The word "exploitation" brings to mind Karl Marx. But when Karlsie punched out his 1867 pot boiler, "Capital Volume 1," he was lifting usage from the American anti-slavery movement.
"Exploitation" is used here in the sense of slavery..
Chronic care patients face extreme coercion. Fear for their lives. They are herded around. Their property is seized: bank accounts are emptied and hundreds of thousands of their houses are taken.
Compare to first-rate treatment at Mayo Clinic and VHA:
-- Over the course of the year our profit-motive medical system generates 500,000,000 medically useless referrals.
-- These extra referrals extract an extra $1-trillion from patients and government agencies.
Compare to Mayo Clinic and VHA:
-- These bogus referrals inflate chronic care costs by 3:1.
-- $500-billion for CC is pumped up to $1.5-trillion.
-- Patient outcomes are worse. Useless prescriptions kill people.
Looking ahead, the Kennedy CHC system is being expanded to 14,000 sites. More of Mayo/VHA. Less of fraud.
Maybe the White House could get behind this ??? Set up winning elections for a generation....
MBTF :::
We're going to beat this concept pretty hard: chronic care is where the money is, not acute care.
Nationally, 75% of all health care costs go to treating chronic care patients.
Move a CC patient over to Kennedy CHCs with a Mayo Clinic and VHA-style management system, you save two-thirds on variable costs related to chronic care and get better outcomes.
The patients get slammed in for-profit meat grinders. The so-called "internal referrals" in the big combined practice offices produce bizarre treatment patterns:
- Single disease patients get bounced among three doctors a year, plus getting seven drugs thrown at them.
- Multiple disease patients get bounced among a dozen doctors -- on average -- and see an astonishing 50 scrips.
Drug interactions and side-effects are out of control. We are the worst in the world. Our private system, that is.
Twelve doctors and 50 presciptions -- that is insane. And its the average.
Mayo does not look like this. VHA doesn't look like this. Not at all.
The overall VHA system is what treats the VHA's CC patients. Not some crazy referrals mish-mash.
In the VHA system, all drug prescriptions for every patient are controlled, cross-checked, managed, and limited through one centralized computer system. Drug cost per coronary disease patient, for example, runs at $1,800 a year and you get to roughly twice that for overall treatment. About a 1/3d the cost of the average for profit-driven care.
We have detailed data on the heart patients. Out there in the exploitation environment, you see the most common chronic disease -- coronary disease:
-- 17-million patients
-- $165-billion cost
-- $10,000 a year per patient
There are people out there who know the medical economics. Nancy Whitelaw at National Council on Aging says that chronic care is the key to "skyrocketing" costs. One recommendation: Stanford's Chronic Disease Self-Management Program. Payback for the $500-per-patient per year cost to adopt this self-defense CDSEMP:
-- $50-billion-a-year for potential savings.
Similarly, don't underestimate VHA. We're looking at a $60-billion-a-year operation.
"239,000 staff at over 1,400 sites, including hospitals, clinics, nursing homes, domiciliaries, and Readjustment Counseling Centers. In addition, VHA is the Nation's largest provider of graduate medical education and a major contributor to medical research." (VHA's web site: va.gov.)
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The political business called the Republican Party would have Americans forget that VHA exists. Same for Mayo Clinic. Same for the Kennedy CHCs.
The $500-million that flows through their propaganda machine every year -- dedicated to lying about quality health care.
Tight, effective chronic care... apparently impossible in their alternate/delusional universe.
But we know better.
The key is to expand high-quality service provision to civilians. The plan for 14,000 Kennedy CHC clinics is perfect. Far more important than the Public Option replacement for insurance companies... which does nothing to control costs.
VHA for civilians -- perfect !
Free the Slaves. This applies to the Tea Party white folks, too. They're scared to death that they're going to get sick and die miserably. They've all seen it happen to their friends and family.
Every one of them.