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Paying for the Bailout: How Unnecessary Medical Procedures Are Taxing the System
by: Nora W. Coffey, The Women's International Perspective
Wednesday 04 February 2009
As we tighten our belts at home and abroad, we are all accountable for the burden of national debt we pass along to future generations. Local and international relief efforts for the poor are also feeling the pinch, which makes the search for ways to heal our broken economy a humanitarian effort.
Although medical profits continue to soar, there have been rumblings lately that the next "industry" to show up in Washington hat-in-hand will be medicine. Meanwhile, evidence abounds that an increasing portion of our tax dollars that fund Medicare and Medicaid are the most lucrative revenue stream for the medical industry, and a large portion of those expenditures are going toward unnecessary, even harmful surgeries - not unquestionably-needed emergency care.
Any savings to be realized, without causing more people to become disadvantaged, must be embraced immediately. So-called pork barrel federal expenses, and those that can be revealed to cause more damage than good, must be the first to go.
In study after study, a staggering number of surgeries have been proven to be medically unwarranted, causing more harm than good. Two of the most over-utilized and most commonly performed surgeries in America are cesarean sections and hysterectomies.
When a doctor and a hospital get involved in the natural process of childbirth, time is money. "Spontaneous deliveries," as they are often referred to (where there is no surgical intervention), are time-consuming for doctors. In rare instances, such as when the placenta happens to block its own exit by attaching to the uterine wall close to, or covering, the cervix (placenta previa), C-section may be lifesaving for both baby and mother. Also, when the placenta does not detach from the uterine wall (placenta accreta), sometimes a hysterectomy is the only way of saving the mother's life. But placenta previa can often be managed conservatively and occurs in only 1 in 200 pregnancies. Placenta accreta occurs in only 1 in 2,500 pregnancies. Combined, they account for only one half of one percent of C-sections, which means that as many as 99% of C-sections may be medically unwarranted.
Dr. Mayer Eisenstein, an ardent advocate of home birth and the founder of Homefirst Health Services in Chicago with over 20,000 women in its practice, reports that Homefirst's C-section rate is only 4.1%. However, the National Center for Health Statistics, Division of Vital Statistics reports that in 2006 31.1% of the 4.3 million births in the U.S. were surgical.
A study published in the New England Journal of Medicine found up to a four-times higher risk of complications for caesarean births. Depending on the severity of C-section complications, each surgical delivery taxes Americans anywhere between $2,000 and $200,000, in addition to the cost of hospital birth. In March 2007, Obstetrics & Gynecology reported that "the average initial hospital cost of a planned primary cesarean ... was 76% higher than the average for planned vaginal births." A conservative estimate of C-section expenses burdening American families and taxpayers would top $3 billion each year, for additional doctor and hospital charges alone.
As for hysterectomy, Ashley Montagu writes in his book The Natural Superiority of Women about a House of Representatives subcommittee investigating the incidence of unnecessary hysterectomy. "Various sources," he writes, "put the percentage of unnecessary hysterectomies anywhere between 24 and 88 percent." Findings from more than 850,000 counseling sessions at the HERS Foundation in Philadelphia puts the percentage of hysterectomies that could be avoided with conservative treatment (or no treatment at all), at about 98%.
The Centers for Disease Control and Prevention (CDC) report that more than 1/3 of American women have their female organs removed by the age of 60. The CDC also reports that the incidence of cancer in the female organs and the male organs is virtually identical, while the incidence of male organ removal is statistically insignificant.
"We have four times the hysterectomy rate of any industrialized nation, in this country,'" says Ernst Bartsich, a clinical associate professor at Weill Cornell Medical College. "At age 60, one out of every three women has had a hysterectomy; and at age 65, one out of two women have had a hysterectomy. And 85 percent are not necessary."
In a September 5, 2007 article published in Health Insurance Underwriter's magazine, Rick Schweikert reports that more than $17 billion each year is spent on direct doctor and hospital charges for hysterectomy. That year, the HERS Foundation released an educational female anatomy video on its website that was vetted by gynecologists and other medical and legal experts. Ninety-eight percent of the women who watch the video and call the HERS Foundation do not proceed with the doctor's recommendations for hysterectomy after learning about the unavoidable and irreversible consequences of removal of the female organs - facts that doctors rarely tell women. The long-term cost of treatment and subsequent surgeries, and a lifetime of harmful drugs and treatments for the problems caused by hysterectomy and ovary removal, could easily top the $17 billion annually paid for the initial surgery.
According to their 2008 SEC filings, the largest hospital chain in the U.S., the Hospital Corporation of America (HCA) - founded by the family of former Senator and Majority Leader Bill Frist - reports that in 2008 about 49% of their revenues and 59% of their hospital admissions were Medicare and Medicaid "related." In 2007, HCA reported revenues of $26.9 billion, approximately $16 billion of which was paid for by American taxpayers.
What most people may not know is that HCA plead guilty to 14 felonies and was hit with a $1.7 billion fine - far and away the largest such fine in history - for Medicare fraud. These fines, it seems, were a minor bump in the road for HCA, on their way to grabbing hundreds of billions of American taxpayer dollars in the years to come. Doctors and hospitals reap the financial benefit of surgeries, whether they are warranted or not. American taxpayers, both in terms of Medicare/Medicaid payouts and higher insurance premiums, pay the real price.
No mother or father whose child has a medical emergency should be required to answer any questions or demonstrate any ability to pay for medical services when they arrive at an emergency room seeking care. But as our government strategizes how to spend hundreds of billions of dollars in its economic stimulus package, we owe it to future generations to unshackle ourselves from doctors and hospitals performing medically unwarranted surgeries.
In a December 2, 2007, article titled "National Debt Grows at a Million Dollars a Minute," (published long before any talk of "bailout" packages), the Associated Press reports that, "retirement and health benefit programs now make up the largest component of federal spending. Defense is next. And moving up fast in third place is interest on the national debt."
Each million dollars saved today could save future generations tens of millions of dollars in interest on the national debt. As President Obama said in his inaugural address, "Our healthcare is too costly."
In these trying times, Americans are not in a position to leave $17 billion a year of unnecessary medical expenses on the table. Especially when it will keep hundreds of thousands of American women off the operating table, with their female organs intact.
Nora W. Coffey is the president of the Hysterectomy Educational Resources and Services (HERS) Foundation. She has been a guest lecturer at medical schools, nursing schools, and conferences, and has appeared on numerous television and radio shows including 20/20, Oprah Winfrey, National Public Radio's Fresh Air, and The Today Show.
Nora founded HERS in 1982 to meet the need for complete, accurate information about the alternatives to and adverse effects of hysterectomy and the multiplicity of physical, social, economic, and political issues surrounding the surgery. HERS is the only organization solely dedicated to the issue of hysterectomy and has counseled over 850,000 women. Ninety-eight percent of the women HERS has referred to board certified gynecologists after being told they needed hysterectomies discovered that, in fact, they did not need them.
Reprinted under Fair Use, in accordance with Title 17 U.S.C. Section 107