medicine (CIM/TCM) may be one important part of the solution to this enormous problem, and towards the end of this article, and in Additional Information, are facts concerning studies of the cost effectiveness (ICER, QALY, ROI). Awareness of the factors that are making healthcare affordability more and more difficult for a majority of the population, though, is also essential.

Healthcare Costs in the United States - allowing profiteering to guide public health strategies in an array of duplicitous ways

As the Affordable Care Act unfolds, the American public is becoming more aware of the growing unaffordability of our healthcare. In January of 2014, the organization National Nurses United, our largest certified nursing professional organization, published alarming data that showed that hospital pricing practices have consistently increased the charge-to-cost ratio since 1996, now averaging charges of $1200.00 for every $100 of actual cost of care in our most expensive hospitals. As our hospital corporations continue to merge and monopolize care, these larger and more expensive hospitals continue to increase in number, and our smaller and less profitable hospitals continue to be closed by these larger and larger healthcare corporations. National Nurses United reported that in 2012 the average disparity between charges and actual costs in our hospitals had risen to over 3-fold, creating a system where more and more patients could not afford the growing out-of-pocket expenses, line item charges not covered by their insurance policy, and eventual medical bankruptcy, now affecting millions of Americans, and the biggest cause of bankruptcy in the country. Our registered nurses, those closest to the suffering of Americans with disease and injury, have raised an alarm concerning the yearly rise in such profiteering, and the harm to our poor and middle class. It is time that Americans finally pay attention to this enormous problem of healthcare unaffordability, in a country that now spends 2-3 times more per capita on healthcare than Europe, Canada and Japan, yet delivers poorer care.

The concern of these nurses was that "such inflated practices continue to price far too many Americans out of access to needed medical care or expose them to financial ruin". Studies have found that nearly 2 million Americans face bankruptcy from medical bills in 2012, and that 20 percent of Americans struggle with healthcare bills, many of whom do have insurance. Other studies have exposed a pricing system in hospitals that shows such a wide disparity in pricing for standard procedures and surgeries between hospitals in the same geographic areas that there is no logical explanation. The 100 most expensive hospitals in the country in 2012 showed a charge to cost ratio of 765 percent, more than double the average of 331 percent, which is alarming enough. Despite the efforts of the complex Affordable Care Act (ACA) to discourage overpricing of healthcare, hospital charges recorded their biggest yearly increase in the charge-to-cost ration in 2011, a 22 percent increase as mandates to reduce the amount of the revenue going to administrative costs, rather than direct healthcare, kick in as part of the healthcare reform. As our hospital corporations continue to merge to form near-monopolies of healthcare in regions of the United States, the price gouging has not decreased, but increased dramatically. The free market system that touts the ability of companies to merge and expand to bring greater efficiency and lower costs to the public is being thwarted as more and more companies rely on the confusing complexity of our healthcare pricing and payment system, and the inherent desperation of the sick and injured to accept whatever is charged.

In 2015, the Centers for Medicare and Medicaid Services released data that showed that again, a dramatic rise in charges for hospital care had occurred from 2011 to 2013, averaging more than 10 percent for all hospital procedures, but kept almost flat for Medicare charges. This pricing system shows that the cost of adapting to the Healthcare Affordability Act, with limits to the amount of money that can go to administrative costs, is being passed on to the patients using hospital services outside of an insurance network, and of course the uninsured. The largest rises in charges occurred with musculoskeletal problems, such as back and neck procedures, care of back pain, strains and sprains, and joint dislocations and subluxations, which increased in price from 17-22 percent. The disparity between pricing for Medicare and insurance coverage has also risen, with the average for joint replacement with prosthetics in 2013 in the U.S. around $54,000, while the average Medicare payment for this same procedure was just $12,000. The rise of prices for hospital services and procedures disproportionately affects the uninsured and patients who need the services but do not have a plan that has negotiated a network agreement with the hospital. The manipulation of the complex network agreements in insurance plans allows such unwarranted increases in pricing for medical care, and the industry is always one step ahead of government regulations. The fault lies with the medical industry and the investors in this industry, though, not 'Obamacare', and only ethical and moral reforms in this human industry will correct this problem. Bringing down healthcare costs is essential in a global economy, as even hospital care and procedures will soon be readily available to us overseas at a much lower cost. To make the U.S. economy stronger for the future, people working in this medical industry will have to create a more affordable and efficient system of healthcare.

The Centers for Medicare and Medicaid Services also continue to report the highest incomes for individual doctors, and here too reform is slow, with enormous sums paid to Medical Doctors who administer pharmaceuticals in their office, such as oncologists, hematologists, ophthalmologists and rheumatologists. In 2013, a Florida cardiologist, Dr. Asad Qamar, received $16 million, and is being sued by the federal government for performing unnecessary surgeries, and a Florida ophthalmologist, Dr. Salomon Melgen, indicted on Medicare fraud charges as well in 2013, received $14.4 million from Medicare, and is linked to large political gifts to Senator Robert Menendez and others in congress. The highest listing for yearly income in 2013 was to Dr. Anne Greist, of the Indiana Hemophilia and Thrombosis Center, with almost all of this income from prescription and sales of pharmaceuticals in office. How one doctor could generate more than $16 million in pharmaceutical sales in one year, mostly to the federal government, is a question too absurd to even answer. The concern that dramatically increasing prices of individual drugs being introduced has become a primary issue in affordability, rising overall healthcare costs considerably. Another cardiovascular business in Indiana, Cardiology Associates of Northwest Indiana, was the focus of a federal investigation after nearly 300 patients sued for malpractice concerning unnecessary surgeries. Records revealed in an October 18, 2015 article, entitled Scarred by a Trusted Doctor, revealed that 3 cardiologists at this clinic in rural Indiana received nearly $5 million in Medicare payments alone in 2012 for these procedures, and such investigations for profiteering from unnecessary cardiac surgeries mirror the FBI investigation of cardiac surgeons and cardiologists in Redding, California n 2002 which resulted in over $32 million of settlements to patients who received unnecessary surgeries and stents at a small, rural Tenet hospital. In the Redding investigation, Father John Corapi, a Catholic priest visiting the area was told that he needed to rush into triple bypass surgery after feeling mild chest pain, but skeptical, sought a second opinion from a renowned cardiologist, who revealed that he had nothing wrong with his heart. Dr. Steven Nissen, chief of cardiovascular medicine at the renowned Cleveland Clinic stated: "We are still a fee for service system, and that creates, in my view, misaligned incentives among some physicians to do more procedures and among some institutions, particularly in areas where there is not tight medical supervision, to turn a blind eye and enjoy the high revenue stream." Of course, this is another polite way of saying that we have reached a crisis point in such profiteering attitudes.

In December of 2014, the Consumer Financial Protection Bureau (CFPB) in the United States of America, reported that medical debt now significantly burdens over 43 million Americans. The agency stated that 1 in 5 Americans now have medical debt on their credit report, with the average reported medical debt for all of the U.S. now at $579.00, and the average medical debt on credit cards over $1000. This growing debt and credit crisis occurs because of the complex system of inflated charges for healthcare and the even more complex system of price reductions and coverage, and seriously affects these 43 million Americans and their ability to rent apartments, get a job, the insurance rates they pay, and of course their ability to obtain lending. The only solution to this problem, perhaps, is an eventual move to simplified medical bills, with an outcomes-based pricing system and a single payer system, as well as adoption of more cost effective medical care.

As the public starts to finally look into this system of healthcare pricing and delivery, ignoring the obvious for decades as they dissociated their insurance payments and taxes from actual pricing practices, some alarming facts are coming to light. For instance, some of the largest hospital chains are called "non-profit" despite acknowledgement of enormous profits and an amazing disparity between annual total revenues and annual total costs. This disparity has grown to such an extent that one can no longer even make logical sense of the numbers, creating a veil that hides the obvious. For instance, in the San Francisco, California based Catholic Healthcare West, which changed its name to Dignity Health in 2012 in response to publicity concerning the corporation's plan to purchase the majority of hospitals and clinics in San Francisco, imposing strict guidelines eliminating both access to abortions and contraception, a seemingly illogical approach to decreasing unwanted pregnancies and terminations, the 2012 financial records show that the total revenue was more than $10.5 billion, and the operating income, a measure of revenue minus operating expenses, was over $59 million, with a reported net income of over $132.5 million, yet the business is considered a non-profit and is exempt from sales and property taxes. As the studies cited by National Nurses United shows, hospitals in the United States now average about a 331 percent markup of charge to cost for their healthcare, which begs the question of where all of this profit is disappearing in such 'non-profit' hospital systems, especially as nurses and administrative employees are forced to strike to prevent repeated decreases in salary and benefits. The Institute for Health and Socio-Economic Policy has found that acknowledged hospital profits have hit a record $53 billion annually in the United States, according to data from the American Hospital Association itself, and that research has found that California hospitals receive $1.8 billion in public subsidies over what they provide in charity care, with most of these hospital systems continuing to claim tax-exempt non-profit status as well. Non-profit status of hospital corporations no longer contributes to affordable healthcare for the middle class and poor in the U.S. Instead, the non-profit system of the past, consisting of religious organizations providing low cost charity care to the poor, have closed most of the small hospitals in poor neighborhoods, leading to a dramatic danger to the health and lives of these poor populations.

Dignity Health is an outgrowth of a merger of truly non-profit hospitals run by different orders of the Sisters of Mercy in 1986, but by 2010, this official ministry of the Catholic Church merged with Blue Shield of California and the Hill Physicians Medical Group to form a Managed Care Organization called an Accountable Care Organization (ACO). While Accountable Care Organizations were intended to provide mergers of healthcare corporations to voluntarily reduce Medicare costs, this ACO succeeded in selling healthcare insurance plans to most of the California Public Employees Retirement System (CalPERS) instead, which grew into a merger with Aetna in 2014 to control choice in healthcare via an EPO (Exclusive Provider Organization) in 37 hospitals and 14 urgent care facilities in California. While such managed care and accountable care plans tout the choice of patients to choose lower cost healthcare via restriction to providers who sign agreements with the Managed Care Organization, the truth is that increased complexity in healthcare plans makes it very difficult for patients to freely choose who treats them and which facility they are receiving care from, lowering accountability, not increasing it. The Accountable Care Organizations did not reduce Medicare costs, and only the Affordability Care Act has accomplished this task.

Bloomberg News reported that in October of 2014, Dignity Health agreed to a $37 million settlement for over-billing Medicare and the military healthcare system in the last 5 years, related to a whistleblower lawsuit. Of course, these settlements, which are now becoming commonplace in our healthcare system, totaling many billions of dollars from both non-profit and for-profit healthcare corporations, come with a standard agreement to not press charges or admit wrongdoing. Obviously, an admission of gross over-billing for elderly patients and servicemen, paid by the federal government and taxpayers, is doing wrong, though, irregardless of the legal settlement. Most of these agreements to enormous financial penalties for healthcare fraud are only reported on the business page of newspapers, and curiously dissolve in the media, who are heavily supported by healthcare advertising and investment. In 2012, the board of directors of Dignity Health included only 2 Catholic Sisters, and while still apparently owned by the Catholic Church, is now managed largely by secular businessmen. Dignity is now the fifth largest hospital system in the country, but is still smaller than another Catholic non-profit, Ascension Health, which is merging with Dignity to purchase other failing health networks, such as Carondelet Health in Arizona. Dignity Health was included in a California Attorney General's antitrust investigation, launched in 2012, concerning the growing monopoly of state hospitals and physicians groups that is driving up the cost of healthcare instead of lowering it.

