Shifting from Sickness to Wellness Medical Care
As explained in Chapter 7, you or your wellness customer may have discovered you can save thousands of dollars each year by purchasing your own individual/family health policy, or you may be ready to switch to high-deductible health insurance, or you may have opened a Health Savings Account (HSA)—or hopefully all of these. Once you do, your healthcare paradigm shifts:
You now want to cut down on your healthcare spending since each dollar you save you get to keep—and over the years these dollars could add up to hundreds of thousands of dollars in your HSA.
You must learn to balance your new financial incentive to save on healthcare costs against the legitimate healthcare needs of your family. You have a new incentive to eat better, exercise more, and invest in wellness care to improve your health—since staying healthy is the best way to save on your healthcare costs.
In this Appendix we examine three things you should do to save on your healthcare costs:
1. Stop taking maintenance drugs.
2. Change your lifestyle (diet and exercise) before it’s too late.
3. Ask your doctors to spend your money as if it were their money.
Stop Taking Maintenance Drugs That Treat Symptoms, Not Causes
There is one very important idea missing from the section of Chapter 7, “Help Your Customers Save 10 to 75 Percent on Their Prescription Drugs.” The idea is that you can save 100 percent on your maintenance drugs (heartburn medicine like Prilosec, antidepressants like Zoloft, heart disease drugs like Lipitor, etc.). These drugs treat your symptoms, not the causes of your illness, which in many cases can be traced to diet, lifestyle, and lack of exercise.
The way to save 100 percent on these drugs is to stop taking them altogether—by finding a doctor or other medical professional who understands the dangers of prescription drugs and will work with you to change your diet or lifestyle.
The prescription drug business was founded by people like Dr. Jonas Salk, who developed the first vaccine for polio, and Dr. Alexander Fleming, who discovered penicillin. The products these dedicated doctors developed prevented diseases from developing in the first place or cured diseases over a relatively short period of time.
Sadly, as healthcare moved away from the work of medical professionals and became the most profitable sector of our economy, the prescription drug industry shifted from making products that prevented or cured diseases to making products that merely treated the symptoms of diseases.
Today about 95 percent of the prescription drugs sold are maintenance drugs—drugs that treat only the symptoms of a disease, and that you are expected to take for the rest of your life.
From an economic/business perspective, at least, it’s easy to understand why this is so, and you need to understand this if you are taking any prescription drugs on a regular basis. I’ll put the answer in the form of a question: If you were the CEO of a major pharmaceutical firm, would you spend your R&D dollars to make a pill that a consumer would only take once (e.g., a vaccine) or for only a short period of time (e.g., an antibiotic), or would you spend your R&D dollars on creating products that consumers would take every day, or two or three times a day, for the rest of their lives?
For the past three decades, the majority of private R&D dollars in the pharmaceutical industry have been spent on products that treat merely the symptoms of disease rather than cure or prevent disease—thus creating customers for life.
If you were a businessperson developing a new health product to sell to your customers, wouldn’t you like to have all Americans indirectly pay a tax subsidizing 50 percent of your retail price, even if they had no interest in taking your product? If drugs like Viagra or Levitra were sold over the counter, employers would have to give employees almost $2 in order for those employees to have $1 left after FICA and income taxes to buy the drugs—but because these drugs are prescription only, employers are forced to pay 100 percent of the cost through their group health plans as a tax-free benefit to employees.
Today many of the prescription drugs sold do not have a strong legitimate reason to be prescriptions—they are not addictive or controlled substances like morphine. They are issued in prescription form partly to get all Americans to subsidize 50 percent of their cost through medical tax deductions and partly to force employers to pay for them.
More important than the fact that many prescription drugs were designed to make you a customer for life, and more important than the fact that all Americans end up subsidizing 50 percent of the price of other people’s drugs, is the fact that many prescription drugs are indirectly dangerous, over the long run, to your life and health.
