The biggest difference between the platforms is the position that the Democratic platform takes for improving access to health care by continuing to support subsidies for the Affordable Care Act (ACA). This law has reduced the number of uninsured Americans by half, from 16% before its passage to 8% currently. More than 21 million Americans have enrolled in the ACA programs this past year. Additionally, Democrats have traditionally supported Medicaid expansion and they want to expand it in the 10 states that have not done so. They also strongly support the Children’s Health Insurance Program (CHIPS), which provides health insurance to millions of American children.

By contrast, the Republican platform mentions nothing about expanding access to health care. Republicans have generally been against Medicaid expansion and frequently offer plans to cut Medicaid funding. During former President Donald Trump’s term, he was unsuccessful in repealing the ACA, but undermined it by cutting the subsidies that have allowed it to thrive. Sixty percent of Americans are now in favor of the ACA.

There are areas of agreement between the two parties. Both want to control prescription drug costs. Neither party wants to decrease Medicare benefits. Republicans have been in favor of expansion of Medicare Advantage programs that have been shown to be more expensive than traditional Medicare; this could hasten Medicare’s projected insolvency. Democrats plan to increase taxes on those making more than $400,000 per year, partly to keep Medicare solvent.

Another area of general agreement of the two parties is the need to control health care costs, since this is a significant contributor to inflation. The Trump administration enacted by executive order the Hospital Price Transparency Rule requiring hospitals to make their prices public to promote competition and thereby lower costs. The Biden-Harris administration has attempted to stop some health care mergers (which raise costs to consumers by eliminating competition) through the Federal Trade Commission. Unfortunately, these cost-control measures have had limited success, given the political lobbying power of the health care organizations involved.

The Democratic Party platform has some additional plans to improve health care. Democrats would like to double the financial support for federally qualified health centers in rural and underserved areas. Additional funding would be provided to grow the health care workforce, especially primary care physicians, nurses and mental health providers. Vice President Kamala Harris has already been successful in expanding Medicaid benefits in 46 states for new mothers to one year post-delivery. She is a major advocate for women’s health issues.

These are some additional ideas that either party is welcome to adopt to help control health care costs. They should eliminate pharmacy benefit managers, expensive and unneeded middlemen who raise drug costs. Billions could be saved by focusing on rational palliative care at the end of life instead of expensive hospital care (which most people do not want). Most importantly, future policy should fund a more robust primary care system where every American has access to a medical home. Specifically, the Center for Medicare and Medicaid Services (CMS) should fund more residency training positions for primary care physicians and increase payments to these doctors. This focus on primary care is used by all other wealthy nations, which spend an average of 12% of their health care dollars on primary care compared to our 5%. Many studies have shown that more primary care leads to better health outcomes and lower costs.

Dr. Bob Newman is a clinical professor of family medicine at Eastern Virginia Medical School in Norfolk. He is the author of “Patient’s Compass,” which is a guide to navigating the U.S. health care system, available online at yourpatientcompass.wordpress.com.

Six weeks later, he received medical bills totaling $10,000 for this encounter, which his insurance negotiated down to $4,800. He contested the exorbitant charges but the health care system refused to negotiate, stating the fees were legal and consistent for all patients. Adams had a high-deductible health insurance policy with a Health Savings Account (HSA), but had not contributed to his HSA that early in the year, and thus was stuck with the entire bill. He could afford it, but most people cannot.

Inflation is one of the major concerns facing voters during this fall’s election. Health care accounts for nearly 20% of our GDP and these costs are rising rapidly, contributing much to this inflation. We should be asking political candidates for federal and state offices of both parties to propose strategies to rein in these costs.

Why are medical costs climbing so rapidly? According to a recent series published in the Wall Street Journal, health care consolidation and mergers are major factors. Despite the promise of lowering costs and preserving quality, many academic studies have shown that as health care consolidation occurs, prices increase as competition is eliminated. Private equity firms and hospital systems have been aggressively buying doctors’ practices over the last two decades; more than 75% of doctors are now employed by large corporations or health systems. An example of why costs increase when hospitals acquire physician practices is the additional billing of “facility fees,” which can double the charge for a doctor’s office visit and adds nothing to its value.