The laudable past healthcare by Catholic Sisters is now a thing of the past, and the Leadership Conference of Women Religious, first condemned by Pope Benedict for their support of fair healthcare access and the Affordability Care Act, and then reinstated by Pope Francis, is set to step up and be heard. The pioneering vision of Sister Juliana Casey in 1990, as well as the reaffirmation of the Catholic Health Association in 2001, naming core commitments of: "defend human dignity, attend to the whole person, care for the poor and vulnerable persons, promote the common good, act in behalf of justice, and steward resources" has been undermined by 2015, given over to a lust for power and profit. A number of studies now show that these reported non-profit hospital corporations are instead the most profitable hospital corporations, and a 2009 Executive Summary of Final Report by the U.S. IRS showed that overall these non-profit hospitals now only self-report 6-9 percent of their work going to "community benefit", and that the vast majority of this community benefit was reported as uncompensated care, not actual charitable medical care. This system of non-profit charitable hospitals was set up to take care of the poor, yet today non-profit hospitals make up 82 percent of all hospitals, with just 23 percent owned by government entities, and the charitable work is almost nonexistent. Steve Brill revealed in a Time Magazine article that "in health care, being nonprofit produces more profit", yet none of these hospitals contributes much to the community tax base, or provides substantial charitable care to poor communities. Executives at these 'nonprofit' hospitals make up to $6 million per year in compensation for this 'charitable' work.

Perhaps the worst state for excess profits and illegal profiteering in the hospital system is Florida, where the governor, Rick Scott, who founded the largest for-profit healthcare corporation, Columbia HCA, which admitted to 14 felonies and billing fraud, largely to Medicare in 1997, and settled for a $600 million penalty, then the largest medical fraud settlement in U.S. history, but now eclipsed by many others, as well as an additional $268 million to state agencies and Medicaid reimbursement. Governor Rick Scott resigned during this admission of criminal conduct, and although he was the Chief Executive Officer (CEO) and founder, was not personally charged, and collected a $10 million severance from his company. Today, 5 of the 10 most expensive hospitals in the United States are in Florida, and one of the largest companies managing these hospitals and many nursing homes in the state, Health Management Associates, has been involved in over $2 billion of settlements for healthcare fraud in recent years. Health Management Associates is still facing multiple lawsuits in different states, as well as from the Federal Justice Department, in 2014, for allegedly systematically admitting patients to hospitals who did not need treatment to incur huge costs to Medicare and Medicaid, and has admitted to systematically overprescribing medications in its nursing homes with little actual individual evaluation, with prescriptions tied to monetary gain. This company employed James McFaddin as Director of Government Relations in 2011, who also served as the Chief of Staff and Director of Legislative Affairs for the Florida Agency for Health Care Administration from 2008 to 2011, and was Campaign Manager for the Republican Party of Florida in 2004, at the time that Governor Charlie Crist was elected, until he was replaced by Governor Rick Scott in 2011. In 2014, as these enormous healthcare fraud investigations continue in Florida, these 2 men are the only candidates in the race for the Governor, as the enormous sums of political contribution and lobbying by the healthcare industry dominate the field. The enormous sums of money involved, and excess profits in healthcare, and the close ties to government garnering an enormous return on investment, should alarm the public, but there seems to be little attention paid, and little hope of fixing this problem, much less the alarming charge-to-cost ratio of 12-fold and rising in this monopolizing hospital system. While the problem of healthcare affordability seems daunting, there are many choices that the individual can make to improve the future of healthcare in the United States.

Health Management Associates was not the only giant nursing home management company that was faced with enormous penalties and criminal allegations for accepting kickbacks to over-prescribe unnecessary pharmaceuticals with adverse health effects by the U.S. Justice Department. Omnicare Inc. was indicted in December of 2014 for soliciting and receiving millions of dollars in kickbacks for Abbot Laboratories for such behavior as well, showing that this had become standard business practice. United States Assistant Attorney General Joyce. R. Branda stated: "Elderly nursing home residents suffering from dementia are among our nation's most vulnerable patient populations, and they depend on the independent judgment of healthcare professionals for their daily care. Kickbacks to consulting pharmacists compromise their independence and undermine their role in protecting nursing home residents from the use of unnecessary drugs." In 2013, Omnicare kickbacks were involved in the massive $2.2 billion settlement for such activities involving Johnson & Johnson, and in 2015, Omnicare was sold to CVS Health Corporation for $10.4 billion. CVS has also faced numerous investigations from 2010 through 2012, for kickbacks, violations of healthcare information privacy under HIPAA, overcharging Medicare, and providing CVS pharmacies in Florida with narcotic pain medications that were 8 times the amount normally consumed by their customer communities. The U.S. DEA stated that they had evidence of every third or fourth car entering the pharmaceutical drive through pickup they were monitoring having prescriptions for large amounts of narcotic pain medications, and pharmacists testifying in the case that often the requests were made for "oxy" and other street slang names of these drugs. Such news stories apparently prompted the looting of CVS pharmacies in the 2015 Baltimore riots concerning the death of Freddie Gray.

In 2016, the U.S. Justice Department released another report investigating unnecessary nursing home assignment and treatment of the disabled by state services, this time in South Dakota, finding that thousands of individuals with disabilities were required to receive their medical care and support services in nursing homes, despite studies that show that providing home services for many individuals was less expensive, and denying these disabled individuals their legal rights as granted in a 1999 Supreme Court decision to receive home care if they desired and when possible (Olmstead vs L.C). The New York Times reported that the Obama administration has opened more than 50 such investigations and reached quiet settlements with 8 states by 2016. The U.S. Health and Human Services states that an enormous amount of taxpayer money is now spent on nursing home care, and that this care is more expensive mainly because of unnecessary care, such as multiple pharmaceutical prescriptions related to kickbacks and solicitation. Until recent years the emphasis has been on investigation and enforcement of living conditions in these nursing homes, now largely run be just a handful of corporations, but now this has shifted to monetary kickback schemes, unnecessary medical recommendations and drug prescriptions, and coercion of the poor and disabled to submit to care in assigned facilities. This is similar to the massive cutting of government services to help individuals with psychological disorders in the past, reducing both funding for community services and then for support of medical services, greatly reducing the number of beds in clinics and hospitals devoted to treatment of psychological disease, and then stripping the money for psychological counseling, and enormously expanding the market for psych drugs. Instead of saving the taxpayer money in the 1970s and 1980s, this instead resulted in enormous increases in government health spending, huge pressure on emergency medical services, and an enormous increase in the chronic homeless. While rooted in so-called 'conservative' politics to cut government spending, this 'radical' approach led to enormous increases in government spending, enormous harm to the community, and most importantly, enormous profits in the healthcare industries.

These problems in healthcare waste and fraud now extend even beyond the nursing home. In 2016, the United States Department of Health and Human Services inspector general Nancy T. Harrison summarized an investigation into fraudulent billing practices by Hospices, stating that many of these companies have been routinely over-billing and defrauding Medicare and the American taxpayer, as well as billing twice for medications administered, billing Medicare Part D when the drugs were already covered and paid for. The estimated cost of these practices to Medicare totaled $260 million a year! Not only fraudulent billing, but inappropriate care for elderly patients was found, with one percent of all hospice stays billed in relation to a patient that was not dying, and did not elect to have hospice care, and a fifth of all patients not needing to be moved to an inpatient facility of terminally ill patients. The allotted payment for inpatient stay at a hospice, providing only palliative care at the end of life, was $720.00 per day, and a large percentage of patients in terminal end-of-life care at for-profit hospices stayed more than 6 months. The largest companies providing this care are Kindred Healthcare and Amedisys, Inc., of Louisville, Kentucky, and Baton Rouge, Louisiana. Amedisys is also under investigation in 2015 by the U.S. Justice Department and SEC, and in 2014 settled an investigation of overbilling for $150 million, instigated by whistleblowers. Likewise, Kindred Healthcare paid a settlement of fraud allegations of $125 million in 2015, and compensated their CEO more than $2.4 million per year, announcing that they had already planned on this large payment for fraudulent billing and intended to record a tax benefit to cover most of this money. Investors responded positively to this announcement.

Not only our system of so-called non-profit and for-profit private hospital corporations, but our public hospital systems have finally come under scrutiny in recent years for fraudulent practices that drive up the costs of healthcare. For instance, the longstanding successful chancellor of the University of Mississippi, Daniel W. Jones, was the focus of controversy in 2015 for his failure to fix a systemic problem with procurement practices and accounting at the University of Mississippi Medical Center. Here, a review panel in 2011 reported that 90 percent of the purchases of supplies and equipment went through a "Group Purchasing Organization" or GPO run by an organization called the University HealthSystem Consortium (UHC) / Novation, of which the Medical Center was a 'member", and that this system unfairly excluded bidders from competing for even new software technology, such as the building automatic controls systems, which controls the mechanical and lighting systems to deliver better efficiency and service. UHC and another corporate entity that requires membership, VHA (Voluntary Hospitals of America), announced in 2015 that they would merge to create a single organization to control supply and services procurement at nearly all academic medical centers and health systems. UHC had already merged with Novation, the largest supplier of technical services for these health centers, which drew its name from a legal term meaning to replace an obligation or party to an agreement with a new obligation or party. Such practices, long considered "anti-trust" in the United States, are apparently now considered usual business practices. While a massive marketing campaign advertises these companies as the most ethical procurement and services companies in the world, there appears to be little oversight in the arena of medical procurement and services, which has led to outrageous pricing practices passed onto the patients and taxpayers, and has led now to a system reaching a charge to cost ratio in some hospitals of 12 to 1! The inability of even someone like Chancellor Daniel W. Jones to change these practices, or even publicly address, them should be alarming to the public, especially in the realm of publicly owned university medical centers, but decades of complacency has apparently led to increasing monopoly of supply and services with little hope of reversing the trend of mounting profits disguised as non-profit healthcare.

Prescription Drug Costs and the Unaffordability of Healthcare

Another area of healthcare affordability concerns the choice of care in prescription drugs, types of surgery or other procedure, and the use of diagnostic tests that are unnecessary and do not contribute to the outcome of treatment. Much attention is now paid to the promotion of more expensive drugs, and research has shown that as new drugs are developed with enormous costs that pharmaceutical companies are spending an enormous amount of money, with an increasing array of tactics, to promote the use of these more expensive drugs, of course. With the U.S. CDC releasing a report in 2015 that between 2009 and 2012 that in any 30 day period at least 10.7 percent of the population was using at least 5 prescription drugs, and at least 48.7 percent were using at least one, the ability to increase healthcare spending dramatically by dramatically rising the costs of new drugs is enormous. Finally, in 2015, even the conservative and profit-motivated American Medical Association (AMA) was forced to call for a total ban on television advertising and other direct consumer advertising for pharmaceutical medicines, which only the United States and New Zealand allow. The rise to more than $4.5 billion per year spent on this advertising to consumers undermines physician choices and greatly increases the cost of pharmaceutical medications, insurance premiums and government healthcare spending, the biggest driver of the federal deficit. Whether the Republican controlled legislature can pass such a ban is the question, as big money now controls the government and making healthcare more affordable has become a political hot potato. Much can be accomplished if the voters speak up and pay attention to facts, not political ads.

