John Livingston News

Why Bernie Sanders it Alive and Medical Costs are so High

I was sorry to hear that Senator Bernie Sanders had an ischemic event crescendo angina or a heart attack while campaigning in Las Vegas. I was also relieved to know that he was being treated at a state of the art medical center where I know many of the physicians and surgeons that practice there. He is a very lucky man. He was transported within 1 hour to the facility and then put on a “coronary protocol” where, with state of the heart equipment and world-class physicians, nurses and technicians an intervention was effected that arguably saved his life. An intervention that would more than likely not have been possible in any other country. The good Senator was recovering within 8 hours of the event and has an excellent prognosis.

This procedure is not done in Cuba—they don’t have the equipment or the trained physicians to do the procedure. In almost every country in Western Europe, a man of Senator Sander’s stature wealth and position would have been taken to a private fee for service facility where emergent cardiovascular procedures are performed, not to a State-run medical facility where emergent procedures like the one done on Mr. Sanders are not done. Trying to get a specialist to attend to an emergency patient in a State-run hospital is almost impossible. I practiced in Europe for 2 years at both private, Catholic and State run hospitals. Physician friends tell me the situation has only gotten worse and not better regarding specialty care.

The most important lesson to learn from this event is that if Senator Sanders had been “Joe off the Street Sanders” he would have received the same care. I bet more balloon angioplasty and cardiac stent placements have been done in that Las Vegas hospital alone on patients over 60 years of age this year than in all of Canada, or England or Germany or France in State-run hospitals. The irony in all this is that Senator Sander’s life was saved because of the very health care system that he has been demeaning and criticizing. The equipment and most importantly the human capital deployed medical care providers are why patients like Senator Sanders survive such events.

The fact that a patient of Senator Sander’s age was even considered for surgery is one of the reasons many diagnoses in our country carry a higher morbidity and mortality than in other countries where such procedures are not offered to patients that carry such high-risk co-morbid conditions, like age, increased cholesterol, gout, diabetes etc. Finally, it is important to note that a hospital administrator, insurance executive, or politician did not save this life nor do they save any lives. People saved his life. Doctors, nurse’s technicians who often go unrecognized but are responsible for Bernie being alive today.

The problems with health care delivery in this country are not with the people who deliver the health care but rather with the people who are charged with the responsibility of allocating the scarce resources—and as any economist will tell you resources are always scarce. Kickbacks from insurance carriers to health care providers along with supply chain kickbacks from drug companies and medical supply companies to pharmacy benefit managers (PBM”S), medical supply chain managers and insurance carriers and large hospital systems need to be scrutinized. And this doesn’t even consider the money that these large companies are paying lobbyists to fund the campaigns of our politicians at both the State and Federal level. Our health care system will be fixed only when these special interests are not able to fund political campaigns.

Do we have any politicians that are willing to stand up to these corrupt organizations? So far the answer is pretty obvious. In Ohio, Texas and Montana billions of dollars have been identified as being wasted because of “the spread” the difference a supply chain manager pays to the supplier and the price they charge the provider that is then passed onto the patient or to their employer. One would think that the insurance carrier would be interested in this “spread” but oftentimes they own the PBO! In Montana, a lady named Marilyn Bartlett took over the States employee benefit plan and scrutinized PBO’s and supply chain managers. She discovered the state plan was going to go bankrupt because of the PBO spreads and kickbacks. The State ditched their previous managers and hired a private company Navitus saving employers and the state $16/prescription that ended up saving $2.5million in spread savings and $3.5million from rebates.

The distribution and allocation of government transfer payments to providers and insurance companies need to be scrutinized. We need an independent outside signed partners audit of all providers and carriers who receive over $100 million of government transfer payments including Medicare Medicaid, Campus, VA, and payments from the Indian Health Services.

In future articles, I will discuss about 10 other steps that could be easily made to cut health care costs in our state and country. By doing so we can make sure that every “Joe on The Street” will be able to receive the same type of health care that US Senators receive. If we don’t address the business issues of medicine we could all find ourselves being in the position of a prominent politician receiving health care in Cuba.

Cost before coverage – Coverage is not access – Access is not quality

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