The Federal Trade Commission (FTC) has attempted to halt some of the mergers and consolidations, but is badly underfunded and understaffed. Over the past two decades, there have been more than 1,000 mergers among the nation’s 5,000 hospitals. More than 200 of these deals should have been halted because of monopoly concerns, but the FTC only acted in 13 cases.

Medical debt is a major contributing cause of 66% of bankruptcies in the United States. Consumers are shouldering more of the costs of their care because 60% of people with employer-provided health insurance have opted for a high-deductible health plan with an HSA. This strategy allows consumers to afford health insurance, either through their employer or the Affordable Care Act exchange. The problem is that they can receive large medical bills until their high deductible is met.

Advocating for price transparency of health care costs would promote competition and help tame the inflation in this sector of the economy. The Hospital Price Transparency Rule, enacted by executive order in 2021, requires hospitals to post their charges in a readable format on their website. Unfortunately, only one-third of hospitals are fully compliant, preferring to pay the small penalties to avoid posting their high prices. Additionally, the posted prices are usually disguised in an Excel spreadsheet of undecipherable billing codes.

We can each do our part to lower health care costs by consistently asking about the cost of care ahead of its delivery, so that an informed decision can be made whether to purchase the care from that facility. Persistence will be required in such requests; the true costs are hidden by design. We should shop for medical care similarly to how we shop for everything else, when we know the price of what we are buying.

Dr. Bob Newman is a clinical professor of family medicine at Eastern Virginia Medical School. He is the author of “Patient’s Compass,” a guide to navigating the U.S. health care system. Email him at fammedrocks13@gmail.com to request a paper copy of the book.

Primary care in the United States is under tremendous stress. Office overhead expenses run 60-70%. Insurers require increased documentation in electronic health records and prior authorization requirements are frustrating and time consuming. There is an aging workforce and it is difficult to recruit new physicians into this challenging line of work. Many primary care doctors have retired or left private practice and joined large hospital-based systems.

Virginia expanded Medicaid coverage in 2018. Medicaid now insures nearly 1 in 4 Virginians, dramatically increasing the number of Virginians who have health insurance. There is a little discussed problem with Virginia’s Medicaid payment system however; the payment amount for services is only 72% of that for Medicare and even less than that compared to private insurance payments. Despite this, 76% of primary care providers continue to see Medicaid patients and 58% are taking new Medicaid beneficiaries.

I learned firsthand the financial problems that result from taking low Medicaid payments as the medical director of two large family medicine residency training practices over 17 years. More than a third of our patients had Medicaid and this percentage increased after Virginia’s 2018 Medicaid expansion. We continued to see more Medicaid patients who needed comprehensive care, but took significant financial losses for doing so. This led to eliminating essential staff positions, making it much more difficult to continue our mission of providing primary preventive care and treating chronic illnesses.

Many Medicaid patients have more severe chronic illnesses than those with private insurance, and thus it takes longer to see them and provide the complex care that they need. This contributes significantly to the stress of primary care doctors, since they are responsible for the many problems these patients have. Other insurance programs have a system for compensating providers with higher reimbursement for treating those with more severe illness and rewarding higher quality care with better payment. Medicaid has no effective system for doing this; payments remain 72% of the average Medicare reimbursement, despite many previous legislative efforts to get these payments to parity with Medicare.

Gov. Glenn Youngkin recently proposed his $84 billion budget for FY 2024 and has proposed tax cuts as noted by The Virginian-Pilot & Daily Press Editorial Board on Dec. 27 (“A tax reform opportunity”). There was a massive budget surplus in the last two years and much debate about how that money should be spent on many worthy causes. A compromise between tax cuts and spending in important areas was finally reached between Democrats and Republicans this past summer. This debate will go forward in the 2024 legislative session, which begins on Wednesday.

It would be a huge boost to our primary care workforce if the legislature were to act to provide Medicaid payments for primary care that are equal to those of Medicare. Estimates put the cost of this at $178 million dollars annually, which is only 0.2% of the total annual Virginia budget. Doing this would provide health care security to our less fortunate citizens by ensuring continued access to primary care services. Millions of future health care dollars would be saved by providing prevention and early treatment of chronic disease instead of treating much more expensive advanced illnesses. What could be a better investment in the future health of Virginians?

Dr. Bob Newman is a clinical professor of family medicine at Eastern Virginia Medical School in Norfolk. He is the author of “Patient’s Compass,” which is a guide to navigating the U.S. health care system, available online at yourpatientcompass.com.