The guidelines for prescription of drugs used to rely just on objective facts generated by the FDA approval trials involving safety and efficacy in short-term randomized, controlled human clinical trials, and eventually on long-term studies that assessed effectiveness and adverse effects associated with chronic use, but today, such objective data plays a small part in the decisions of which drug or drugs are prescribed. For instance, a December 8, 2014 article in the New York Times, entitled Paid to Promote an Eye Drug, and Prescribing It Widely, details how just one new drug, Lucentis (ranibizumab), produced by Genentech Roche, was heavily promoted over its predecessor, Avastin, both VEGF inhibitors (vascular endothelial growth factor-derived antibody), that were created to inhibit new blood vessel growth in cancerous tumors, but now heavily prescribed to treat wet macular degeneration in an aging population. Numerous studies show how these two drugs show almost identical outcomes and adverse effects, but Lucentis costs $2,000 a dose, while Avastin, made by the same company, costs $50 a dose! The main difference between these 2 drugs is convenience, with Lucentis altered for easier delivery, and fewer injections in the treatment of the eye. The cost to the consumer, in the form of higher government healthcare expenditures and higher insurance premiums, of the widespread prescription of the much costlier drug, is enormous, with Medicare alone recording over $1 billion spent for Lucentis prescription in 2010 for treatment of wet macular degeneration, while only $27 million was spent on Avastin prescription for this condition! Of course, targeting the aging population means that most of this rising cost for a drastically more expensive drug is paid by the taxpayers, in the form of Medicaid. Studies show that about half of the largest prescribers of Lucentis received huge promotional and consulting fees from the pharmaceutical manufacturer, and while Medical Doctors and drug companies continue to state "how dare you" accuse these large monetary gifts as influencing of doctor choices, experts in public health are in agreement that such practices heavily influence prescription practices. Dr. Eric Campbell, a professor at the Harvard Medical School, specializing in public health and health care policy, stated in the New York Times article: "They are suggesting that the drug companies that are spending this money, that these companies are dumb enough to be wasting their money (with monetary promotion to insure prescription of the costlier drug)."

An area of concern in the United States are laws that protect the price set for certain classes of drugs, blocking any negotiations by government healthcare, or private healthcare to some extent, to achieve a fair price. The classes of drugs with mandated price protections set by the U.S. Congress include cancer, psychiatric and HIV. These Medicare pricing protections occurred in 2006, when supposedly free market anti-regulation Republicans mandated 6 classes of drugs, which included antidepressants and antipsychotics, be paid whatever price the manufacturer requested. By 2012, antidepressant medications were number 3 on the most prescribed drug list of the U.S. CDC. With incentives to the prescribing doctors, a drug that cost 5 times that of another drug that was proven to be just as good would of course be prescribed, purely because the profit from the prescription would be so much greater. Another area of concern are common price protections for the retail pharmaceutical market that cannot be enforced for drugs provided in the hospital or clinic. With the ability to distribute the drug as part of the therapy, rather than have the patient buy the drug at a pharmacy, as the means to generate a larger profit, cancer chemotherapy is almost always provided by the clinic, for no other reason than it then generates an enormous mark-up and profit. On top of this almost unlimited mark-up, the prescribing doctor will be paid a percentage of the sale cost for as long as the patient refills that prescription or it is provided to the patient in the clinic, and in some specialties, such as cancer, psychiatry and hematology, the greatest source of income is often this percentage of sale of pharmaceuticals, not the actual direct work of the physician.

This system has slowly developed until the price of pharmaceuticals in the United States for cancer drugs has become unacceptable even to the hospital system and doctors. To see some of the top experts in the nation discuss this in a still conservative manner, on the CBS network show 60 minutes, click here: . If this video is blocked (censored) on your computer, you can access the new story by clicking here: . The important parts of this show, and other news articles on the outrageous cost of cancer drugs shows that another new VEGF inhibitor, with no benefit proven over Avastin, called Zaltrap (ziv-aflibercept), but costing more than twice as much as Avastin, and needing a longer dosing, adding $60,000 to the cost of the cancer care for just a few months of extended life. When Sloan-Kettering Cancer Center in New York decided that adding enormous cost burdens to patients for no benefit was not ethical, and explained this in the New York Times in an op-ed article, the company producing Zaltrap immediately cut the price of the drug in half, but lowered the price to prescribing doctors only if the patient was still charged the higher price, adding even more financial incentive to the prescription of the drug. Such practices were revealed as common practice today, as outrageous as this seems, with amazing financial incentives and promotions widely accepted in the business of medicine, with less and less regard for the financial burdens on the patient, and the taxpayer, as increasing health expenditures are the main driver of the federal and state budget deficits.

The reasons cited for this growing profiteering concerning the most desperate patients, cancer victims and those afflicted with psychological illness, is that the cost of developing and delivering these drugs now averages about $1-5 billion, according to the source of this information. What is not discussed is that we created a legal system of drug patent protection that is tied to the amount spent on this research and development, and the cost of clinical trials. In this system, the more money spent on research and development, the longer the patent protection exists. With such a system, the industry only makes more money by increasing these costs, insuring longer patent protection, as well as increased profits from higher costing drugs. In many cases this initial cost of research is still actually born by the taxpayer, though, with government funded research in healthcare still the main source of new technology. The development of these ideas, freely provided in many cases to the pharmaceutical industry, is inflated enormously to insure a longer patent protection, and the researchers, of course, defend this system fiercely, because it provides their income. But in the last decade, even the cost of research and development is often irrelevant in the long-term pricing. In the arena of protected classes of drugs, the drug companies have tripled the cost of drugs that are already on the market for a decade, despite paying off the cost of research and development long ago. In other words, the free market system, coupled with enormous amounts of money spent lobbying lawmakers, has allowed the patients to be charged whatever the company determines, regardless of the excess profits or competitive alternatives. This pricing is now largely determined by the amount spent on advertising and control of specialty guidelines.

Despite the legal giveaways already afforded the pharmaceutical industry concerning protections for pricing of cancer drugs and the ability to evade price controls by prescribing cancer chemotherapy in the clinic instead of just writing a prescription, leading to a 10-fold markup in many cases, in 2016 these pharmaceuticals were able to increase profits on cancer drugs by only producing these clinic administered drugs only in maximum dosage vials. A March 1, 2016 article in the New York Times, entitled Researchers Describe Costly Waste in Cancer Drugs, reported that a lack of regulations that are enforced in Europe, Canada and other countries, allows pharmaceuticals to force a waste of nearly $3 billion a year by only producing these drugs in maximum dosage vials, causing the administering nurses and doctors to throw away the excess drugs, often incurring large costs to both the cancer victim and the insurance and government payees, raising insurance premiums and adding to the federal and state budget deficits. Peter B. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering in New York, is quoted: "Drug companies are quietly making billions forcing little old ladies (dying of cancer) to buy enough medicine to treat football players, and regulators have completely missed it (sic)." Not only cancer drugs, but other drugs administered in the clinic to avoid price controls, such as Remicade (infliximab), an immunosuppressant used to treat rheumatoid arthritis, Crohn's disease, psoriasis, and other autoimmune disorders, creates an estimated $500 million dollars in wasted drugs from max vials out of $4.3 billion in annual sales! All of this waste and unaffordable and unnecessary overpayment is obviously now considered standard practice and accepted by all of the health professionals and insurance companies involved. This is outrageous, especially considering the laws and lack of regulations that already protect the wasteful overpricing and profiteering for these drugs. It seems that the more money we give away to the pharmaceutical companies the more that they will just take advantage and create even more profiteering. Is this a fault of government, or just the fault of human nature?

With so much money invested across the industry, with the same source investment in pharmaceuticals, insurance companies and hospital groups, there is no market incentive to control these prices. Our sense of the free market from 1950 is outdated, and the new meaning is a market that is freely manipulated by extremely large global businesses with unlimited amounts of money to spend. In 2015, a report by oncologists at the Mayo Clinic, published in the Mayo Clinic Proceedings, outlines these systems of unfair pricing, with a summary available on YouTube: . In this paper these Mayo Clinic experts show that the 5 main reason cited to justify these high costs are not true, and in fact could be called lies. These explanations are coming from the most conservative sources, and only because the system of healthcare affordability has been pushed to extremes. This system has used every aspect of medicine and business to reinforce the outrageous pricing system, leaving no stone unturned in devising a complex system from the ground up that struggles to keep up, and thus justifies the enormous costs and burdens on sick and injured people, and the taxpayer.

One answer to the fast-rising and outrageous pharmaceutical costs in the United States is to better utilize Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM), which are low-cost and actually help to resolve the underlying health problems that drive the need for these drugs that are prescribed to "manage" the disease or just relieve symptoms. Professional herbal and nutrient medicine, combined with short courses of symbiotic acupuncture and physiotherapy, provide a holistic treatment protocol that could potentially decrease the real need for more and more drugs taken forever, with higher and higher prices. This is not an "alternative", as has been widely repeated ad nauseum, but just a means to provide a more thorough and effective outcome and integration with standard medicine. Pharmaceutical drugs are absolutely necessary and effective, but need to be prescribed more intelligently, and integrated with more conservative care as a healthy complement. The path we are on is unaffordable and creates too many adverse health effects.

Numerous studies now show that the healthcare system in the United States is intrinsically ruled by prescription of newer drugs to support the high profitability of the pharmaceutical companies, which now spends an enormous amount of money on influencing the prescribing habits of medical doctors and hospital groups, direct patient marketing of new products, government lobbying to control regulations, and even the research and guidelines that prescribing medical doctors rely on. This 'free market' system has created a scenario where big money trumps the small guy, and there is no longer any choice in the market for low-cost healthcare, especially in pharmaceutical medicines. An example of such healthcare unaffordability was revealed in a March 19, 2015 article in Shots, Healthcare News from NPR (National Public Radio), by Anders Kelto, describing how Medical Doctors such as Dr. Jeremy Greene of Johns Hopkins University have noticed in recent years that their patients with diabetes increasingly show poor control of blood sugars, and an inquiry found that many patients now could now not afford their out-of-pocket costs of synthetic insulin, which for many has reached a sizable portion of the $400 per month this now can cost. As pharmaceuticals have developed synthetic insulin products, and thus maintained patent rights, cheaper generic products have been eliminated from the American market, although some studies show high patient satisfaction even from the early bioidentical insulin products derived from bovine organs, which are still available in Canada and Europe, where overall pharmaceutical costs are much lower than in the United States. The justification for this is that the American healthcare market insures higher quality products, but these arguments are no longer holding water even for the most conservative voices in the delivery of healthcare itself. Such manipulation of the pharmaceutical market has led to enormous healthcare costs and a crisis in unaffordability. It appears that only a public change of attitude will correct this problem.

