John Goodman on Priceless Healthcare: The Problems With Healthcare

A while ago I finish John Goodman’s great book Priceless:Curing The Health Care Crisis. If you learn one thing about this book it is how to make healthcare more free market oriented. People forget the free market does not exist in healthcare like it does in technology, the grocery store, and other markets. People also forget that doctors and hospitals work for insurance companies. Goodman made some excellent points in the book. I wanted to share not only what I learned but my comments as well. 

Part of the problem with health insurance is that very few people are paying for their own healthcare. In fact, 90% of the costs is paid by someone else (government, insurance, company). It is interesting how doctors nor most health professionals can't tell you the price of tests, drugs, or other services. In fact Medicare has 7,500 different billing codes. According to Goodman there are actually Medicare 6 billion prices at any given time. Medicare by the way will go broke as the unfunded liability is around  There is actually something called the International Classification of Diseases which is now on its 10th edition (starting in 2014) and will feature over 68,000 codes. Some of the codes are bizarre including people who get sucked into a jet engine and contact with dolphins. The codes seem to dumb down critical thinking and decision making. The way I understand these codes is doctors have to explain to the insurance company why a patient saw them. The "code" is suppose to explain what the purpose of the visit was and then is used to determine how much doctors get reimbursed. There is plenty of fraud and abuse in these codes. There will be bill padding, up charging, kickbacks, along with other shenanigans.

How confused would people be if we had food insurance and went to McDonald's and had no idea what a burger actually cost? We should make healthcare single payer in terms of having the individual pay of course. I will talk later about how we can actually do this using a free market system.

Health insurance is a very bizarre market. Employers offer what is known as group health insurance. Due to HIPPA rules in group insurance everyone has to be offered insurance (regardless of their health condition, age, or sex). Health insurance is tied to unemployment which is strange. Part of the reason why so many people are uninsured is their health insurance isn't portable. Could you imagine how many uninsured drivers we would have if your car insurance was tied to employment? Actually if you think about it you actually need car insurance to utilize your health insurance. Despite what some people say the insurance market is highly regulated by each individual state and if an insurance company wants to raise rates they first must get approval from the state to do so. The average profit margin of the insurance companies like Aenta, WellPoint, and Humana is only 3.5%. Compare this to the rich profit margins of broadcasting which has a profit margin of roughly 69% or software companies with an average profit margin of 18%.  They are also told how much they can spend on "administrative costs" which is known as a medical loss ratio which requires 85% of their premium income on medical care and less than 20% on administrative costs. However, no one can seem to define what administrative costs precisely are. Could you imagine if bureaucrats were able to tell Wendy's how much they could spend on food?

Speaking of insurance President Barack Obama promised people that if they liked there plan they could keep it. However, employers may just drop employees as employers can always just just pay the $2,000 fine/employee if the employee amount is greater than 50 employees. The Congressional Budget Office predicts that 9 million will actually lose their healthcare insurance. In terms of cost Avik Roy at Forbes does an excellent job of summarizing the costs of both California (64% to over 160% increase) and the Ohio Department of Insurance which recently said they were going to be increasing premiums 88%. People fail to realize that since insurers will be forced to insure people with above-average risks they will recoup that money by charging healthy people higher premiums.

The average wait time for the emergency room (ER) has been increasing in recent years. In 2009 (the last year for which data is available) the mean wait time was 58 minutes (which is a 25% increase from 2003). Some patients wait and die in the ER. In 2008, this happened to Michael Herrara of Dallas, Texas who waited 19 hours at Parkland Hospital Retail and died waiting for care. Compare this to retail clinics (for-profit) which are often open around the clock, post prices online, and often have little to no wait time. This may explain why retail clinics have had a four fold increase with an estimated 6 million people using a retail clinic in 2009. What is even more surprising is that 91% of patients are satisfied with retail clinics. The only free market hospital in the country is the Oklahoma City Surgery Center which posts prices and one of the only free market doctors (Dr. Michael Ciampi) posts prices online, Even the Cancer Treatment for America posts success rates online.

When looking to other countries it seems the United States actually does have a decent quality healthcare system despite what critics like Michael Moore say. The problem with world rankings is that they take into account things that have nothing to do with healthcare. For instance the fact that Americans kill each other more, have more fatal car crashes, and other events distract from the quality of medical care. Another example is when the United States calculates things like infant mortality we count all births instead of other countries which use more liberal measures and only count the infant dead depending on various factors which would artificially make their infant mortality statistics look better.