Unfortunately, this is a national problem for the United States and is particularly acute in rural and poor inner-city areas. There is a shortage of adult primary care doctors (family physicians and general internists) as practices close to new patients and have long wait times for appointments. Nearly a third of Americans do not have a source of basic medical care and thus skip needed care or use an expensive urgent care center or emergency department.

Currently, only 12.6% of medical students enter family medicine residencies, according to data from the Society for Teachers of Family Medicine. The 2023 graduating class at Eastern Virginia Medical School had only 5% of medical students entering family medicine training programs (7 students out of 160).

Since family physicians currently comprise half of Virginia’s primary care workforce and provide care to adults and children, the need to train more of them is obvious. The American Academy of Family Physicians set the goal of 25% of U.S. medical school graduates choosing family medicine training by 2030 to meet the primary care health needs of an aging population. Clearly, more needs to be done to meet this goal.

The value of primary care is well known and documented. The Commonwealth Fund compares the health systems of wealthy countries and has shown that systems with at least 50% of doctors in primary care perform much better than in the U.S., which has only 30% of doctors practicing in family medicine, general internal medicine and general pediatrics. States that spend more on primary care have much better health outcomes and much lower costs, according to data from the Patient Centered Primary Care Collaborative.

The 2021 report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” from the National Academy of Sciences, Engineering and Medicine details the value of primary care and outlines strategies to bolster our faltering medical system. Providing a primary care medical home for all Americans and adequate reimbursement for these medical services are the report’s most important recommendations.

Local health systems are eager to hire graduates from the EVMS Family Medicine residency, knowing these doctors are trained in high-value, cost-conscious care. The residency provides some of the doctors to staff local offices, but demand is greater than the supply, particularly as many older doctors are retiring.

As EVMS and Old Dominion University work to merge (“Editorial: Promise of ODU-EVMS merger looms large for Hampton Roads,” June 3), part of the strategic plan should be to increase the number of medical students choosing to train in family medicine or general internal medicine. Loan repayment and forgiveness programs are effective recruitment tools and these programs should be expanded. The most powerful predictor of which students choose primary care is having a credible role model in that discipline with whom they can identify. Supporting those primary care doctors who serve as teachers for medical students should be a high priority. State legislative initiatives to increase Medicaid reimbursement rates and to limit administrative burdens would help make primary care a more attractive choice for medical students.

All of this will require smart strategic planning and coordination with multiple entities, but the goal of ensuring an adequate supply of primary care physicians should be an easily measured outcome. This will be an important investment in the future health of our population and a good way to lower health care costs.

Dr. Bob Newman is a clinical professor of family medicine at EVMS. He is the author of “Patient’s Compass,” which is a guide to navigating the U.S. health care system, available online at yourpatientcompass.com. Email him at fammedrocks13@gmail.com to order a paper copy. 

Americans spend over $66 billion on diets and weight loss programs every year and the vast majority of these are ineffective. They may yield short term weight loss, usually followed by regaining the weight.

Sound familiar? Understanding the physiologic reason for this helps explain why diets usually fail and are a waste of time and money, causing needless stress.

Our bodies evolved to adapt to starvation by slowing our metabolism when calories are restricted. As we lose weight by cutting calories, we also burn fewer calories. When we go back to our usual eating habits, our metabolism remains slowed down, and the lost pounds return. This results in a frustrating “yo-yo” pattern of dieting, losing weight and then regaining it.

Being mildly overweight has no adverse health consequences. Our culture glamorizes being thin, which has spawned an epidemic of eating disorders, mental health problems and unhealthy relationships with food. The Health at Every Size (HAES) movement promotes acceptance and appreciation of one’s body, regardless of the size. The focus of this philosophy is to eat healthy foods and to stay physically active.

The American food supply is highly processed with many unnatural chemical additives. Michael Pollan’s book “Food Rules: An Eater’s Manual” is an excellent resource for healthy eating. He starts with the premise to eat only real food; those are foods with, at most, five familiar ingredients on the food label and that your grandmother would recognize as food. Fresh fruits and vegetables are the best examples and these are available in every grocery store, usually found on the outer food aisles. Spend most of your time while grocery shopping in these areas.