I am an economist and businessman, not a medical doctor; however, in conducting the extensive research for this book, I concluded that few of the tens of millions of people taking maintenance drugs should be taking them. Instead, most people taking maintenance drugs should be working with a medical professional to cure the underlying disease—for example, changing their diet instead of taking Nexium for life (to counteract heartburn), losing weight instead of taking Lipitor for life (to lower cholesterol).
In addition to preventing you from focusing on the causes of your illness rather than on the symptoms, the prescription medicines you take are the number one reason your application for individual/family health insurance could be rejected or your premium increased (uprated).
Let’s go back and examine more closely the world’s five top-selling prescription drugs—Lipitor, Zocor, Nexium, Prevacid, and Zoloft—which account for more than $25 billion in sales in the United States alone. These drugs have the following things in common for most people taking them:
• They do not prevent a disease.
• They treat only the symptoms of a disease.
• They are designed to be taken for the rest of your life.
• They are not narcotic or controlled substances and thus should not be prescription versus over-the-counter medicines.
• They would have less chance of being sold directly to consumers as real products without first coopting trusted physicians as sales agents.
• They are dangerous to your long-term health, because by treating only the symptoms of a deadly disease, they prevent you from modifying your behavior to cure the disease.
Lipitor: Lipitor, the number one selling prescription drug in the world, is prescribed to lower your cholesterol. Every health and medical professional will tell you that the best way to lower your cholesterol is to change your diet and to exercise, which we will examine in a moment. Instead, millions of Americans take this drug for their entire lives—which is dangerous because it prevents them from making the lifestyle changes that they sorely need.
Zocor: Zocor, the number two selling drug in the United States, is functionally the same as Lipitor. It is truly amazing that Americans spend more than $10 billion a year for these two drugs when generics are available for both for about one-third the price (see Chapter 9).
Nexium: Nexium, designed to treat heartburn, is the latest trick perpetrated on consumers by the pharmaceutical companies. The majority of people who have heartburn have it because of what they eat, not because they are genetically disposed to acid reflux disease. A bad diet can cause depression, heart disease, cancer, and heartburn. Yet when their body screams out in pain for help, millions of people take this little purple pill to stop their body’s natural alarm system (i.e., heartburn) from functioning, so they can keep eating unhealthy foods.
Prevacid: Prevacid is functionally the same as Nexium. If Prevacid and Nexium were over-the-counter medicines instead of prescriptions, their advertising would have to inform consumers that the best way to cure heartburn is to stop eating the food that is causing the heartburn. But because they are prescriptions, in addition to getting a 50 percent medical tax subsidy, their national, direct-to-the-public advertising is exempt from normal truth-in-advertising regulations. Prescription drug advertising targeted to consumers should be prohibited since, in the real world, “ask your doctor” often means “change your doctor” if he or she won’t give you whatever prescription drug you request.
Zoloft: Zoloft is the number one selling drug in the world for depression and anxiety—more than 28 million Americans (1 in 10) have taken Zoloft or its functional equivalents Prozac and Paxil. According to its own web site (www.zoloft.com), one of the major side effects of taking Zoloft, Prozac, and Paxil is that 2 to 4 percent of people under 18 taking these drugs have suicidal thoughts.
1 In addition to being expensive, drugs for depression are dangerous because they prevent people from dealing with the causes of their depression (including their diets). In psychiatric cases requiring chemical intervention, there are much cheaper alternatives like St. John’s wort, which outsells Prozac 25 to 1 in Germany. According to a recent study at Harvard Medical School, antidepressant drugs should not be used in 75 percent of the cases where they are prescribed.
If you take any prescription drugs on a regular basis, find a medical professional and develop a plan to get off your prescriptions: Do not attempt to do this without the advice of a medical professional.
To find a medical professional to help you, start by telling your current doctor: “I currently take [prescription drug] on a regular basis and am looking for a medical professional to work with me to stop.” If your doctor can’t help you, he or she may be able to recommend a wellness-oriented MD who can, or refer you to a wellness health professional such as an osteopath (DO), naturopath (ND), or chiropractor (DC).