Canada which touts its "free" healthcare isn't so free. Canada also outlaws private insurance. Of course Canadians are paying for healthcare in the form of longer wait times. The wait times in Canada are horrendous. 10% of patients wait more than 8 hours in the emergency room. 25% of Canadians wait more than 4 months to see a specialist. No wonder why close to 30% of Canadians find the length of wait time for a specialist unacceptable. Canada is also behind on medical technology as well. According to Goodman, the United States has 1,000 PET (positron emission tomography) units while Canada has only 24 units. This technology is used to diagnose cancer. What is astounding is that even the people uninsured in the United States get more access to medical treatment than other countries. In the United States even the uninsured get more preventive care in Canada (prostate exam, mammogram, etc). Also doctors in the United States typically spend more time with patients than nearly any other country.

British National Health Service found after 30 years access to healthcare was better than when the program started. Speaking of Britain in a survey that came out a few months ago 40% of people who work for the National Health Service wouldn't even recommend it to their family or friends!

The United States is also facing an increasing in shortage the number of drugs available. Data from the University of Utah shows there was a shortage of 74 drugs in 2005 and by 2010 increased to was 211 drugs. Some of these drugs are used to treat serious and life-threatening conditions. There are a few reasons why these drugs are in such short supply.  A program known as the 340B program requires drug companies to give 23% rebates on brand named drugs and a 13% rebate for generic drugs to providers that treat a large number of people without means, clinics treating Medicaid patients, and hospitals and clinics in the Public Health Service, etc. Another reason why there is a shortage is because the FDA after 2010 began heavily regulating drug manufacturing plants. As can be seen on page 11 of this House Oversight Committee report the number of FDA warning letters to manufacturers increased 155% from 2010-2011 and 250% from 2009-2011.

Speaking of costs what I learned in reading Goodman's book was that even "preventive care does not actually lower costs. This study done in Health Affairs showed that preventive care actually increases costs. The study showed 20% of preventive options actually lowered costs while 80% of preventive options actually increased costs. Something else I learned was the price of lab tests are 50-80% lower in hospitals compared and also available within one day. Wal-Mart has multiple drugs that can be purchased for only $4 for a one month supply (Wal-Mart has saved people $3 billion on prescription drugs as of March 2013)

What will even make things worse is a bureaucratic led Preventive Services Task Force which will decide who should or shouldn't get a mammogram, prostate exam, or colonoscopy. I am not a doctor but I do know everyone is different in terms of how they respond to drugs, treatments, and the side effects they receive. A cookie cutter top down approach is a pretty ignorant way to run healthcare.

As someone who is interested in technology even I thought electronic medical records (EMRs) would have done a world of good. These records started around in 2004. Recently one of my doctors learned the EMR system for one hospital but now is no longer seeing patients at a different hospital because he doesn't want to learn their EMR system. He told me he spent 12 hours just learning the EMR system for one hospital. President Obama years ago wanted to "invest" take $50 billion of taxpayer money over 5 years to look into EMRs and the results haven't been too great. This Washington Post editorial finds that after the Children's Hospital of Philadelphia added electronic prescriptions resulted in a threefold increase. The EMRs also add about half an hour more because part of the program is the person using them having to keep okaying hundreds of messages the EMR system might have. Even the New York Times published this article that showed that EMRs did not help doctors help increase productivity or quality benefits. 

Medicare and Medicaid are two more future train wrecks waiting to happen. The Medicare unfunded liability $89 trillion. Not to mention Medicare fraud is about $60 billion a year. Between both Medicare (for people over 65) and Medicaid (people with few resources) the waste is about $100 billion per year. Medicare is expected to go broke between 2016-2024. A survey from the American Medical Association (AMA) shows that about 20% of doctors are already reducing the number of Medicare patients they see. According to Goodman about a 1/3 of doctors don't take Medicaid patients. What is tragic is that children on Medicaid wait 22 days longer than children on private insurance. According to Goodman an experiment in Florida showed that when Medicaid enrollees could choose between private managed care plans the cost was lower and patient satisfaction was much higher than traditional Medicaid.People like to say how efficient and cost saving Medicare is. However, the facts tell a different story. Robert Brook at the Heritage Institute shows that actually private insurance spends less on administrative costs than Medicare (which is quite amazing given how much private insurance companies can spend is heavily regulated). 