Farmers markets are an inexpensive source of whole foods in the summertime. Read the labels on foods and avoid those with large amounts of sugar (more than eight grams per serving). Eat fruit with its natural fiber instead of drinking juice, which is loaded with sugar. Drink plenty of water daily instead of sugary sodas and sweet tea. Low-fat products do not help with weight loss, since the fat is replaced with carbohydrates. Whole milk and eggs are excellent sources of protein.

Intuitive eating was recently discussed in two webinars on public radio (WUNC’s Relearning How to Eat; How Intuitive Eating Can Heal Your Relationship with Food). Intuitive eating involves listening to your body’s hunger signals and eating what your body needs.

Foods should not be considered good or bad. Most of us eat until we are “full” (remember last Thanksgiving’s feasting?) instead of eating until we are satisfied. This usually means we chronically overeat, especially if we eat in a hurry. Waiting 20 minutes after finishing a meal before getting a second serving allows the brain to receive the signal that we have eaten.

A good rule is to limit your total meal portion to the size of your hand, which is about the size of your stomach. Finally, eating three meals a day helps maintain a healthy body size. Skipping a meal just makes you ravenous and more inclined to overeat later. Getting eight hours of uninterrupted sleep limits nighttime snacking; allowing an overnight fast of at least 12 hours helps the body burn fat.

Eating a wide variety of foods is one of the great pleasures in life. Enjoy that special treat occasionally. Take the time to cook your meals at home and cook on the weekend for the next week if necessary. Mindful eating involves being fully present with your food and enjoying the process of eating, without other distractions.

Remember, we are what we eat, so feed your body nutritious foods. Common sense and sustainable changes in lifestyle will help you stay healthy.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 20 years teaching family medicine. He teaches part-time at Eastern Virginia Medical School in Norfolk.

Pfizer and Moderna have received well deserved credit for the rapid development and deployment of the highly effective mRNA vaccines to battle COVID-19. Many other miraculous medication advances have occurred, revolutionizing treatment of certain diseases, thanks to the research and development by drug companies.

However, there are problems with how drugs are approved; “Big Pharma” has undue influence on the process.

The U.S. Food and Drug Administration is tasked with assuring the effectiveness and safety of drugs sold in the United States. The drug industry is heavily involved in this process; drug companies are the usual sponsors of studies on their new drugs. This research frequently leads to a positive bias towards showing the drug’s effectiveness with the minimization of side effects. The most recent and graphic example of this is the approval by the FDA in June of aducanumab (Aduhelm), a new drug for treatment of early-stage Alzheimer’s disease.

This is the first of a new class of drugs that might halt the progression of Alzheimer’s, not just treat the symptoms. It would be a major breakthrough, since more than 6 million Americans are affected. Patients and their families are desperate for a treatment for this cruel disease.

Unfortunately, there are many problems with the FDA approval of aducanumab. Two large studies (EMERGE and ENGAGE) done prior to its approval had conflicting results: one showed no effect and the other showed minimal improvement. The FDA expert panel of 10 neurologists who reviewed the data on aducanumab voted overwhelmingly against its approval based on its questionable effectiveness. Additionally, this drug can cause some serious side effects; 35% of those taking the monthly infusion developed small areas of bleeding into the brain or cerebral swelling. One quarter of patients experience headaches, confusion and dizziness.

Three of the experts on the FDA panel reviewing aducanumab resigned in protest over the FDA’s inexplicable approval of the drug, despite the objections of the review panel. This certainly suggests that Biogen, the drugmaker, had undue influence over the FDA on their decision. There is a well-documented history of this type of influence, with many former drug company executives later being employed by the FDA. The controversial approval of aducanumab has been a major blow to the credibility of the FDA. Many experts are calling for the FDA to pull the drug from the market.

The initial cost of aducanumab was more than $56,000 per year. Biogen recently cut the price in half, since the drug has not been widely utilized. Medicare and other private insurers have not decided whether to cover the drug, given the problems with it and the cost. The price reduction was an attempt to influence these coverage decisions favorably. Half of the 14% increase in the Part B Medicare premium for 2022 is due to anticipation of approval of this drug and its huge expense.

Medicare and private insurers should not approve coverage until more robust studies prove the drug is worth the cost. Aducanumab should continue to be studied for longer term effectiveness in ongoing clinical trials. There are many drugs in the pipeline for treatment of Alzheimer’s that may be safer, cheaper and more effective.