Justification of enormously inflated drug prices in the U.S. is also supported fully by professional medical journals, and our system of medical research, or the manipulation of these published articles and medical studies. In 2013, a team of researchers led by Dr. Vinay Prasad M.D. of the NIH and the Medical Oncology Branch of the National Cancer Institute, reviewed 10 years of original articles published in the prestigious New England Journal of Medicine concerning standards of current new treatments and medical practices. This research team evaluated 1344 articles published between 2001 and 2010 and found that only 27 percent of the studies seen regarding new medical practices tested the established medical practice to compare them to the new treatment intervention. Of the 363 studies out of 1344 reviewed, that tested current standard medical practice against the new treatment, 40 percent of these studies found that the newer treatments and procedures being studied offered no benefits (over the older treatments), and never did. Dr. Prasad was quoted as saying:

"They (published studies of new medical technology) were instituted in error, never helped patients, and have eroded trust in medicine. Health care costs now threaten the entire economy. Our investigation suggests that much of what we are doing today simply doesn't help patients (more than the prior lower costing treatment). Eliminating medical reversal (treatments that don't work to improve healthcare) may help address the most pressing problem in health care today." (Dr. Vinjay Prasad of the National Cancer Institute). While control of information in marketing, advertising, and the writing of guidelines, as well as what is published, has largely controlled what we perceive to be real, experts in this realm are finally starting to see the manipulation in this system, and calling for unbiased panels of experts to provide this information and guidance in the future, not just big money and its manipulating influence. When these expert panels to form real guidelines not influenced by profit were proposed in the Healthcare Affordability Act, the opponents called these panels of experts to provide truthful guidelines "death panels", and the media repeated this outrageous and absurd statement endlessly. Public health is one realm where ethical rules must dominate. Integration of Complementary Medicine (CIM) is just one part of the solution to provide more affordable healthcare in the United States.

By late 2015, the PEW research foundation released a study that showed that the continued rise in health spending in the United States was now driven by what are called specialty drugs, mainly new biologics that target a specific biological pathway to decrease symptoms of a specific disease. While the gradual reforms of the Affordable Care Act kick in, and law changes that inhibit some of the past profiteering and control of pricing, such as greater use of generics and more pricing regulation and negotiation, the rise in these 'specialty' drugs, which often cost more than $100,000 per year for each patient, is driving a continued rise in yearly pharmaceutical healthcare spending. The PEW Charitable Trusts report showed that these 'specialty' drug prescriptions accounted for about 1 percent of total drug prescriptions in 2014, but 32 percent of pharmaceutical spending. In 1995, there were just of few of these types of drugs, and now there are hundreds, and soon thousands. The PEW report stated that in 2013 the price of existing specialty drugs rose more than 10 percent, and the industry stated that this just reflected demand. In healthcare, when we don't actually have a system that even evaluates whether these new drugs outperform much less expensive drugs already in use, and we use patient desperation with difficult diseases to justify overpricing, there is something seriously wrong. Not only specialty drugs designed for difficult to treat diseases, but commonly prescribed drugs are being introduced now that raise the cost of healthcare enormously. An example is the Amgen drug Repatha, which targets a gene called PCSK9, involved in creating cholesterol, which comes at a cost of $14,000 per year, compared to a statin drug, which costs just $365 per year! In the first 3 months the drug was approved and marketed, the sales in the U.S. totaled $16 million, and was considered a monetary failure even at this level due to resistance on the part of insurers to pay for it. The promise of genetic research is turning into a financial nightmare. It appears that only patient awareness and changes in attitude will actually correct these systemic problems, as the industry is always one step ahead of the government, and spends as much as they need to on government lobbying and manipulation. These enormous costs of advertising, lobbying, payments to election campaigns, perks, etc. are simply passed on to the consumer and taxpayer, as are the enormous profits in a field where public health should be the guiding goal, not the highest profits of any industry because the desperate need is so great. What most of us do not realize is that a high percentage of these high-priced specialty drugs are paid for with Medicare Part D and the taxpayer is on the hook for 80 percent of the cost above a certain price termed catastrophic. In addition, few of us are aware that most insurers will demand that that the patient pays 25 percent or more of the cost for specialty drugs to treat serious chronic diseases such as rheumatoid arthritis, hepatitis C, multiple sclerosis and cancers. These tactics are greatly increasing the federal deficit and quickly depleting savings of older patients desperate for these medications.

The freely manipulated market for pharmaceutical drugs in public health has also found a niche market for investment that mirrors the economic patterns of the greater society in 2015, using enormous amounts of investor money to purchase companies with a type of medicine that our sickest Americans are desperate for, and then increasing the price to these desperate individuals enormously. There appears to be a reward system for the most unethical, cruel and immoral individuals in our society. For instance, in 2015, Rodelis Therapeutics purchased a tuberculosis medication developed by the Purdue Research Foundation's Chao Center, associated with Purdue University, a publicly-funded, taxpayer funded, land grant University that set a record for sponsored research in 2010 with $438 million generated almost entirely from government organizations. This drug, cycloserine, was created for patients with drug-resistant tuberculosis (TB), desperate for something to save their lives, and Rodelis immediately raised the price of a single month course of treatment from $500 to $10,800, with much of this enormous cost covered by government healthcare! Also in 2015, New York-based Turing Pharmaceuticals purchased the rights to a drug created to treat toxoplasmosis, a systemic food-borne disease that commonly affects patients whose immune system is weakened by cancer or AIDS, and is on the World Health Organization's (WHO) list of Essential Medicines. After securing the rights to sell this drug called Daraprim (pyrimethamine), which is no longer protected by patent rights, the company raised the price from $13.50 a pill to $750.00 a pill, creating a burden for these patients that could exceed $500,000 per year, with most of these patients receiving the care from taxpayer funded government healthcare! Once again, medicines created by enormous public expense are now able to be marketed with outrageous profiteering that again is largely paid for by the taxpayer, contributing to the enormous federal deficit, and protected by specific deregulation of the pharmaceutical industry, and laws that specifically protect these pharmaceutical companies and their rights as "persons" to hold desperate patients hostage to these enormously overpriced drugs. Pyrimethamine is an antimalarial drug effective to treat protozoal infections, and specifically Toxoplasma gondii, when combined with a sulfa antibiotic, and was developed by the Nobel prize winning researcher Gertrude B. Elion, who developed her amazing research at Duke University, the National Cancer Institute, the American Association for Cancer Research, and the World Health Organization, all publicly funded. The supposedly free market system is not bringing down the cost of healthcare, as is so frequently touted, but profiting from taxpayer-funded health research and a manipulated market regulation that guarantees outrageous payments. We need to go further with the Affordability Care Act, not get rid of it. Government must obviously keep up with the machinations of these global corporate giants, and be for the people, not just the biggest businesses.

Much of this pharmaceutical speculation is based on laws in the United States that prevents the marketing and purchase of the same drug licensed outside of the United States, and these laws, denying a true free market in medications, come from the same "conservative" Republicans that tout their support of the free market. These same laws deny any of the price controls on pharmaceuticals seen in almost all other countries to protect the public. The above mentioned drugs, with rights bought and the price skyrocketing to sick and desperate patients, concerns a young pharmaceutical CEO named Martin Shkreli, the founder of Turing Pharmaceuticals, who has responded with a big disinformation campaign to exonerate himself on social media. Mr. Shkreli is the focus of a New York Times article on December 6, 2015, entitled The Bad Boy of Pharmaceuticals Hits Back, but a close reading of the article finds that Mr. Shkreli, now just 32 years old and very rich, gained success with a strange history. The son of hard working quiet immigrants, he was given a scholarship to perhaps the most prestigious high school for high IQ students in New York City, Hunter College High School, but instead of working hard, failed to show up for class or do his homework, and was expelled. He then obtained an internship at the investment firm Cramer, Berkowitz & Company (probably lying about his failure to graduate from Hunter), but earned his high school equivalency, and enrolled to study business at Baruch College. With this background he was able to start his own hedge fund, Elea Capital, with millions of dollars of investment obtained. Elea Capital went bankrupt with speculative investment, betting on the stock market crashing when it didn't. Despite these failures, Mr. Shkreli was able to secure more investment to start a second hedge fund, MSMB Capital, where he started the pharmaceutical company Retrophin, mimicking Valeant Pharmaceuticals, and purchasing the rights to older drugs, raising the price drastically, often by 20-30 times the old cost. Mr. Shkreli justified this price gouging by stating that it was necessary to provide extensive marketing education to prescribing doctors (and perhaps perks to prescribe). In 2014, the board of directors of Retrophin removed him as CEO, and suing Mr. Shkreli for $65 million dollars for allegedly using MSMB Capital to pay off discontented investors in a sort of shell game that is being investigated by the U.S. Justice Department. Mr. Shkreli dismissed all of this and responded to this bad press by announcing that he would offer the Turing drug Daraprim for half price, and then did not do this, instead making deals with large hospital corporations to receive the discount if they did not pass it on to the patient, insurer, or the government, in effect a sort of large bribe to prescribe the expensive drugs, just as the manufacturers of Zaltrap did. All of this outrageously bad behavior he justifies on social media by promising to develop new miracle drugs for rare diseases, yet he holds no degrees outside of a small college business degree. He is still finding success attracting enormous investment in these scams, though, acquiring KaloBios, a biotech company. There appears to be no repercussions that would stop this behavior.

Another increasing ploy by the pharmaceutical industry is to create specialty online pharmacies to handle drugs that are outrageously priced to circumvent the difficulties in getting these expensive drugs approved by the insurer or government health entity. For instance, an October 20, 2015 article in the New York Times, entitled Drug Makers Sidestep Barriers on Pricing, it is revealed that a pain medication called Duexis, by Horizon Pharma, which is just two medications that have been used for decades and have gone generic, or lost patent protection, Motrin and Pepcid, which can be individually obtained at a drug store without prescription and for little cost, is being sold for $1500 a month by prescription! A huge amount of incentive is needed to actually get Medical Doctors to prescribe such an expensive drug that can be bought without prescription at any drug store when the two medications are bought separately. Added to this, though, is the difficulty in getting the insurance or government to pay for this drug when the patients can just go to the drug store and obtain the same thing for a fraction of the cost per month. The pharmaceutical company creates its own direct specialty pharmacy to deal with this approval system, and the enormous cost of monetary incentives, advertising and now complex delivery approval that circumvents rules and laws, is of course passed on to all of us in the form of enormous healthcare costs that raise our insurance rates and add greatly to the federal deficit. Now, Motrin is just ibuprofen, available as Advil, Midol, and other common generics without prescription. Pepcid is a histamine type 2 (H2) antagonist that inhibits production of gastric acid, which is also available in various drugstore products, as Fluxid, Cimetidine, Ranitidine, etc. without prescription. Pepcid is combined with Motrin only because constant daily use of ibuprofen has been shown to be damaging to stomach and digestive function, but the H2 antagonist acid inhibiting drugs have also been shown to create serious health problems with chronic use, such as osteoporosis and increased risk of enteritis and Irritable Bowel Syndrome. A better solution, and much healthier, would be to use CIM/TCM to provide better gastric function and alleviate these medication side effects when a chronic use is needed. With CIM/TCM therapy, the actual causes of the pain could be reversed as well, and the ibuprofen would no longer be necessary. The cost of this CIM/TCM therapy is obviously much less than the $1500.00 per month charged for Duexis, which may be 100 times the cost of simply purchasing generic ibuprofen and pepcid! Insurers will not readily pay for the few hundred dollars per month that would be spent on CIM/TCM care to treat chronic pain and stomach dysfunction, though, and most Medical Doctors will still discourage this type of care, despite its proof of efficacy and low cost, prescribing an endless course of Duexis for $1500.00 per month instead! (OMG)!