Dr. Devi Shetty: Higher Quality Heart Surgery, Low Prices, and Making a Profit

I was thrilled to see this article showing for only $800 you could get heart surgery in India. However, the article is a little misleading since the average price people pay is $2,000. The average cost for doing a heart bypass operation varies around the world. In the United States the cost is $144,000, while in Mexico the cost is $27,000, and just $14,000 for the same procedure in Colombia.  You might be surprised to know that an actual individual entrepreneur doctor is able to do this. His name is Dr. Devi Shetty. Dr. Shetty runs a hospital named Narayana Hrudayalaya in India. The hospital has 5,000 beds and Shetty wants to expand this to 30,000 beds.  What is interesting is that the hospital performs more surgeries than first rate hospitals in the United States and still maintains high quality. For instance Narayana performs twice as many surgeries as the Cleveland Clinic. The mortality rate is very low at 1.4% which is less than the United States rate of 1.9% (and even less since the hospital doesn’t adjust for risk factors like the United States does). The heart facility in Bangalore does 30 cardiac surgeries a day (more than any place else). The same place also handles 1,000 walk in patient per day.

What is really interesting is that the hospital is for profit. The company has a profit margin of 7.7% profit after tax which is higher than the average profit margin in the United States of 6.6%. It always amazes me that people claim hospitals are greedy. If hospitals are so greedy why are they only making profit on less than 7 cents out of every $1? Dr. Shetty finds ways of reducing his costs like using cheaper sutures which saved him $50,000. He points out that you have to find many different things to cut.  He pays nurses to watch over patients in 8 hour shifts but doesn’t allow them to sit down. He claims that nursing efficiency decreases 30% if a nurse is provided a chair. He even hires people with a college degree to read radiology charts. What is fascinating is that Shetty has real time performance measures. Every day doctors can see the profit and loss statement from the prior day which would be unheard of in an American hospital. Not only can Shetty see the profit and loss statement he can also see how many surgeries were done the prior day in addition to how many surgeries were done for the month. If earnings fall below a certain amount they tell the people with free surgeries to come back until they get more paying customers.

It is too bad that Dr. Shetty couldn’t set up shop in the United States. For one his hospitals don’t have air conditioning in most parts of the hospital which would not even be allowed in the United States. Shetty plans on building a hospital in the Cayman Islands.  The United States would greatly benefit from hundreds of hospitals like the one Dr. Shetty has created. The cost of heart bypass in the Cayman Islands will only be $10,000 in the Cayman Islands.

The United States should recruit Dr. Shetty on how to reduce healthcare costs. I actually think many people would be open to business model of charging people with money for surgery and using that money to provide for those that can’t don’t have the means to pay for surgery. While at the same time on the whole the hospital would be making money which would allow them to grow and provide care to even more people in the future. I have feeling some people would still object to this.

The Case For More Nurses and Physician Assistants

With much people still talking about healthcare reform I thought there was one area thing people were not talking about: nurse practitioners (NPs) and physician assistants (PAs). I see both of these professions doing mountains of paperwork and it seems as if they are not being put to their highest valued use: helping and serving patients. States like Texas nurses practitioners are required to have a doctor sign off on 10% of the charts. However, 34 states don’t have this requirement. Not only does this waste time for the nurse practitioner but also takes time away from the doctor who is trying to help patients. There is an expected shortage of doctors (expected to grow to 130,000 by 2025) however there are some issues with this.  Why not add 155,000 nurse practitioners and over 83,000 physician assistants? So let’s assume that only 90% of nurse practitioners and physicians assistants are working with patients. If they on average see 8 patients a day that means 1.7 million more people per day could see a medical professional! Every week that would be close to 11.99 million who would have access to someone who could help them.

Much of the criticism comes from people who say things like “Nurse practitioners and physicians are not as qualified as doctors”. Sometimes things that seem true are not true once you look at the evidence. What is fascinating is this article in The Journal of the American Medical Association from January 2000 entitled “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians a Randomized Trial” the study concluded that even when patients were randomly assigned to either a nurse practitioner or doctor the outcomes were comparable. What is even more fascinating is that the patients with hypertension did better under the care of the nurse practitioners than doctors.

Perhaps the real icing on the cake is that the American Medical Association would publish this considering it has a vested interest no one other than doctors see patients. A 2000 RAND study found no evidence that nurses provided lower quality care than their counterparts and actually could reduce office visits by 35%. This case study showed that in the late 1990's when nurse practitioners were introduced to Loyola University for their cardiovascular program the mortality rate decrease from 3% to .9% in only 4 years, complication rates decreased, and the costs also decreased. This study in a 2 year follow up found that there was no difference between the care physicians provided and that of nurses. This study showed that nurses and PAs provided similar care as HIV experts and even better care than non-HIV experts.