The best way to develop a plan to stop taking prescription drugs is to find an MD-type medical professional who works together with a wellness health professional. For example, in Dover, Ohio, a cardiologist noticed that two of her patients with high cholesterol had good results after attending a Creating Wellness center run by chiropractor Dr. Shawn Kapper. The cardiologist was so impressed that she sent 40 of her patients with heart disease to Dr. Kapper, and the two doctors (chiropractor and cardiologist) developed a nondrug program to lower cholesterol for the betterment of their mutual patients.
Change Your Lifestyle (Diet and Exercise) to Dramatically Cut Your Lifetime Healthcare Expenses—Before It’s Too Late
There’s a lot you can do to improve your health and cut your healthcare costs, but first let’s look at why we spend so much on healthcare.
Why Americans Spend So Much on Healthcare
The United States spends far more per person on healthcare than any other country—about twice as much as other developed nations. Yet people in the United States don’t appear to be getting their money’s worth. The United States lags far behind other developed countries on almost every important medical statistic—life expectancy, infant mortality, cancer, diabetes, heart disease, and so forth.
So, what is the problem with American healthcare?
Is it our inefficient medical bureaucracy, where 2 to 3 million Americans are employed by medical providers and insurance carriers—not to deliver healthcare, but merely to pass the buck for that care to someone else?
Is it the cost of medical malpractice insurance, which adds more than $27 billion a year to the cost of providing healthcare—enough to annually pay a high-deductible insurance premium for more than half of the 45 million Americans without health insurance?
Is it our employer-based system, whereby the ultimate providers of healthcare for most people (employers) have little incentive to spend even $1 today on wellness and preventive care in order to save $100 tomorrow—because the odds are that the employee will be long gone or receiving Medicare by the time serious diseases like cancer and heart disease develop?
The partial answer is yes to all of these questions, but the main reason Americans spend two times what they should on healthcare is not because of something wrong with American healthcare.
The main reason Americans spend two to three times what they should on healthcare is because Americans (along with Australians and Britons) are two to three times more unhealthy than people in most other nations, primarily because of their diet and a lack of exercise.
Today, more than 65 percent of Americans are overweight or medically obese—a figure that has doubled since the 1980s. Being overweight is just one of the symptoms of having a terrible diet—most Americans are also deficient in the basic vitamins and minerals necessary to keep their minds sharp and avoid major diseases like cancer. If you are overweight or obese, please get immediate help in changing your lifestyle. Already, 59 million Americans have diabetes or prediabetes, mostly due to being overweight—if you are one of them, you have a 65 percent chance of dying from heart disease or stroke. Moreover, before you die, if you are obese, you will likely consume much of your estate in medical expenses and will needlessly and selfishly be torturing yourself and those you love the most.
The Effect of Diet and Exercise on Your Prescription Drugs
Refer back to the list of the five most popular prescription drugs. Most people taking these drugs can eliminate or reduce their consumption through diet and/or exercise. The primary cause of high cholesterol (Lipitor, Zocor) is your diet and lack of exercise. The primary cause of heartburn (Nexium, Prevacid) is also the foods you eat—although many people do have a genetic predisposition to acid reflex disease requiring long-term medication. And, when it comes to depression (Zoloft), I am convinced that diet and/or lack of exercise is a cause of depression and that a lifestyle change can yield amazing results, particularly for young people.
If you have a child experiencing either depression or hyperactive behavior, try changing his or her diet—specifically, eliminate fast foods and processed foods containing preservatives and salt, cut down on dairy products, and add large quantities of fruits and vegetables. As a parent of four and as a teacher of college freshmen for 21 years, I have seen amazing improvements in behavior from changes in lifestyle, diet, and exercise.
Speak to Your Doctor about Spending Your Money as if It Were His or Her Own Money
I’ve found that in many cases, doctors already know how to spend your money as if it were their money. They are just too busy to take the time to do so, or they may be prohibited from doing so by the owners of their medical practice or by their malpractice insurance carriers. Here’s how to get them to do it.