“Big Pharma’s” influence is also pervasive in Congress, where their lobbyists spent more than $300 million last year. This explains why, despite broad bipartisan and public support, Part D Medicare has not been allowed to negotiate drug prices, costing taxpayers and consumers billions of dollars annually, as noted by Dr. Aubrey Mason in his Nov. 22 Op-Ed column, “Federal intervention on drug price would offer broad benefit.”

Allowing our government to negotiate drug prices to lower costs is essential for individual patients and to assure the solvency of Medicare for future beneficiaries.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 20 years teaching family medicine. He teaches part-time at Eastern Virginia Medical School in Norfolk.

COVID-19 is continuing to plague us, killing more than 670,000 Americans total and 30 Virginians per day. It is threatening our economy once again. Most of the United States and Virginia remain in the red zone, indicating high rates of community transmission.

Fortunately, we have the tools we need to end the pandemic and put the fear and anguish from this disease behind us.

We need more testing for the virus. Three types of tests are available in pharmacies, urgent care centers and some doctor’s offices. There are accurate rapid antigen home test kits available (BinaxNow, Ellume and QuickVue) at pharmacies that are easy to use and cost $12 each. These can be used prior to a visit to vulnerable relatives for reassurance that you are not carrying the virus. If this test is negative, but there is a high degree of suspicion for the virus, a PCR test is done that takes 1-2 days for results and is free through select pharmacies and health centers. Lastly, the antibody test checks for previous infection or vaccination and costs $40. Since we do not know the level of antibody that protects you from infection, these currently have limited usefulness.

There are simple mitigation measures that we can use to stop the spread of the virus. High-quality surgical masks, multi-layer cloth masks or N-95 masks work to lessen the chance of transmission. They should be used indoors in public places and outdoors in crowds (such as football games) when you cannot distance yourself from others by 6 feet, regardless of vaccination status. We now know that you can get the virus and spread it even if you have been vaccinated. Masks protect yourself and others.

All three vaccines licensed in the U.S. are safe and effective. They lower your likelihood of severe illness and death. The Pfizer vaccine has received full FDA approval and can be given to children ages 12 and up. Vaccines will likely be approved for younger children in the near future. There have been nearly 400 million doses of these vaccines given in our country with extremely rare serious side effects. The risks of COVID-19 far outweigh any risks of the vaccine.

The vaccines are free and widely available. You can find out where to get a vaccine at vaccinate.virginia.gov or by calling 877-829-4682.

The FDA may approve booster shots this week, 6-8 months after the last dose of vaccine, but these are only indicated for high-risk individuals: those over 65, those with chronic illnesses and those who are immunocompromised. Our health care workers also need the booster. The goal should be to get vaccines out to the rest of the world, to prevent further spread and mutation of the virus.

What should you do if you get the virus? The symptoms are well known: cough, fever, congestion, fatigue, loss of smell and taste, vomiting and diarrhea. If you have typical symptoms, stay home and quarantine. Call your doctor’s office if you have questions. Remember, the vast majority of people will get better with increasing fluids and rest. Testing can be done at home or at a facility suggested by your doctor. If you are in a high-risk group, you can be given outpatient treatment with an infusion of monoclonal antibodies, which reduces your chance of severe illness.

If you have persistent shortness of breath or signs of dehydration and inability to drink fluids, seek medical attention. Otherwise, stay home in quarantine and protect members of your family by masking everyone. Our emergency rooms are overloaded with COVID-19 cases and we should triage only the sickest people there.

There are good treatments now if you have to be hospitalized, including oxygen, fluids, steroids and remdesivir, which have improved survival rates. Working together, we can win the battle against COVID-19.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 20 years teaching family medicine. He teaches part-time at Eastern Virginia Medical School in Norfolk.

The COVID-19 pandemic has reminded us what really matters in health care and has exposed the problems in our health system. We have underfunded our public health system and were left vulnerable when we needed it most.

Ten percent of our population is uninsured and suffered the most from the ravages of the pandemic. We have undervalued the importance of good primary care in controlling chronic diseases such as diabetes, hypertension and heart disease that left people with these conditions targets for severe COVID-19 infections.