Women’s right activists should embrace more this since nurses make up 92% of all nurses. By giving the women in this field more responsibilities it will increase their pay which I see as positive. The elitist view view that only doctors can help people is such utter nonsense.  Medical information is more dispersed now than ever before. States and the AMA should allow nurse practitioners and physician assistants to provide care. As I mentioned the level of care is similar to that of a physician, healthcare costs would be reduced, statistically speaking women would be given more responsibilities and in turn make more money. I see all of these things as positive. The only people who wouldn’t like this are people who would have to compete with these “new” medical professionals. 

Surgery Center of Oklahoma: First and Only Free Market Hospital in America

I saw this recent video about the Surgery Center of Oklahoma which may be in fact the only free market hospital in America if not the world. I blogged about the hospital in this post.  What is interesting is that the hospital actually posts prices for surgeries. What I found interesting was the hospital also published infection rates which I don’t see regular hospitals do. In the investment industry fund managers post data like risk, return, and other important data. Why don’t hospitals, physicians and surgeons do the same? As long as the insurance company is picking up the bill do patients really have that much incentive to care? By the way the Surgery Center of Oklahoma has a lower infection rate of a mere .001% which is much lower than the national average of 2.6%. Hospitals hire administers which can be in the six figure range and really just handle paperwork. I am amazed when I go to a doctor why they ask me the same questions (even after I have been to the same doctor for years). Never mind the fact that there is a staff just talking to insurance companies and filling out paperwork. Is this really making us better off? I would say no. Healthcare is not run like a business. What we need is more hospitals like Surgery Center of Oklahoma which don’t take insurance and inform patients of what the prices are. If you had more hospitals like this they would have to compete not only on price but also quality as well. This would be great for patients and lead to some advancements as doctors would try new things to improve care and reduce the risk for the patient. I notice we don’t need an Affordable Food Care Act, Affordable Computer Care Act, or Affordable Video Game Act. Food, computers, and video games operate in a free market where competition increases quality and lowers prices. Healthcare is not a free market by any means. Can you think of any think the government provides that is of higher quality and cheaper than the private sector? Economist Dr. Walter E. Williams summed it up with his own Williams’ law which states: whenever the profit incentive is missing, the probability that people’s wants can be safely ignored is the greatest.

H/T- Carpe Diem

Retail Clinics Grow

Interesting chart showing how more and more people are using retail clinics. No doubt we need more of these doctors with a future shortage of doctors and with more people to take care of. Don't people realize retail clinics are actually a free-market solution?

H/T-John Goodman

Lowest Blood Supply in 15 Years and How General Blood Can Help

I saw this recent headline that the blood supply was at its lowest level in 15 years. This is quite interesting because our population has only grown dramatically since 1996. The article blames the low supply on the weather and the fact that Fourth of July fell in the middle of the week which of course is utter nonsense. Donations of blood have been increasing at 3% per year while demand has been increasing closer to 6%-8% per year.

What the article failed to mentioned was how the American Red Cross has a monopoly on the supply of blood. I go back to one of the basic principles of economics: when there is a shortage look to incentives to determine the cause. A few weeks ago while waiting in a doctor’s office I read this article about how a company called General Blood is trying to change that. General Blood buys blood cheap from blood centers and then distributes them overnight to hospitals all over the United States. Blood is also worth different prices in different markets. For example a pint might be worth $210 in Wisconsin while $265 in New Jersey.  

The market for blood is a $4.5 billion business and currently the Red Cross controls 44% of this. As a result every year 1.3 billion pints of blood go to waste (between 5%-14%). Apparently 1 pint of blood can save three lives. So in theory the amount of wasted blood adds up to 3.9 billion people. Surgeries One thing the blood market doesn’t have is an exchange which would make it much more efficient to match types of blood, what areas need blood first, and the best way to get blood to where it needs to go in the shortest amount of time possible.  The federal regulations with blood are burdensome ridiculous and should be scaled back since real people are suffering and even in some cases dying because they are unable to get blood in a timely fashion.

One hope this is on the horizon is artificial blood. This article claims that artificial blood could be here within the next decade or so but I won’t hold my breath. The blood would just be a temporary place holder for people in emergency situations which would be positive.