To further increase profits with these tactics, the same company, Horizon Pharma, also bought the rights to a similar drug combo called Vimovo, which is just a combination of Naproxen and Nexium, again two common drugs that lost patent protection and can be purchased without prescription at the drugstore for very little cost. The company took this competing similar product and raised the price about 600 percent! This was to insure that no competition for the outrageously priced Duexis was available. The creation of a direct specialty pharmacy to circumvent difficulties in authorizing this outrageous cost by the pharmaceutical company was in response to announcements by the largest pharmaceutical benefits managers, Scripts and CVS Health, that they would no longer pay for Duexis or Vimovo. The protection of the pharmaceutical industry that allows such lucrative patenting of what are called "new" medications and the outrageous pricing, totaling as much as $18,000 per year per patient for the most common drugstore medications, is indicative of the complex healthcare arena in the United States, and where enormous industry lobbying has got us. Of course, one also has to realize that there must be a monetary aspect to the collusion between the major insurance companies and these pharmaceutical companies to allow such outrageous pricing and payment. What the public is slow to realize is how these tactics dramatically increase healthcare spending, and thus the price of insurance coverage and the enormous rise in the federal deficit. Without sensible regulation of these practices profiteering will bankrupt us all. Most of us readily blame President Obama for the high cost of health insurance yet voice no objection to all of these practices.

In 2015, in response to investigative reporting and a federal investigation, the pharmaceutical company Valeant, a specialty drugs company based in Canada but founded in the U.S., with a large varied portfolio of both generic and new drugs, including Wellbutrin XL, Kinerase, and a focus on dermatology and neurology, severed its ties to a planned acquisition of an online and mail-order marketing pharmacy called Philidor Rx Services, which drives up the price of pharmaceuticals by aggressive marketing strategies. Philidor provides incentives to prescribing Medical Doctors and hospitals to fill prescriptions for certain drugs only through them, and then raising the price dramatically. The top drug benefit managers in the U.S. CVS Health, Express Scripts, and OptumRx announced plans to stop paying for any drugs distributed by Philidor in light of these investigations and probable fines. Valeant admitted to buying an option to purchase Philidor, and is involved in a wide range of international acquisitions that allow greater control over pharmaceutical pricing. Valeant rose from an obscure company to a major success in just a few years prior to 2015 by efforts of the CEO J. Michael Pearson, to focus on acquisitions of new and existing drugs and aggressively increasing the prices. In one case, Valeant bought a diabetes drug Glumetza in a takeover of Salix Pharmaceuticals and raised the price 800 percent! In response to these profiteering actions and the subsequent investigations of Valeant, the stock price plummeted in 2016, and the CEO was forced to resign. The annual sales of drugs by Valeant rose quickly to $10 billion, spurred by a $30 billion debt from acquisitions easily acquired by eager investors. This totally unethical and immoral behavior appears to be the new norm in the age of the "Unicorns", or billion plus dollar companies that emerge only from the heavy speculative investment from so much money now residing in the hands of so few. For this strategy to exist in high tech startups, though, is one thing, but to dominate public health concerns, or even energy, food and water needs of the public, is an alarming development. We must insure that money is invested more wisely, and does not damage public health and healthcare affordability.

The role of investors in the amazing rise in drug profiteering is also coming under scrutiny, and may lie at the heart of the solution to healthcare unaffordability. For instance, a San Francisco based group called ValueAct that has large shares in Microsoft and other successful tech giants, invested billions of dollars in Valeant as it approached its sudden and cathartic growth, and members of ValueAct's board gained board seats on Valeant, Microsoft and other companies. The explosive growth in Valeant, driven by acquisitions and and enormous price rises for drugs that select groups of patients were dependent on, and on a plan to bypass pharmaceutical distributors by creating its own distribution company, resulted in a return on investment for ValueAct of 2100 percent, according to a New York Times article from March 29, 2016, which also reported that just before the Valeant stock price plummeted 88 percent because of federal investigations for these practices, ValueAct sold $1 billion of Valeant stock. The Times reported that ValueAct is now under investigation by the U.S. Securities and Exchange Committee (SEC) for obvious insider trading, but that anticipating this, ValueAct had their member step down from the Valeant board before the crisis hit. This company, ValueAct, has touted the "operational excellence" rather than "traditional research and development strategies" of Valeant for this amazing success, completely overlooking the harm to patients and their families, to the American taxpayer, and to everyone who is paying higher and higher insurance policy costs due to such profiteering. While it is certain that even with fines or settlement with the SEC and temporary losses in stock value the company will surely emerge with net profit from such actions, they are indeed reprehensible in the field of healthcare.

Changes in the Healthcare System that must Integrate Complementary Medicine with Standard Care to achieve more affordable outcomes

Many of the provisions of the Affordability Care Act (ACA) will not take effect for years, as changing such a huge part of the economy cannot be accomplished smoothly overnight, although most of our media and public apparently thinks it should, and blames the ACA now for all of our healthcare woes. One provision that is highly encouraged by this ACA law is the adoption of outcome measures to determine payment rather than simply paying for all of the line items billed.

The present system has encouraged overpricing and overbilling to increase profits, with a health managed system introduced to lower the percent paid for each line item billed in medical care. This health management system was introduced in the 1980s and 1990s, but resulted in lowered health spending for only a few years. Instead of a sensible approach to managing health care costs, this system instead added so much complexity to the billing structure that it became impossible to manage and difficult to understand. This system eventually became so unwieldy that pricing of healthcare became outrageously inflated as network rules of limiting payment to lower and lower percentages of the billed cost produced unrealistic medical prices, which were billed at this inflated cost to patients with no insurance or those insured out of the networks applicable to a specific plan. Eventually, hospitals and clinics were billing for services outside of the network to collect inflated payments for added physicians that were not needed, just so that enough money was paid to cover the procedures performed and make enough profit. This line item and network discounting system has become so confusing that hospitals and clinics also began hiring more and more administrative staff to handle the growing complexity, and insurance companies spent more on administration as well. Eventually a majority of the money taken in was paid for this complex administration of the healthcare billing rather than the care of the patients. While this produced yearly increases in profits for the healthcare industry, it also produced alarming rises in costs for insurance and a fast growing federal and state budget deficit.

To better manage healthcare spending, other large industrial nations started using a system of outcome measures to determine payment for care, as well as a single-payer system with uniform pricing and payment. In early 2015, a coalition of major hospital and insurance companies announced that they would begin the transition to this new outcome measures system, as the U.S. Health and Human Services Secretary Sylvia M. Burwell announced that half of the U.S. Medicare payments would adhere to this outcome measures system by 2018. The coalition of medical industries that agreed to start changing their system in kind included Aetna, Partners Healthcare of Boston, and Ascension, the largest non-profit hospital corporation and Health Care Service Corporation, which operates 5 major state Anthem Blue Cross plans. This coalition called themselves the Health Care Transformation Task Force, and was led by a former Medicare official, Dr. Richard J. Gilfillan, the chief executive of Trinity Health, a Catholic nonprofit hospital system that operates in 21 states. While this transition to a new payment system will not be easy, it is expected that all major healthcare businesses will follow suit, and that eventually, much of the healthcare pricing and payment in the United States will again be simplified and made fair and uniform, as well as holding down the cost of healthcare spending, both for the government and the individual and business insurance costs. This new outcome measures system is also necessary for the healthcare industry, as more and more patients will start going outside of the country for healthcare if it is too expensive in this country. To compete on a global scale in the future, there must be a lowering and simplifying of American healthcare costs.

In the September 8, 2015 New York Times, an investigative article entitled Utah Hospital System Is Trying to Learn Its Costs reported how this system was seriously tackling the issue of absurdly rising charge-to-cost ratios in U.S. hospitals. The outcome measures payment system, slowing coming into effect from the ACA legislation, prompted the University of Utah Health Care system to create software that for the first time actually tracks hospital charges and costs and aligns these with healthcare outcomes. Florence Nightingale, the first serious healthcare data analyst in Western history, would be proud. This system, soon available to all hospital systems, has already resulted in an annual decrease in hospital care costs and charges in the University of Utah Healthcare System, while the rest of the country's hospitals have reported significant increases. Inpatient hospital costs account for nearly 30 percent of total healthcare spending in the U.S. and a lowering of these costs is essential to provide better healthcare for all citizens in the future that is affordable. Some simple solutions have been already enacted at the University of Utah, with simple requirements by resident doctors to justify lab test necessity resulting in a $200,000 per year lowering of lab costs at just one hospital. Instituting of 9 measures analyzed in post-surgical care to improve outcomes, such as providing sufficient oxygen and adjusting medication to control blood sugar levels by the nursing staff, without waiting for the Medical Doctor's prescription, reduced post-surgical care costs by 30 percent, and the software showed that prior measures, such as providing antibiotics before surgery did not improve outcomes at all. Finally, the practice of medicine has started to rely on objective evidence rather than the general opinion of the hospital administration and staff, which are often guided by larger economic pressures. Whether or not our system can utilize Big Data in a practical and sensible manner, and not let it be itself manipulated by larger economic concerns and profitability, is the question.

Of course, there are problems with any new system, which must be solved. Already, a rising burden of data analysis is shifted to the nursing staff, with increased time spent with computer forms, taking away from actual patient care. The practice of putting the burden of administrative practices on the already overworked and underpaid nursing staff is endemic in our hospitals, and will not contribute to the efficiency that we seek, and will not result in better care for the patients. Patient care and data analysis need to be separated, and specially trained clinical specialists need to oversee the efficiency of patient care and management. More specific and improved care needs to be sped to suffering patients, not delayed. Laboratory testing could be greatly improved to increase efficiency, lowering overall costs of care as well as providing the best data in a more timely manner. One innovative company, Theranos, founded by Elizabeth Holmes, has taken the research of such renowned experts such as David Zava of ZRT Labs in Portland, Oregon, to great heights, creating technology that can deliver more immediate and specific test results to guide correct choices in therapy. Like ZRT labs, though, with low-cost testing utilizing saliva, veinous blood samples, and urine on blotters collected by the patients themselves, this has been heavily resisted by the standard medical industry, despite decades of proof of accuracy, and now the promise that specific and individualized tests can be performed and data often uploaded immediately into a cloud data system to speed accurate diagnosis and guide therapy in a more nuanced manner.

