Sunday, January 18, 2009


As we tighten our belts at home and abroad, we are all accountable for the burden of national debt we pass along to future generations. Local and international relief efforts for the poor are also feeling the pinch, which makes the search for ways to heal our broken economy a humanitarian effort.

Although medical profits continue to soar, there have been rumblings lately that the next "industry" to show up in Washington hat-in-hand will be medicine ("Disappearing Credit Forces Hospitals to Delay Improvements," Reed Abelson, New York Times, October 14, 2008). Meanwhile, evidence abounds that an increasing portion of our tax dollars that fund Medicare and Medicaid are the most lucrative revenue stream for the medical industry, and a large portion of those expenditures are going toward unnecessary, even harmful surgeries, not unquestionably-needed emergency care.

Any savings to be realized, without causing more people to become disadvantaged, must be embraced immediately. So-called port barrel federal expenses, and those that can be revealed to cause more damage than good, must be the first to go.

A staggering number of surgeries have been proven in study after study to be medically unwarranted and cause more harm than good. Rob Stein of The Washington Post reports, "One of the most common surgical procedures performed in the United States - arthroscopy to treat arthritis in the knee - is useless, researchers reported yesterday." So let's take a look at the two most over-utilized, most commonly performed surgeries in America - cesarean sections and hysterectomies.

When a doctor and a hospital get involved in the natural process of childbirth, time is money. "Spontaneous deliveries," as they are often referred to (where there is no surgical intervention), are time-consuming for doctors. In rare instances, such as when the placenta happens to block its own exit by attaching to the uterine wall close to or covering the cervix (placenta previa), C-section may be lifesaving for both baby and mother. Also, when the placenta does not detach from the uterine wall (placenta accreta), sometimes a hysterectomy is the only way of saving the mother's life. But placenta previa can often be managed conservatively and occurs in only 1 in 200 pregnancies. Placenta accreta occurs in only 1 in 2,500 pregnancies. Combined, they account for only one half of one percent of C-sections, which means that as many as 99% of C-sections may be medically unwarranted.

A study published in the New England Journal of Medicine reports that nearly 1/3 of all births in the U.S. are surgical, with up to a four-times higher risk of complications ("Caesarean Section Before 39th Week Poses Extra Risk, Study Finds," January 7, 2009.) Judith Reichman of NBC News reports that more than 30% of the 4.3 million U.S. births each year are surgical deliveries. However, Dr. Mayer Eisenstein, an ardent advocate of home birth and the founder of Homefirst Health Services in Chicago, reports that Homefirst's C-section rate is only 4.1%.

Depending on the severity of C-section complications, each surgical delivery taxes Americans anywhere between $2,000 and $200,000, in addition to the cost of an in-hospital birth. As reported by Rita Rubin in the January 7, 2007 USA Today, "The average initial hospital cost of a planned C-section for a first-time mother was 76% higher than that for a planned vaginal birth." A conservative estimate of C-section expenses burdening American families would top $3 billion each year for additional doctor and hospital charges alone.

As for hysterectomy, Ashley Montagu wrote in his book The Natural Superiority of Women about a House of Representatives subcommittee investigating the incidence of unnecessary hysterectomy. "Various sources," he writes, "put the percentage of unnecessary hysterectomies anywhere between 24 and 88 percent." Findings from more than 850,000 counseling sessions at the HERS Foundation in Philadelphia puts the percentage of hysterectomies that could be avoided with conservative treatment (or no treatment at all), at about 98%.

The Centers for Disease Control and Prevention (CDC) report that more than 1/3 of American women have their female organs removed by the age of 60. The CDC also reports that the incidence of cancer in the female organs and the male organs is virtually identical, while the incidence of male organ removal is statistically insignificant.

"'We have four times the hysterectomy rate of any industrialized nation, in this country,'" said [Ernst] Bartsich, a clinical associate professor at Weill Cornell Medical College. At age 60, one out of every three women has had a hysterectomy; and at age 65, one out of two women have had a hysterectomy. And 85 percent are not necessary" (Newsday, May 2004, Roni Rabin).

In a September 5, 2007 article published in Health Insurance Underwriter's magazine, Rick Schweikert reports that more than $17 billion each year is spent on direct doctor and hospital charges for hysterectomy. In 2007, the HERS Foundation released an educational female anatomy video on its website that was vetted by gynecologists and other medical and legal experts. Ninety-eight percent of the women who watch the video and call the HERS Foundation do not proceed with the doctor's recommendations for hysterectomy after learning about the unavoidable and irreversible consequences of removal of the female organs - facts that women are not informed of by doctors. The long-term cost of treatment and subsequent surgeries, and a lifetime of harmful drugs and treatments for the problems caused by hysterectomy and ovary removal, could easily top the $17 billion paid for the initial surgery.

According to their 2008 SEC filings, the largest hospital chain in the U.S., the Hospital Corporation of America (HCA) - founded by the family of former Senator and Majority Leader Bill Frist - reports that in 2008 about 49% of their revenues and 59% of their hospital admissions were Medicare and Medicaid "related." In 2007, HCA reported revenues of $26.9 billion, approximately $16 billion of which (according to HCA) was paid for by American taxpayers.

What most people may not know is that HCA "plead guilty to 14 felonies" and was hit with a $1.7B fine - far-and-away the largest such fine in history - for Medicare fraud, as reported by Kurt Eichenwald in the December 18, 2002 New York Times. These fines, it seems, were a minor bump in the road for HCA, on their way to grabbing hundreds of billions of American taxpayer dollars in the years to come. Doctors and hospitals reap the financial benefit of surgeries, whether they are warranted or not. American taxpayers, both in terms of Medicare/Medicaid payouts and higher insurance premiums, pay the price.

No mother or father whose child has a medical emergency should be required to answer any questions or demonstrate any ability to pay for medical services when they arrive at an emergency room seeking care. But as our government strategizes how to spend hundreds of billions of dollars in its economic stimulus package, we owe it to future generations to unshackle ourselves from doctors and hospitals performing medically unwarranted surgeries.

In a December 2, 2007 article titled "National Debt Grows at a Million Dollars a Minute," (published long before any talk of "bailout" packages), the Associated Press reports that, "retirement and health benefit programs now make up the largest component of federal spending. Defense is next. And moving up fast in third place is interest on the national debt."

Each million dollars saved today could save future generations tens of millions of dollars in interest on the national debt. As President Obama said in his inaugural address, "Our health care is too costly." In these trying times, Americans are not in a position to leave $17B a year of unnecessary medical expenses on the table. Especially when it will keep hundreds of thousands of American women off the operating table, with their female organs intact.

Published February 4, 2009 in The Women's International Perspective.

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