The National Academy of Sciences, Engineering and Medicine recently published a detailed study of the American health system. The report titled “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” concluded that “primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.”

We currently spend only 5% of our $3.8 trillion health budget on primary care, compared to the 14% most other industrialized nations spend. We have much worse health outcomes in nearly every measure, despite spending nearly twice the per capita amount on health care compared to our peer nations.

Primary care focuses on the total health care of an individual with an emphasis on prevention of problems. Immunizations are one of the best examples of services with low cost and high value, as we have seen with the COVID-19 vaccines. Vaccines are routinely given in primary care offices for prevention of influenzae, pneumonia and other diseases.

COVID-19 vaccines should be available in primary care doctors’ offices, since many reluctant people can be convinced to get the shot by a doctor or nurse that they know and trust. This might help get us to “herd immunity” and blunt the effect of the threatening Delta variant of COVID-19.

A comprehensive primary care team includes doctors, physician’s assistants, nurse practitioners, nurses and medical assistants. Ideally it should include a mental health professional and a nutritionist. Having a mental health professional embedded in this “medical home” is particularly helpful, given the lack of availability of psychological counseling services and the barriers to obtaining them. Similarly, nutrition counseling is a vital component of good medical care and leads to improved wellness.

We have an opportunity in Virginia to make needed improvements in our health system, since $4.3 billion are coming to us from the federal government as part of the American Rescue Plan. Additionally, Virginia has a budget surplus this year of $2 billion, and thus more than $6 billion is available for many worthy causes.

Absolutely money should be used for expanded broadband access, mental health and support for small businesses. Since the health of our citizens is of paramount importance, using some of these dollars to provide better access to health care to the 648,000 uninsured Virginians makes sense.

The Virginia General Assembly will meet again in August to decide how to spend this money. I propose that some of it be spent to bolster the primary care system in Virginia, which evidence clearly shows will improve the health of our population. We can increase funding for the existing Virginia State Loan Repayment Program, which provides loan forgiveness for health professionals who choose primary care careers and serve for two years in underserved areas.

Additionally, some money could be spent on programs to place nutritionists in selected “medical homes” around the state. A good place to start is in primary care residency training programs that don’t have these services. Residents who learn in a comprehensive “medical home” are more likely to implement the same model where they eventually practice. Physicians who learn nutrition counseling from an expert would greatly contribute to improved health for their future patients.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 19 years teaching family medicine, most recently at Eastern Virginia Medical School in Norfolk.

Remember the scenes of spraying streets and sidewalks with chemical disinfectants? How about the recommendation to wipe your groceries with sanitizer to prevent inadvertently catching COVID-19?

Turns out, all of that was a waste of time and money. There is very little evidence that surface transmission of the virus occurs, with a risk of only one in 10,000. It still makes sense to wash your hands for 20 seconds after being out in a public place.

COVID-19 spreads through inhaling respiratory droplets from an infected person’s cough or sneeze. Thus, wearing a mask will have much more preventive effect than wiping down surfaces. It makes sense to assume that we can spread it through a handshake with someone infected and then touching our nose, since this is a known mode of transmission for colds and flu.

By eliminating close human contact and wearing masks, we saw a dramatic decrease in colds and flu this past winter. Perhaps handshaking might best be permanently replaced by the elbow bump.

What is the harm in using these chemical disinfectants? Aside from the hazard of exposure to the chemicals themselves, we can wipe out the good bacteria in our environment and on our bodies that protect us from disease. Recall that each human has billions of bacteria in and on our bodies, mostly in our intestinal tract, that are critically important for keeping us healthy.

We are now learning that these good bacteria serve a major role in maintaining our gut health and even our cardiovascular and brain health. An April 25 New York Times article by Markham Heid explains this in detail. If we kill too many of the good bacteria that protect us, we might pave the way for a pathogen (bad bacteria) to invade and cause disease.

The familiar story of Clostridia Difficile (C. Diff.) illustrates this best. Due to our indiscriminate and inappropriate overuse of antibiotics for colds and problems that resolve on their own, we can kill off our healthy gut bacteria and allow for this pathogen to take over and produce a toxin that causes severe diarrhea that can be fatal. The best treatment is a fecal transplant of “healthy” stool with many good bacteria to restore the balance.