Theranos has invested in new technology to insure that the samples themselves are collected in high-tech containers that improve quality of the samples, and speed nanotechnology-related analysis, with mass spectrometry, gas chromatogramy, and other types of metabolite testing that goes much farther than the gross chemical analysis we are still utilizing in standard medical testing. Unfortunately, this would reduce profits at standard medical testing facilities, and much lobbying has resulted in an endless delay in FDA approval for this new technology, despite such renowned figures as the chemical engineering professor Channing Robertson of Stanford University, Lawrence Ellison, founder of Oracle, former Senator Dr. Bill Frist, a renowned surgeon who served as Republican Senate Majority Leader, and George Schultz, former Secretary of State and famed economist. Unfortunately, the manipulated delays in FDA approval, and the typical propaganda campaign spurred by large industry influences, threaten to undermine this promising development of speedy and efficient health diagnostic testing. Fortunately, the brilliant Elizabeth Holmes studied Chinese as she grew up as well, preparing to work with health technology experts in China as well, and if the U.S. system continues to stymie her progress here, we may see the emerging healthcare systems in China adopting this more efficient technology before we do.

In March of 2015, the renowned Cleveland Clinic announced that it would work closely with Theranos to provide independent testing of the technology, advancing the necessary peer-reviewed processes as the FDA is pressured to speed its approval system. Industry backlash was strong, with a small study funded at the Icahn School of Medicine, in New York, that compared the complete blood count (CBC) results from Theranos in comparison to standard testing by Quest and LabCorp, using just 60 volunteers in the Phoenix, Arizona area showing that Theranos results for LDL and lymphocyte counts were outside the normal range more often, but the study design did not measure accuracy, and showed that there was a considerable difference in lab results between the standard samples tested by Quest and LabCorp. In addition, the study design had the patients first get blood drawn from the vein in an arm, and then immediately used the veinous finger blood sticks from that same arm, which could alter the metabolites in the veinous blood. Of course, Theranos strongly objected to such manipulative study design, and to the study summary stating that Theranos was inaccurate, when the study did not measure accuracy, and that the Theranos testing presented dangers to patient health, when this cited danger cited inaccurate blood clotting factors that was not tested by Theranos, and so was a theoretical potential danger. The Theranos testing is still being improved with data, and even now costs just one fifth of standard testing, and does not require a visit to the doctor's office or clinic, greatly reducing costs as well. Such technology is also useful to speed integration of Complementary Medicine, providing specific individualized health data that would show that an integrated approach to care will achieve much better outcomes, as well as provide Complementary and Integrative Medicine (CIM/TCM) specialists the data to choose the best therapies to help improve outcomes. In fact, this exact type of testing has now been used for almost two decades for a limited number of diagnostic metabolites, pioneered by the esteemed Dr. David Zava in Portland, Oregon, which has been improved yearly by data, and is proven very accurate and inexpensive, yet is still rarely paid for by the insurer or hospital group. To counter this trend of low cost and improved testing that would support integrative medicine, we see in 2016 that the industry was able to use the media and our government to threaten Theranos. In response to these accusations in Wall Street Journal, the Justice Department and the SEC announced investigations into the company, and the New York Times characterized Elizabeth Holmes as a Stanford "dropout". The expected spin, and pressure on such technology to fail, was not unexpected. The medical industry is very powerful.

Of course, this issue of lowering cost through medical efficiency is not new, and the medical industry has been anticipating this issue for some time. Unfortunately, what the public sees as a sensible set of measures to make healthcare more affordable, and thus more humane, does not correlate with growth and profit in the healthcare industry. Less expensive healthcare equals lower profits, and this mathematical equation cannot be denied. To counter a significant move toward less expensive healthcare, the industry has made this movement less appealing, creating negatives to discourage public support. One of these moves in the healthcare industry is to limit the time each medical doctor spends with each patient, and to limit the number of nurses caring for a set of patients on a ward. Of course, these tactics do not promote real healthcare efficiency, as limiting a diagnostic visit to 5-10 minutes just delays the actual solving of the diagnostic puzzle for many patients, delaying care and creating a succession of unnecessary visits to the hospital or clinic to actually solve and treat the condition, and denying adequate nursing care obviously does not promote efficiency or successful outcomes.

Even Medical Doctors are now fighting against this cynical trend to discourage affordable healthcare measures. A January 10, 2016 article in the New York Times entitled Doctors Defying the Medical Machine outlines one example of how medical doctors at the Sacred Heart nonprofit hospital in Springfield, Oregon resorted to forming a union to oppose the juggernaut trend of outsourcing management of doctors and the time they spend with patients. Managed care organizations in the 1990s, such as Kaiser Permanente, started managing the time that medical doctors were allowed to spend with patients, often limiting this diagnostic time to 5-10 minutes, and requiring doctors to see a minimum of patients per day. This trend resulted in a class of doctors that is now called "Hospitalists", or Medical Doctors that are denied a private practice and contracted to perform their jobs under the rules of a corporate business administration, not the needs of the patient or the science of medicine. In the mid-1990s there were no "hospitalists", just doctors doing their jobs as they were taught in an ethical manner. By 2015, conservative estimates in the United States reported that there were at least 50,000 "hospitalists" nationwide that were denied a private practice and had to adhere to rules of medical practice created by young men with an MBA. The total number of licensed Medical Doctors in the United States has been estimated at about 900,000 in 2015. This New York Times article describes how these "hospitalists" at one hospital objected to being forced to provide inadequate diagnostic care to patients and successfully unionized to allow themselves to spend the time needed to make a real diagnosis. They were not opposed to efficiency measures, and indeed welcomed many improvements in the system to increase their efficiency. They were opposed to measures that threatened their patients' health. While these large hospital corporations are blaming this situation on "Obamacare", capitalizing on a negative perception of the Affordable Care Act tied to perhaps racist views in the United States, obviously, such measures as denying the Medical Doctor the time to do their job effectively is not a measure of efficiency, but a cynical corporate move to discourage the broad set of measures demanded to stop profiteering and achieve more affordable healthcare.

Healthcare charge-to-cost ratios and affordable outcomes are now a number one concern going forward. What this means for Complementary and Integrative Medicine, such as the Acupuncture or TCM profession (CIM/TCM), is that many treatment plans will add this relatively inexpensive but effective Complementary and Integrative care to achieve better outcomes at a lower cost. If the payment for an individual treatment is determined by the outcome, rather than a host of line items with inflated pricing, integration of the care of a Licensed Acupuncturist, or Complementary Care physician, that can deliver short courses of acupuncture combined with physiotherapies and herbal/nutrient medicine, will achieve a faster and better outcome with less treatment cost by the standard provider of care. In this scenario, the Licensed Acupuncturist and herbalist, or TCM physician, will become a great choice of care for a low cost, rather than be seen as a competitor for the health dollar. The same will be true for any Complementary and Integrative Medicine specialist that delivers quality medical care and improved outcomes, such as the Naturopathic Doctor, the Osteopath and the Chiropractic Doctor.

Choice by the public for lower cost healthcare that fills the needs for more conservative therapies with less adverse effects and risks, as well better health maintenance and preventive care, will send a message that our system needs to be fixed

Government regulation alone cannot fix a broken healthcare system that has become twice to three times as expensive per capita as Europe, Canada and Japan, with costs continuing to rise. A more proactive public attitude is needed to bring down the alarming cost of healthcare in the United States, including increased utilization of low-cost and effective Complementary and Integrative Medicine.

While the Healthcare Affordability Act is succeeding in slowing the rise in overall healthcare costs in the United States, as well as providing more comprehensive insurance and government healthcare benefits for the population that can no longer afford standard healthcare, only public demand and pressure will fully fix the problem. Choices concerning utilization of less expensive healthcare when possible, with Complementary Medicine, is sensible, and should be integrated. Greater choice in physicians and healthcare facilities, not more restricted choice, would serve to place a real market pressure on the healthcare charges and quality of care. Most countries now use some sort of single-payer system, even with a free choice of insurance plans and a free market with private insurance, creating a managed guideline of actual cost and payment that is uniform, along with an outcomes based pricing system. All of these solutions will work to achieve a more equitable healthcare system for all citizens, and reduce the per capita spending on healthcare to a reasonable level, making the cost of insurance, and the cost of government healthcare, once again affordable for everyone. We must be thankful that 2013 again showed the lowest increase in total health spending since 1960, according to the U.S. Centers for Medicare and Medicaid Services, rising just 3.6 percent from the total spending in 2012. This stands in contrast to a 16 percent rise in 1980, a 12 percent rise in 1986-88, and a 10 percent rise in 2001, with increases in total healthcare spending staying below 4 percent since 2008, driven mainly by reduced Medicare payments, and a proliferation of high deductible policies, which has discouraged consumers from overuse of unnecessary healthcare. This spending rise correlates with the rate of inflation, meaning that the overall spending on healthcare in the United States has not risen at all since passage of the Healthcare Affordability Act, despite the incessant political claims that it is increasing the healthcare cost burden.

With the rise in higher deductible insurance policies, the public is looking for low-cost and preventive care that helps avoid paying these high deductible costs. Complementary Medicine, especially in the form of Traditional Chinese Medicine, or the integrative care from a Licensed Acupuncturist and Herbalist, provides such low-cost care, and with 4 types of tax-advantaged spending account plans available, much of this care can be both billed against the deductible and offset by a tax-advantaged account plan, such as a Flexible Spending Account (FSA), a Health Savings Account (HSA), Medical Savings Account (MSA), or Health Reimbursement Account (HRA). In addition, some investment in health maintenance and preventive medicine can greatly reduce the increasing out-of-pocket costs in the the Medicare system. Investing in holistic preventive care, combining acupuncture stimulation, herbal and nutrient medicine, and physiotherapies, will be an investment in healthcare affordability for the future.

One issue that we rarely see mentioned in the news media, much less in scientific journals, is the analysis of cost effectiveness of integration of Complementary Medicine. If one looks closely, though, there are a number of studies that assess this cost effectiveness, both in immediate return on investment (ROI) and in quality adjusted life years (QALY), which were both proven before the European Union agreed to adopt Complementary Medicine legally into their healthcare mandates. While these studies are often difficult to read and interpret, couched in acronyms and complex economic analysis that purposely avoids a simple reading, there are numerous examples of studies by renowned University researchers that demonstrate the cost-effectiveness of Complementary Medicine. For example, a 2013 meta-review of such QALY studies of CIM (Complementary and Integrative Medicine) by researchers at Harvard Medical School and Charite' University Medical School, and published in the esteemed British Medical Journal (see link to the study below in Additional Information), found that of 28 sound cost-utility comparisons of Complementary Medicine, that Incremental Cost-Effectiveness Ratios (ICER) of up to $10,000 QALY were clearly demonstrated for treatment by Licensed Acupuncturists in private practice in the United Kingdom for low back pain, by acupuncture therapies in the hospital setting in South Korea for low back pain, by physicians trained in acupuncture therapy in the treatment of dysmenorrhea (severe menstrual cramps) in Germany, by osteopathic spinal manipulation, chiropractic therapy, and other soft tissue physiotherapies (e.g. Tui Na in TCM) in the United Kingdom, with or without integration of a protocol to instruct patients in targeted therapeutic exercise. The one study that did not show cost-effectiveness was simple massage therapy for back pain. The authors stated that: "Details of the 31 recent higher-quality full economic evaluations indicate potential cost-effectiveness and cost savings across a wide variety of CIM (Complementary and Integrative Medicine) therapies applied to different conditions." (Patricia M. Herman, Beth L. Poindexter, Claudia M. Witt, and David M. Eisenberg; BMJ Open 2012; (2) e001046).