Ever since our family switched our health insurance in 1999, when a doctor writes out a prescription, I say: “We have high-deductible insurance.” Twice, I’ve seen the doctor rip up the prescription and write a new one stating, “This drug is cheaper and is really the same thing anyway.”
Don’t wait for your doctor to prescribe something and then ask for a cheaper equivalent—tell your doctor up front that you have a Health Savings Account and high-deductible health insurance. You’ll be surprised how many doctors already know about HSAs and how to save money on healthcare.
One reason doctors don’t prescribe cheaper equivalent drugs is that doctors and their medical practices have enormous financial incentives to prescribe certain brands of drugs. The pharmaceutical companies have armies of lawyers figuring out the latest “barely legal” way to compensate medical doctors who prescribe their brand-name products.
Many times doctors don’t prescribe cheaper equivalent generics or therapeutic substitutes out of ignorance. There are equivalent generics or therapeutic substitutes for almost all popular drugs if you take the time to search for them. When you politely tell doctors about these generics, most doctors are pleased to learn about less expensive equivalent therapies. They don’t teach economics in medical school, and you should not expect doctors to know the price of the things they prescribe. Unlike you, they rarely see the inside of a pharmacy. Doctors get many of their own prescriptions for free, as samples from pharmaceutical representatives.
Unnecessary medical tests are another area where doctors can waste hundreds or thousands of your dollars. There are obviously some medical tests you should never skip—like having an annual mammogram or taking a biopsy of an unusual growth. But many tests are simply a waste of money. When doctors tell you they want to send you, or a sample of your fluids, for a medical test, here are some questions you should ask them:
• Why do you want this test?
• What are the likely results from the test, and what is the recommended action for each outcome?
• If the therapy is the same regardless of the result, could we skip the test and just begin the therapy?
• Are there any different tests that we should consider?
• How much does the test cost, and is there any way to get it done less expensively?
• If you were spending your own money, would you take this test?
You may be surprised by the responses you get, particularly to the last question. Many tests and medical procedures are not even sanctioned by the doctors who prescribe them—they are forced to do so for liability reasons by their medical malpractice insurance carriers. Ask again, “Would you take this test with your own money?” If the candid answer is no, ask whether you can sign a waiver instead, stating that your doctor advised you to take the test but that you refused against medical advice (AMA).
Check your wallet when a doctor starts talking about surgery—then get a second or third opinion. Make sure you receive advice from at least one doctor who is not a candidate to perform the surgery. Doctors often have an enormous financial conflict of interest when it comes to recommending a surgery they might perform themselves. Be particularly careful when your doctor has already leased or purchased expensive equipment (e.g., LASIK tools) that they need to keep busy. Do not hesitate to ask, “What do you get personally if I choose to do, or not to do, the surgery?” Doctors are not subject to the same conflict-of-interest standards that have become commonplace for lawyers, public officials, and other professionals.
*Adapted from The New Health Insurance Solution (Wiley, 2007)
1. “This analysis showed an increased risk of suicidal thoughts and behavior from 2% to 4% in people under 18,” About Zoloft: Common Questions, 2005, Pfizer Inc., 9 May, 2005, www.zoloft.com/zoloft/zoloft.portal?_nfpb=true&_pageLabel=common_questions.
2. Glenmullen, Joseph, “Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives,” Dr. Joseph Mercola Online, 2005, 9 May 2005, www.mercola.com/2000/apr/9/ prozac_backlash.htm.
3. Krugman, Paul, “Passing the Buck,” New York Times Online, 22 April 2005, 9 May 2005, www.nytimes.com. 4. Americans spend more than $27 billion a year on medical malpractice, according to the Congressional Budget Office. The average individual health insurance premium for a healthy individual is $92 per month, or $1,104 per year ($27 billion per year divided by $1,104 per year equals 24.5 million), U.S. Congressional Budget Office, Limiting Tort Liability for Medical Malpractice, 8 January, 2004, 9 May, 2005, www.cbo.gov/showdoc.cfm?index=4968&sequence=0.