A healthy gut flora may have a protective effect against many chronic diseases. The best way to maintain gut health is to eat plenty of fresh fruits and vegetables and fermented foods such as sauerkraut and yogurt, and to minimize the number of processed foods consumed.

The “hygiene hypothesis” was first proposed by David Strachan in 1989 and argues that bodies need exposure to bacteria for their immune systems to function properly. Lack of this exposure might be an explanation for why we have seen an increase in asthma, allergies and autoimmune disorders. It is also one explanation why the populations of Africa have been so little affected by COVID-19. They may have much healthier immune systems because of their exposure to many bacteria over their lifetimes, which has “programmed” their immune systems to fight infections effectively.

We have made great progress in our fight against COVID-19 by administering 274 million doses of vaccine and fully vaccinating 45% of our adult population. The vaccines are amazingly effective and extremely safe, and some will likely soon receive the Food and Drug Administration’s approval for use in young children. The Pfizer vaccine is now approved for kids older than 12.

You can find out where to get the now readily available vaccine by visiting the Vaccinate.Virginia.gov website or by calling 1-877-829-4682. Two weeks after finishing the vaccine series, you will be highly protected against this deadly virus, which is profoundly more effective than any sanitizing you have been doing.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 17 years teaching family medicine, most recently at Eastern Virginia Medical School in Norfolk.

An April 19 letter to the editor by Ronald McLemore in The Virginian-Pilot & Daily Press describes his experience of having a kidney stone in the middle of the night. He went to a local ER and received good treatment for three hours, but later received a bill for $10,153. He paid only $120 because he had insurance coverage, but correctly explains that such inflated charges are increasing the cost of health insurance. All of us are paying for this either in taxes to fund Medicare and Medicaid or higher private insurance premiums.

How does this Byzantian system of medical billing work? The hospital generates a bill that can be many pages long, including charges for everything from the room to the Tylenol you take for a headache while there. Your insurance company has negotiated a discount with the hospital that pays them only a fraction of what they billed. Adding to the confusion, each private insurance company has negotiated a different discount with the hospital depending on their market clout.

Medicare and Medicaid negotiate the greatest discounts as the largest insurance programs. You pay only deductibles and co-pays, usually a small amount compared to the total charged. Therefore, you are insulated from the total cost and are less likely to complain about the high charges, unless you are uninsured (more than 30 million or 10% of us) and bear the total burden without the benefit of the insurance discount.

This is a complicated system by design. Good luck trying to find out the cost in advance of any elective procedure. Prices are well concealed, since consumers might decide not to have the procedure when they find out what it will cost. How can the capitalist free market of competition work if the prices charged by different providers are unknown?

Who are the winners in this system? Clearly, large hospital systems and insurance companies benefit financially from this arrangement. Who are the losers? Employers, taxpayers and consumers pay more, giving us less to spend on other important needs.

Administrative costs amount to 20% of the $3.8 trillion that we spend on health care. Other wealthy nations pay no more than 12%. Simplification of our billing system to cut these expenses in half would easily cover medical care for the uninsured.

Medicare pays only 2% of its budget for administrative costs. Medicare and Medicaid also cap charges for services to “cost” plus a small profit, something that every other successful health care system in the world does, as pointed out in a recent PBS NewsHour special entitled “Critical Care: America vs. The World.” The government sets prices even in the highly privatized Swiss health system, which performs better than the U.S. system and has much lower costs.

What are the differences in premiums for Medicare and private insurance? Medicare coverage costs $140 per month whereas a typical private plan costs more than $600 for a healthy 64-year-old. Paradoxically, we subsidize the cost of care for those over 65, many of whom have wealth, and burden younger individuals and employers who have many other expenses with massive health costs. A better system would provide basic care coverage for all with a standardized premium and provide supplements for those with lower incomes, as the Affordable Care Act does.

Requiring cost transparency in advance for non-emergency health services would rein in health care costs by improving competition in our private health system. Capping all prices for services as Medicare does now would dramatically lower costs. Recently, I had a brain MRI and the charge was $6,660. Medicare paid the hospital $284 and I paid $71. No surprise that many are advocating Medicare for All.

Dr. Bob Newman, a University of Virginia Medical School graduate and U.S. Navy veteran, spent more than 15 years in private practice in rural Virginia and 17 years teaching family medicine, most recently at Eastern Virginia Medical School in Norfolk.