Such studies of cost effectiveness of Complementary and Integrative Medicine still have trouble finding both funding and publication, though, despite the alarming rise in healthcare costs in many countries, especially the United States. In fact, there are no published studies of merit of such cost-effectiveness published from the United States, only from the European Union, Brazil, South Korea, Japan and China. These studies that have been noted in medical journals in the last decade or two have always come with caveat that adding Complementary and Integrative Medicine to standard care will incur additional costs, implying that this low-cost, and relatively popular specialty in medicine, would of course come with some additional financial burden in healthcare. Any logical mind can reason that this warning has been ridiculous, as the rising costs of standard medicine have been enormously expensive, while the costs of Complementary Medicine are ridiculously low, and if Complementary and Integrative Medicine is utilized, that this often results in lowered need for expensive therapeutic methods in standard medicine, thus saving enormous amounts of money overall. In addition, such Complementary Medicine as TCM (Traditional Chinese Medicine) are centered on real preventive medicine with a holistic approach, incurring real future savings as the patients achieve better overall health and prevent future disease and injury. This persistence of analyzing Complementary and Integrative Medicine as an additional cost is what led researchers to devise the ICER and QALY measures, although these technical terms and analysis have served to obscure the positive findings in technical jargon for the public.

As the public takes a closer look at the question of cost effectiveness of Complementary and Integrative Medicine, though, they need to look more closely at these relatively few studies, even with proof of cost effectiveness. Anyone can see from the studies of cost effectiveness of acupuncture that a realistic assessment of the real benefits of a more thorough and holistic treatment approach that we see in TCM (Traditional Chinese Medicine) are not being assessed. TCM emphasizes that combining safe and gentle therapeutic protocols that are inexpensive, such as a combination of acupuncture stimulation, herbal and nutrient therapy, physiotherapies, and patient education and instruction, are the key to effectiveness and cost-effectiveness in TCM. The combination of these therapies in clinical practice is what makes the medical specialty so effective, and provides an effectiveness while utilizing therapies with virtually no adverse effects. This is the intelligent approach designed into TCM thousands of years ago as a Complementary Medicine benefiting public health, yet today we see only studies of one of these therapies provided alone, and even this single therapy dumbed down to a minimal standardized protocol for all patients in a study. These studies do not reflect the real benefits of TCM, and any reasonable and logical mind can see this, although not from reading the biased studies in standard medical research.

