Top Ten: Doing the math.

Where is Daddy Warbucks when you need him?

My fellow blogger-slash-sisterfriend-slash-colleague-slash-fellow medicine nerd, Dr. Toni Brayer, authors one of my favorite medical blogs called EverythingHealth (which is a perfect name for her blog since she really does discuss everything. . .well. . .health.) She gets her blog on at ACP, too. If you like learning, check her out--very laypeople friendly.

Trust us. We're doctors.

Anyways. This week she shared a nice post with us summarizing what the CDC deemed the top ten public health achievements of the century. I peeped the list and thought, "Eh. Not bad to only be eleven years into it." If you get a chance, you can check out that top ten out here.

Oh yeah. I also enjoyed another of her posts this week that discussed the New England Journal of Medicine's recently published "The $650 Billion Dollar Question: Why does cost effective care diffuse so slowly?" or as she retitled it--"Why Health Care Costs So Much." Peep that post, too -- good stuff.

Okay. . . .now the link Dr. Brayer provides on that last post about health care costs points out some of the barriers to us delivering health care despite our abundant budget and resources. Stuff like legislative issues, uninsured patients, public misinformation about health care reform, misspending . . . all that.

But is that really the problem?

For real, y'all. What is it that REALLY is standing in the way of us getting folks healthy in a more cost effective way that doesn't make people fight, scream, dump tea bags, picket, or yell out uncontrollably while congress is in session?

Aaaaahhh. Look no further, my friends. . .because this week I bring you:

The Top Ten Things that, if we could simply erase completely, would make delivering effective health care without breaking the bank a piece o' cake.*

*(For the record, this list does not include calamities, catastrophes and accidental traumatic events which we can all agree would save us lots of money.)

But it does include everything else.
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#10 -- (Frickin') Cigarettes.

Grrrr.

Seriously? Just about every health problem under the sun is made exponentially worse by blazing up even a few per day. Think of it like playing the lottery--just by living you get one ticket. Add age and genetics into it, you get another ticket. Smoke on top of that? Just think of it like someone handing you an extra stack of tickets. Oh, and the jackpot? Try any one of the following:


Coronary Artery Disease (Heart attacks)
Lung Cancer
Cervical Cancer
Chronic Obstructive Pulmonary Disease
Throat Cancer
Bladder Cancer
Hypertension (High Blood Pressure)
Premature aging

Just to name a few. If cigarettes would just disappear, no one would ever get hooked on them. This would add fifteen minutes to a lot of doctor's visits and a whole, whole, whole lot of money to the health care honey jar.


#9 -- Obesity.

Sigh. What a doozy. It's the bane of our existence. Often a symptom of many, many different complicated things which is why it's such a hard thing to tackle. One time I was discussing weight loss tips on Fox 5 News. At the end of the chat with the anchor I said, "Here's the secret: move more, eat less." Although I actually think that is partially true, that oversimplified (and smug) statement coming from a person who technically hasn't struggled with being overweight makes me cringe. Shame on me for that. Obesity is like having your favorite necklace tangled up into an absolutely impossible ball at the bottom of your jewelry box. It's not as simple as tugging on both ends to unravel it.

That's all I can say about it. Obesity is complex. Food in western culture is worrisome. And the health care complications of all of it? Downright depressing. And costly, too.

#8 -- Drug Addiction and Illicit drugs.

What drug depends upon where you live and what's prevalent there. In Atlanta and Los Angeles, they seem to like crack. In Baltimore and central Ohio, heroine rules. Rural and suburban America digs methamphetamine and prescription drugs. But regardless of the drug of choice, the effects of addiction are the same--awful and destructive.

If there wasn't any drug addiction for us to overcome, we sure would be in a different place. I shudder when I think of the high risk behaviors that people struggling with addiction engage in and what the aftermath costs us. HIV from needle sharing and sex-working. Accelerated coronary disease and strokes from cocaine. Fractured and decaying teeth from meth. Liver failure from the acetaminophen component of Percocet and Vicodin.

Yeah. Drugs pretty much suck. Suck money. Suck period.

#7 -- Low Literacy and Low Health Literacy.

This is another complicated thing that costs money. Generational curses, crappy communicating skills on our part, a failing education system. . .these are just a few of the reasons why literacy issues annihilate the bottom line when it comes to health care dollars.

Guess what happens when people don't understand their health problems and the health care system? They take medications wrong. They leave the hospital and "bounce" right back. They don't understand the importance of what they need to be doing. They can end up in harms way. Case in point: Several years ago the AMA put out a set of health literacy videos, and in one of them an elderly, placid chap spoke with Grady doctors about his high blood pressure.