The position the government takes on regulation the sale of organs, blood, and everything else under the sun causes more harm than good. As I mentioned in this post about bone marrow, this post about kidneys, and this post about organ donation the government only gets in the way of people making voluntary choices about their own body. As economist Dr. Walter E. Williams would say the true test of whether you own something is whether or not you can sell it. According to the government we do not own our own body since we are able to be compensated for our own body parts or organs and create a market for them. 

Obamacare and Taxes

The Case for For-Profit Hospitals: Why We Need More

With the Supreme Court expected to make a decision about Obamacare this summer it will be interesting to see how healthcare unfolds in this country.  One of the major problems is that the government has intervened so much with the practice of medicine that real free market solutions are not possible. For instance, we all see McDonalds, Starbucks, and Wal-Marts on every corner but it takes a little while to see a hospital.

The number of U.S. registered hospitals is 5,754. The number of nongovernment not for profit community hospitals is around 50% of the total. Less than 18% are for profit community hospitals. Why don’t we have more of a percentage of for profit hospitals? Why don’t we have hospitals on every corner like other for profit institutions like Wal-Mart and McDonalds. The average hospital doesn’t make any money. One of the most profitable hospitals according to Forbes is Flowers Hospital in Dothan, Alabama which brings in around $389 million in revenue with a 53% operating margin. One of the problems is that there are only a few for profit healthcare hospitals. For example, the three major companies in the industry are Health Corporation for America, Tenet, and HealthSouth. I think it is desirable to have more of the companies opening up hospitals to increase access. Also trying to move away from the third-party payer system and moving to a single-payer system (people paying out of their own pockets is always desirable). 

                As I have mentioned one of the problems with health care is that health insurance covers too many things. It would be if we bought insurance for groceries and only had a $30 co-pay every time we went to the store. As consumers we have no incentive to care about what the prices are and are encouraged to consume more.  Insurance should be for catastrophic circumstances (cancer, chronic illness, or something live threatening). The idea of insurance is to protect against unforeseen events that will cost a lot of money. Another large problem is too little competition from insurance companies. The insurance companies are regulated by states which is ridiculous. Could you imagine if the food industry was regulated by each state how many more limited choices we would get? The idea is to get away from insurance companies, Medicare, and Medicaid paying and allowing individuals to pay for their own healthcare. At the same time it would be wise to break the American Medical Association cartel of deciding who can practice medicine and allowing anyone to practice medicine including nurses. Also limiting drugs to only Phase I testing just to check the safety of a drug would dramatically bring down drug prices since in essence consumers pay indirectly for all drug companies failures when the FDA fails to allow a drug on the market. This in addition to this, I would also let anyone open a hospital without regulation. Heck there is even a trend in at home hospitalization as mentioned here. All of these things would reduce the overall costs of healthcare while at the same time increasing quality. Remember the Peter Rule: If over time prices increase while quality decreases look to government intervention as the culprit. 

FDA: Stifling New Cures

In this report by Avik Roy of the Manhattan Institute finds that the cost of Phase II trials is increasing the costs of drugs. Roy finds that 90% costs related to the development of a drug occur in Phase III. Roy response is to allow drugs that have passed Phase I and Phase II trials to be marketed to patients. This is something similar to what I have purposed, however I would be okay with letting drugs on the market once they have been approved from a safety standpoint. Since everyone has different body chemistry, cells, and since no two people are alike it is unwise for the FDA to make a blanket statement when they disallow certain drugs that could clearly benefit certain individuals.

The costs of drugs according to the Tufts Center for the Study of Drug Development have increased from $100 million in 1975 to $1.3 billion (in 2000 dollars). The cost even after adjusting for inflation has dramatically increased. One reason the costs have increased is because the trials have required more patients, more resources, longer trial periods, and more medical tests to be performed. In 1999 the average length of a clinical trial was 460 days. By 2005, the average increased to 780 days (or just over 2 years).

The author’s suggestion of allowing limited marketing before Phase III is a step in the right direction. I would also want to not require prescriptions for drugs. What is really interesting is why people need to waste their time to make an appointment just so a doctor could renew a prescription (think of how wasteful it is for someone to make an appointment with a dermatologist just to get face wash). If a prescription weren’t required people would still go to the doctor for medical advice. Also moving drugs from behind the counter to over the counter would dramatically drop prices since places like CVS, Walgreen's, and Wal-Mart would all have to compete with each other. The most important point however is that people along with their doctors could experiment with different drugs to see if they helped. This would allow for more information to be spread to the masses which in the long run would benefit everyone. Some people might get hurt in the short term but in this world we do face tradeoffs.