Additional Information / Information Resources and Links to Studies

  1. A 2014 report from the group National Nurses United, the largest professional association of registered nurses in the United States, outlines the alarm among those closest to the problems of the healthcare industry, showing the explosive rise in profiteering from those most desperate. With a yearly explosive growth in disparity between actual costs of healthcare and the charges for this care, now 12 times the actual cost at our largest and most expensive hospitals, and averaging more the 3 times the actual cost on average, with most of our gigantic merging hospital systems still calling themselves non-profit while hiding the obvious profits from such a system, and being convicted for massive fraudulent practices, these nurses are mainly are concerned with the enormous out-of-pocket costs passed onto patients that have injuries and diseases and cannot afford the expense, leading to a denial of care and medical bankruptcy adding their already devastating health problems:
  2. A 2014 report by the U.S. Justice Department conservatively outlines the rationale for the investigation and criminal complaints against just one of the huge healthcare provider corporations that have been found to have accepted enormous kickbacks from giant pharmaceutical companies in a complex manner to over-prescribe unnecessary drugs to helpless nursing home patients, often incurring adverse health effects. In 2013, Johnson & Johnson pharmaceuticals paid $2.2 billion to end the criminal proceedings against it for kickbacks and false marketing schemes of antipsychotic and cardiovascular drugs to nursing home patients via Omnicare and others:
  3. A 2013 article outlining the ridiculous variations in hospital charges now occurring in the United States, by the conservative Washington Post, showed that even when billing Medicare for a particular type of case there may be a disparity in the charges of 25-fold! There is not only an impossible to explain variance in charges, but a variance in payments that does not logically match the actual charges, and almost no way for the consumer to judge actual quality of care and outcome. The old formula of seeking the most expensive care when insured to get the best healthcare is no long reliable:
  4. A 2014 study by the University of California in San Francisco (UCSF) found that even a simple vaginal delivery of a baby to a healthy woman may vary in charges from one hospital to the next by almost 10-fold! The main determinants of excess charges in this study were a more severely ill patient population (or desperation), a for-profit status, and location in an area of higher income residents and a higher cost-of-living. The growing trend in pricing healthcare out-of-reach for the lower end of the income earners is alarming to many experts, as high out-of-pocket and high deductible expenses continue to rise in the U.S. system:
  5. A 2008 U.S. Congressional Report outlines the findings related to outrageous numbers of fraudulent unnecessary surgeries in areas of medicine where we find patients that are fearful, such as cardiac surgery, and the complete lack of ethical peer review to curb such profiteering. This congressional fact finding commission was spurred by a case in Redding, California in 2002, where a small rural hospital owned by the Tenet Healthcare Corporation paid millions of dollars per year to a a cardiac surgeon, Dr. Fidel Realyvasquez, and a cardiologist Dr. Chae Hyun Moon, for generating many millions of dollars for cardiac surgeries and stent implants, which resulted in more than $32 million paid to patients who were harmed. Most of these unnecessary cardiac surgeries were billed to Medicare, and an FBI investigation proved that more than 600 patients received unnecessary surgeries from 1995 to 2002, yet in the end, out-of-court settlements were accepted and no one was prosecuted, resulting in numerous FBI investigations for similar outrageous profiteering in this area in cardiac care across the United States in the next decade:
  6. A 2014 article from Arbiter News documents the recent array of studies, and a Time Magazine article, that show that 'nonprofit' hospitals, which make up 82 percent of all U.S. hospitals are more profitable that for-profit hospitals, and that the small percentage of their work that now goes to charitable care is compensated by the government 10-fold over the cost to these hospitals for that charitable care:
  7. A 2013 report by The PEW Charitable Trusts details the fast growing expenses incurred in marketing new pharmaceutical drugs and influencing physician prescription practices, showing that in 2012, the actual facts generated by the human clinical trials now accounts for less than one percent of the expenditures used to guide clinical prescription. The bulk of the money spent on marketing new drugs, now totaling between $20-30 billion per year in the United States, is generated by giving Medical Doctors expensive meals at restaurants, office gifts, free drugs, free textbooks, numerous promotional conferences, inexplicable consulting fees, and free continuing education credits, as well as pressure from patients generated by enormous television and internet advertising, which was deregulated in 1997:
  8. The U.S. Centers for Disease Control and Prevention (CDC) released a report in 2015 that in any 30-day period between 2009 and 2012 that at least 10.7 percent of the entire U.S. population was using 5 or more prescription drugs, and that at least 48.7 percent were using at one prescription drug. The potential for profit, and the potential to increase healthcare spending dramatically with uncontrolled pricing of new drugs is enormous. The overprescription of drugs to control symptoms compared to other developed countries is alarming, and the CDC reported that over 75 percent of doctor visits involved drug prescription:
  9. A 2015 report in the esteemed and conservative Journal of the American Medical Association (JAMA) reported that the U.S. National Health and Nutrition Examination Survey (NHANES) reported that between 1999 and 2012 that the percentage of U.S. adult that were taking at least 5 prescription medications rose to 15 percent in 2011-2012 from 8.2 percent in 1999, and that the percentage of U.S. adults taking at least one prescription drug rose to 59 percent! The highest prescription drug class was pain medication, coinciding with an enormous rise prescription drug abuse and overdose deaths, and one of the most prescribed drugs was cholesterol and lipid control medications, despite acknowledgement that treatment protocols without adverse effects, such as increased activity, improved diet, and herbal and nutrient medicine was effective in restoring lipid homeostasis, and that a great majority of patients were not taken off these drugs when their lipid metabolism was healthy:
  10. A 2015 article from National Public Radio revealed that the tight and thorough control of pharmaceutical guidelines and prescription practices in the United States has led to a crisis with diabetes, where soaring costs of synthetic insulin has reached $400 per month, and out-of-pocket expenses has led many patients to poor utilization of insulin to control their blood sugars, a dangerous situation. We are finally realizing that the scheme of American healthcare to accelerate costs exponentially and pay for them with increased insurance premiums and government spending has reached its endpoint, demanding change. The low-cost of generic medicines, bioidentical hormones, herbal and nutrient medicines are needed to provide affordable healthcare:
  11. A 2012 article in the Mayo Clinic Proceedings outlines how the reasons cited to justify the outrageous cost of cancer drugs are not true, to state it politely, with the average cost of cancer drugs rising from $5000 per year to $100,000 per year from 2000 to 2013, with the cost of care often adding enormous stress to the patient with cancer and their family, and the outcomes of cancer care for metastatic cancers largely with little change since the middle of the twentieth century, and the measure of success often the extending of life, and treatment, for just a few months. These conservative experts reveal that the industry has all but eliminated a free market, but that the ways that the free market in healthcare have been subverted in the U.S. are more extensive than even Europe, Canada or Japan, creating a total package of control and justification from the ground up in medicine:
  12. A 2011 article published on by Donald W. Light of the University of New Jersey School of Medicine showed how the 2003 figure of an average of $1 billion spent on research and development for new pharmaceutical drugs was arrived at, and how this information was manipulated by the research design, with the choice of companies manipulated, the exclusion of government funded research and massive tax breaks for R & D not included, and gross inconsistencies in the calculations. For instance, industry studies cite a figure of 1.2 percent of pharmaceutical income going to research and development, whereas the 2010 study funded by Tufts Center for the Study of Drug Development at Tufts University, itself funded by the pharmaceutical companies, came up with figures for research and development that would account for more than 33% of pharmaceutical income going to basic research and development. In addition, the figure of $1 billion was based on statistics from 2000, with an inflation rate of 26% applied to this figure. Such analysis clearly shows how the pharmaceutical industry is manipulating even the top economists at Tufts, the University of Rochester, and Duke University. The analysis by Light and Warburton found that with all of these study flaws considered, the actual average cost of research and development would have been only $55 million, instead of $1 billion. This analysis was widely discounted in 2011, but as the Mayo Clinic article shows, many experts studied these figures and were alarmed. By 2015, some industry voices and media raised this average cost of research and development of new drugs to $5 billion!!!:
  13. A 2015 article in the journal ProPublica showed that the costs of new pharmaceuticals introduced to treat Hepatitis C resulted in Medicare spending alone in the first year of $4.5 billion, with costs of a single course of treatment as much as $84,000 for a 12 week supply of pills, and one medical doctor at a liver disease clinic reporting 925 prescriptions in a single year that cost $22 million. While these drugs are proving to be effective, at least in the short term, the cost of care is estimated to be over 15 times higher than prior treatment, and it is feared that they will be heavily marketed and prescribed to patients that are not experiencing threatening symptoms, but that have been diagnosed with a mild form of hepatitis C, and that the large out-of-pocket costs will keep many patients that are in dire need from obtaining the expensive treatment:
  14. A 2010 analysis of healthcare problems and solutions in the United States, by the Rollins School of Public Health at Emory University, in Atlanta, Georgia, U.S.A. concluded that the U.S. healthcare system is dysfunctional because the cost of healthcare can be "astronomical", a growing percentage of citizens can no longer afford good healthcare, and that "the marketplace that controls health care is concerned primarily with profit, only secondarily with patients or with quality of care." Solutions to these problems, according to these conservative experts, and the Global Health Program of the Bill and Melinda Gates Foundation who funded the study, would be to nationalize the healthcare system in the United States, moving to outcome measurement for patient care cost, and incentivizing the recruitment of sick rather than healthy individuals into insurance plans by these measures, as well as moving to a true preventive health program rather than a program that calls itself preventive, but is designed primarily to generate more patients into expensive treatments. These public health experts state that Medical Doctors and the health industry are violating the Hippocratic Oath of medical ethics by omitting advice on true preventive medicine, which is largely the realm of Complementary and Integrative Medicine (CIM) and TCM:
  15. In November of 2015, the U.S. American Medical Association (AMA) finally responded to the rising array of television drug ads by calling for a complete ban on these misleading and manipulative ads, now accounting for most of the $4.5 billion per year that is spent on pharmaceutical advertising, that is drastically driving up the spending on pharmaceutical drugs with patient demand for more expensive drugs despite the proven clinical efficacy of less costly treatment. Only the United States and New Zealand allow pharmaceutical drug ads on television, a very manipulative practice that undermines physician decisions and has become a major contributor to healthcare unaffordability:
  16. A November 2016 report by the esteemed PEW research organization and PEW Charitable Trusts showed that while the affordable care act has kept the rise of health spending in the United States lower than in the past, and the rise of spending on pharmaceutical medicine lower, the overall spending on pharmaceuticals is still rising about 5 percent per year, a figure greater than inflation, which has been about 2 percent. While the U.S. has succeeded in decreasing the unnecessary spending, medication overuse, excess charges, and other factors that led to Americans using about 3 times the number of medications per patient than other comparable countries and spending up to 3 times that amount for the average prescription drug, the rise in pharmaceutical spending is now driven by the very high cost of specialty drugs and biologics, and this is tied to the highest tier in drug fomulary plans, and incurring the highest out of pocket (OOP) costs for patents. These specialty drugs now incur more than $100,000 per year costs for many patients, and while just 1 percent of patients were receiving these new drugs, this accounted for 32 percent of total pharmaceutical costs! While systems using generics and negotiated prices are reducing standard drug costs, the industry has responded with new biologics that they charge obviously outrageous prices for, and provides them with even more profit than ever before:
  17. A review of scientific studies of acupuncture and healthcare cost savings easily resulted in an analysis of ROI (return on investment) that showed the amazing healthcare cost benefits resulting from this inexpensive care. These analyses are just examples of the numerous scientific studies that show the proven effectiveness of acupuncture, but rarely express such unbiased analysis of actual benefits in public healthcare:
  18. A 2012 meta-analysis of the cost effectiveness of Complementary and Integrative Medicine (CIM) by researchers affiliated with Oxford Medical School in the United Kingdom and Harvard Medical School in the United States (Dr. David M. Eisenberg MD), and published online in the esteemed British Medical Journal, found from careful analysis of the highest quality studies published on the established medical scientific databases in the West that treatment with acupuncture and physiotherapy by licensed physicians in CIM, including Licensed Acupuncturists, Chiropractors, and Osteopaths, was proven effective in a cost-benefit analysis, using standard measures of Incremental Cost-Effectiveness Ratio (ICER) and measured in Quality of Life Years (QALY):
  19. A systematic review of all published studies of cost effectiveness of acupuncture, including only studies based on high quality randomized controlled human clinical trials that showed effectiveness, conducted by experts at the Kyung Hee University College of Medicine, and the STAR project (Studies of Translational Acupuncture Research), definitively demonstrated the cost-effectiveness of this treatment protocol. Considering that the practice of TCM often adds a number of effective treatment modalities to the same acupuncture treatment session for very little additional cost, such as soft tissue physiotherapy, herbal and nutrient medicine, and targeted instruction in therapeutic activities performed by the patient, we see that integrating Complementary Medicine and the Acupuncture profession into standard care would contribute to healthcare affordability directly, much less indirectly, as low-cost healthcare as a standard would bring down the overall insurance rates and calculated government healthcare budgets:
  20. The full published study of the above Kyung Hee University confirmation of cost effectiveness of acupuncture when studied alongside randomized controlled human clinical trials that prove its effectiveness is available here, reprinted online from the esteemed British Medical Journal (BMJ):
  21. A review of this meta-review of studies cited just above, by the Huffington Post, explains the continuing complexity of the fight to downplay any actual proof of cost effectiveness of Complementary Medicine. The author points out that this systemic discouragement of acknowledging such cost benefits of CIM now appear more and more ridiculous each year as the issue of Healthcare Unaffordability takes center stage in the United States, and is the leading driver of the federal deficit:
  22. One of the researchers of the 2012 meta-review of cost effectiveness of CIM cited above, Dr. Claudia Witt, of Charite' University Medical School, in Berlin, Germany, reveals a new direction in standard medicine that should be supported by the public:
  23. A 2012 randomized controlled study by experts at the Cedars-Sinai Medical Center in Los Angeles, California and the University of Arizona, in Tucson, Arizona, U.S.A. found that a majority of patients in the United States admitted to acute care in a hospital setting now accept the practice of acupuncture to achieve more successful outcomes. This practice is almost nonexistent in U.S. hospitals, though, despite its simplicity, low-cost and extreme safety:
  24. A 2016 article in the British Medical Journal (BMJ) describes how successful the integration of acupuncture into the hospital setting and outpatient clinic setting has been since Brazil voted to integrate evidence-based Complementary Medicine in 2005:
  25. A large meta-review of randomized controlled human clinical studies of Complementary and Integrative Medicine (CIM), in 2010, found that "acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain", in a review of 265 randomized controlled human clinical trials published on standard medical databases. This review also noted that soft tissue mobilization and joint manipulation were effective, and noted insufficient trials to clearly determine cost effectiveness at that time. Obviously, the combination of acupuncture, soft tissue mobilization and manipulation would increase the effectiveness of treatment and provide a cost effective treatment protocol for back pain:
  26. A large study of the cost effectiveness of acupuncture for chronic low back pain, at the University of Western Sydney, in New South Wales, Australia, found that: "According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP (low back pain)." The study recommended integration of acupuncture with standard care for cost effectiveness. When comorbid depression was included in the study, acupuncture alone was proven cost effective, showing the potential for acupuncture to treat multiple health problems in the same session. In addition, acupuncture can be combined in the same treatment session with physiotherapy in TCM, called Tui Na, as well as topical and oral herbal and nutrient medicines, and patient instruction in targeted therapeutics and postural mechanical correction:
  27. A 2014 study of the cost-effectiveness for integration of acupuncture in the treatment of patients with allergic asthma, by Charite'-University Medical Center, in Berlin, Germany, Institute for Social Medicine, found that adding short course of acupuncture therapy to the care of patients with allergic asthma resulted in cost effectiveness in terms of quality of life (QALY) as well as improved outcomes of therapy. The resulting Incremental Cost-Effectiveness Ratio (ICER) averaged about 24,000 Euros per patient in this randomized controlled human clinical trial with 306 patients:
  28. A 2009 randomized controlled study of the cost-effectiveness of acupuncture integrated into standard care for allergic rhinitis, again by Dr. Claudia Witt of the Institute for Social Medicine and Health Economics at Charite University in Berlin, Germany, shows that short course of acupuncture produced improved quality of life measures after more than 3 months over controls, and while adding acupuncture therapy in Germany to standard care increased the cost overall, especially as this treatment must be administered by Medical Doctors in Germany, not Licensed Acupuncturists, as in the U.S.A., the ICER (incremental cost-effectiveness ratio) in the long-term favored the integration of acupuncture into the treatment protocol:
  29. A 2010 study of the cost-effectiveness for integration of Complementary Medicine in Australia found that even simple therapies that are popular in Complementary Medicine could produce an enormous monetary savings if used professionally for the Australian Healthcare System. This broad study into the economics of Complementary Medicine was conducted by researchers at the University of Western Sydney. Health spending has increased in Australia from about 3.8 percent of GDP in 1960 to over 9 percent of GDP today, which is about half of what is spent in the United States:
  30. A 2014 analysis of cost effectiveness in the treatment of depressive mood disorders, by experts at the University of York, in the United Kingdom, concluded that "acupuncture is cost-effective compared with counseling or usual care alone". Both acupuncture and counseling had higher QALY than standard care, and acupuncture was estimated to have an ICER of 4,500 British Pounds per additional QALY, and a probable long-term cost effectiveness of 20,000 British pounds in currency, equal to about $30,000. Of course, integrating short courses of acupuncture or TCM holistic therapy with short courses of cognitive and behavior counseling would be most effective:
  31. A review of healthcare cost effectiveness study and policy by David Meltzer, Associate Professor of Medicine at the University of Chicago, and a former economist, emphasizes the need to utilize cost effectiveness study to benefit the outcomes in medical care, not only in stopping the alarming rise in total healthcare spending in the economy and the burden on government spending and the individual and small business, but to actually improve health outcomes with use of more cost effective treatments:
  32. By 2013, institutions such as Harvard Medical School and the associated Massachusetts General Hospital were responding to the 2012 meta-review of acupuncture treatment for chronic pain by Dr. Andrew Vickers of Memorial Sloan-Kettering in New York, published in the Annals of Internal Medicine, which showed clearly that acupuncture treatment alone, even in the standardized constraints of human clinical trials, works, and outperforms standard treatment, at a much lower cost. We see from this Harvard publication that while the standard misconceptions about acupuncture are still repeated even in supportive articles, that the medical field is finally admitting that acupuncture provides proven, effective, low-cost healthcare. When this acupuncture is performed properly, and combined in the specialty of Traditional Chinese Medicine (TCM) with soft tissue physiotherapies (Tui na), herbal and nutrient medicines, and patient instruction in therapeutic activities and mind-body cognitive-behavioral approaches to chronic pain (Qi gong), that these benefits could be expanded greatly at little additional cost, since these treatments may be combined by the same physician in the same therapeutic sessions. The blog responses to the article by the public are also enlightening:
  33. A 2015 study on the number of licensed doctors in the United States is very revealing, examining the issues of the expected shortage of Medical Doctors in the United States with an aging population, the fact that an estimated 8 percent of licensed doctors are not allopathic medical doctors from University Medical Schools, that now 23 percent of our medical doctors are trained out of the country, that males still made up 66 percent of all doctors, that only 36 percent of new doctors receive their first medical license from a state board, and that the system requires an average of 9 years in a medical college and specialty training to obtain a license: