Robert Wood Johnson and St. Barnabas healthcare networks merge, is this really good for us, the consumer?

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Robert Wood Johnson and St. Barnabas healthcare networks merge, is this really good for us, the consumer?

Recently, I read that the reason for high healthcare costs are the few super utilizers of care. While it may be true that a few people (roughly 5% of patients) use a lot of care, few physicians in private practice have been responsible for these costs, yet the drug companies and hospitals continue to profit immensely from cases like these.

Obamacare has had the effect of creating more mergers, as more doctors struggle to compete. The end result is that the larger the healthcare systems get, the more clout they have to negotiate higher rates with insurers.

Most recently, the Robert Wood Johnson and St. Barnabas healthcare networks have announced their merger, which gives us less competition and if history repeats itself as it usually does, higher costs. You can read more about the merger here.

This is about as good for us as the continuing mergers of the airlines, with higher costs for us, poorer service and fewer competitors.

The next merger that was announced may be two healthcare behemoths; Aetna and United Healthcare, and on 7/24/2015, Anthem has announced they are purchasing Cigna. United is one the largest healthcare companies in the USA, as well as Anthem who operates many Blue Cross/blue shield plans across the country. This is likely good for patients who are covered by Cigna whose business models have often been questionable, especially under the chiropractic realm.

Is this good for doctors, and does it really save costs? It may in fact be helpful to have fewer competitors since the growing pricing power of the ever larger hospital chains make it more difficult to keep costs in line when you have more insurers, which is why a single payer system has the most pricing power (Medicare is very good at controlling and negotiation hospital rates).

The truth is if history repeats itself (as it routinely does), the consumer often loses the closer to a monopoly these healthcare giants become. They want to preserve high priced health care and many of the changes insurers are responsible for including the 10 minute doctors visit, ultra high hospital costs and high drug costs are huge cost drivers in the system. They have trained us to live in a high cost healthcare world they maintain and help drug companies maintain their high margins of profit here ins the USA, when compared to other countries who health care costs are much lower by comparison. A great example of this is Luxottica, an Italian company who over the past 20 years has purchased most of the brands of eyewear you love, including Ray Ban and Oakley two name a couple, and they own Sunglass hut, and other chains that sell their brands. The company has made eyewear more expensive now than it has ever been, because there is no competition. 20 years ago, brand name sunglasses cost much less than they do now and they have trained us to pay the high prices, since there is little option to do otherwise.

To reduce healthcare costs, we need a paradigm shift, to interrupt what is currently our accepted medical/drug/intervention model that minimized primary care by starvation (they need more patients to be seen to pay themselves and their overhead), which is why the typical office visit is 10 minutes (3 with the patient, 7 with a computer). One physician used the term quarterbacking to explain how she makes referrals since she cannot afford to spend the time, and simply makes the referral which begins the escalation of costs almost immediately. The disease and symptom based paradigm needs to change markedly, and research needs to actually cure rather than relieve. Most drug companies are not looking for cures, since is not their model of business, but when they do like they did with the Hepatitis C cure, they price it ridiculously and unfortunately, even with negotiations with the companies, we pay the price they ask without any idea of what it costs them to make the serum. Cancer cures are being worked on that can help the body fight the process, and show promise, but there is growing evidence that ultimately, viruses may be what causes many cancers to develop, so why isn’t the research pointed in this direction? Most doctors know little about the myofascial system, yet growing evidence supports the idea that many tests your doctor runs for you may not be necessary if they understood and could better diagnose myofascial dysfunction, which can save the system money. A move toward holistic practice can likely save the system a huge amount of money if doctors were motivated and allowed to spend the proper amount of time with their patients. Would a primary practice rather than a specialist consult regimen in hospitals result in fewer tests and better patient care vs. the current model? These are things to think about. Do senior citizens constantly need to visit the doctors for problems that are more about aging than disease, as we see commonly in older Florida communities and what about their quality of life vs. the quantity of it?

Unfortunately, until this changes, our system is now doing the same, exacerbated by mergers. We need to change the model before it’s too late.