It seems puzzling that year after year the FDA increases regulation when we have more data about who we are and how we operate. Medical data has exploded in the past few decades leading doctors and patients to know more about certain conditions. In some cases now patients know more than some doctors especially if they have a certain illness. Doctors sometimes will look up symptoms during a patient’s visit to pinpoint exactly what they might have. Also with genome sequencing doctor's can look at a patient’s DNA and have a better understanding of what illnesses or diseases they may get face in the future. With all this information you would think the FDA would be regulating less. Knowledge is power and there is no question the FDA is doing more harm than good. 

Health Care: Problems, Solutions, and Cures

Recently, I have been thinking a lot about markets and how healthcare really isn’t a free market. When I think about free markets I think about people buying goods and services. In any free market people decide what products and services they want. Healthcare does not work like this. According to the U.S. Department of Health and Human Services in 1960 close to 50% of total health expenditures were out of pocket. In modern times this percentage has dropped to 10%. However, other people picking up the tab (insurance companies, government, third parties) has skyrocketed from 55% in 1960 to close to 90% in recent years. Clearly, this is not a free market when someone else is paying. One problem is that insurance covers too many things. I can understand a market for catastrophic insurance (getting cancer, a serious illness or disease), but for everything else we should let free markets reign.

One argument you hear a lot is “Insurance companies are just greedy”. Insurance companies profit margin are just a little above 3%. Software companies, oil companies, and even telecom companies have higher profit margins. Health insurance companies are highly regulated.

Another problem I see is one of barriers to entry in medical care. The American Medical Association (AMA) restricts who can and can’t become a doctor. The AMA is in charge of granting medical schools. What is very interesting is that today there are around 129 medical schools which is less than the 166 medical schools we had a century ago. This is all despite the fact that the number of medical school applications has increased exponentially in the last 100 years! I am perfectly okay with allowing nurses to do some of the duties of doctors. A lot of ailments that people have (sinus infection, aches, and sore throat) nurses could easily handle. In 2008, there were around 2.6 million nurses. Nurses would be paid more since they would be engaging in more valuable activities. The other major problem is the FDA (Federal Drug Administration). The cost of developing one drug in 2008 was $993 million. If you are one of the major drug companies you are going to be very sure you have a product that can make it to market. The FDA requires that companies go through a clinical trials and a four step process. The drug has to first be evaluated for safety, then the drug has to be evaluated to see if it effective, then people have to actually take the drug and double blind tests with placebos have to be in place. This process takes many years. Meanwhile people with the ailments that the drugs are trying to cure or help are suffering. The number of patients required to conduct a clinical trial have also increased. In the late 1970s only 1,600 people were required for a trial. By the mid 1990s this number increased to 4,200. The number of drugs getting approved every year by the FDA is not in the hundreds its only a couple dozen. In 2009, the FDA only approved 25 new drugs. Yet in that same year more black box warnings were issued than the amount of drugs approved. The black box label warnings are warnings for people who may misuse the drug even though there are directions and a list of possible side effects already on the prescription. Could you imagine if iTunes was in charge of approving new songs and only approved 25 songs in one year? Consumers would be outraged. People could argue “Well songs are one thing but health is another issue”. I think I care more about my life then even my own doctor. There are times when consumers are more informed than even their own doctors because people do actually seem to care about living. When people are dealing with decisions that have huge consequences they will seek information. The icing on the cake is prescription drugs which I mentioned in a previous post. There are close to 4 billion prescriptions written a year. What doesn’t make any sense is requiring a prescription for harmless things like benzyl peroxide (face wash) which I don't believe anyone has ever died from. Drugs like this should just be moved to over the counter which would free up time for the doctors writing the prescription and the consumers who have to waste their time going to the doctor. Also consumers would save money because if you got CVS and Walgreens competing for prices they would drive down prices instead of insurance companies trying to figure out how much they would cover. Moving hundreds of prescriptions from back of the pharmacy to over the counter would improve healthcare.

People are often mad because of the prices they pay for healthcare, but often see what are causing the high prices. Getting rid of the AMA would allow more people to become doctors which would bring down the cost of medical care. Also bringing more drugs over the counter would decrease the cost of prescription drugs since they would be sold in free market places like CVS and Walgreens which would have to sell the drugs for what consumers would pay.