"You take this medication for hypertension. What is hypertension?"

"Ummm. . .I thank it means it's when yer hyper."

"So do you think I think that you're 'hyper?'"

"Ummm. . .I thank so. Like you can't sit still."

This guy could NOT have been more NON-hyper. He really thought that's what his medicine was for. Do you think he took it on the days when he felt sluggish and not "hyper?"

If low literacy and low health literacy weren't a speed bump on the road to exceptional health care, that would sho' nuf save some bucks. And some lives.

#6 -- Alcohol abuse.

Alcohol is a sneaky little devil. It creeps into families and strangles the offspring of alcoholics to the ground. Almost every time I meet someone struggling with this addiction, I ask them if they grew up with a drinker. And almost always, the answer is "my father" or "my mother" or "my grandfather" or someone else.

Then there are the casual drinkers that it tip toes up on. Starts as a cozy shoulder massage that evolves into a headlock. The college kids that play quarters in the dorm that find themselves having a couple of vodka and cranberries every night when they're alone. The "happy hour" fun loving uber-achiever that throws back more than ten martinis per week over jokes and clients. And of course, the soccer mommies and their red wine chat fests. It adds up.

Yeah. It adds up. To health problems and to big bucks.

#5 -- Poverty.

Sigh. Eating right costs money. Doing right costs money. Education costs money. Opportunity is often most abundant to those who have money. Getting medications costs money.

Being healthy costs money. And as some wise dude with a big afro once said,

"Nothin' from nothin' leaves nothin'. You gotta have somethin'."

'Nuf said.

#4 -- Ignorance.

This is different than low literacy. This is just not knowing and kind of not really caring that you don't know. Or kind of knowing but not caring. Like, when this lady I met told me she started smoking at forty years old. Not fourteen. Forty. Really?

Then there's the innocent things like eating ramen noodles because you think they are healthy or pouring a whole bottle of olive oil into a frying pan and drowning a few lonely broccoli spears in it for the same reason. That's ignorant, too.

Ignorance is tricky, too. Sometimes it's a person's fault. Other times it totally isn't. But I know one thing--if we all would just do better once we knew better, a whole stack of health care dollars could be saved.


#3 -- Cancer.

I wish there was a way to run cancer out of town for good. It would save money, yes. But more than that, it would keep a whole bunch of families intact.

#2 -- HIV and AIDS.

With Ryan White funding, the U.S. has definitely put forth a decent effort at treating our patients with HIV and AIDS. But when all of the other factors listed above get swirling along with it, it can be the ultimate costly train wreck. Sure, there are thousands of super motivated patients beating HIV down to the ground through healthy practices and antiretroviral medications. Absolutely. Even so, unfortunately, there are a whole lot of of other people who aren't. Especially when you get outside of the western hemisphere. And especially when you get inside of Africa.

If HIV would just disappear and never, ever, ever come back. . . .that would be good. And would save a lot of money.

#1 -- Mental illness.

Have you ever seen someone who has a genetic disease or birth defect that has caused them to have a distorted physical appearance? How about someone with a stroke whose face is flaccid on one side and whose speech sounds like they have a mouthful of sand? Your heart sinks a little. Because from what you see, their life has been profoundly affected. The key there is "what you can see."

That's what I hate about mental illness. It's slippery and elusive. It's dirty and cruel. It sucker punches twenty-one year old college whiz kids melting them into a pool of nonsensical voices. It drop kicks loving mothers rendering them frozen statues of fear, tears and pain. It turns even the very best people into marionettes on strings. . . snatching all control from them and handing it all over to a mind that skips like a broken record. All without being outwardly apparent. No tell-tale low set ears or downward slanting eye folds. No postured arm from neurologic deficits or dragging limp screaming stroke. Just odd behaviors and unexplained impulses.

Some people get a diagnosis and get treated. But my God. The incomprehensible number of people whose lives are ruined by mental illness--without even knowing what hit them--is horrible. Horrible and costly and devastating and. . . .yeah. Don't even know what else to say about that.

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So . . . . that's my take on it. Mow these things down and there will be zero discussions about health care costs. For real. Sure, we'd still have to deal with tuberculosis and a few other things. But the mutinous money pit called health care as we know it now? It would be on a whole 'nother level.

Don't believe me? Read that list again. Then imagine a world without these barriers to contend with. And then. . . . you do the math.

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Happy Thursday.

Check this out. . . . and tell me if this isn't costing us big health care dollars.