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I learned about a major obstacle to genuine health care reform recently when I participated in an online chat group. I'd expected a passionate discussion, but instead found people drily exchanging statistics and prices. Deflated, I looked up the group's roster. Of 62 members, almost all were administrators or economists.
In fact, I was the only one identified as either a patient or health care practitioner.
What can we possibly be thinking when we omit health care's obligate participants from the reform discussion? The current Congressional hearings involved numerous representatives from the insurance, hospital, and pharmaceutical industries, but hardly any patients or practitioners. Evidently, Congress is convinced that the health care crisis is exclusively economic.
Seen through that lens, health care is a commodity like pork bellies and winter wheat. Never mind that medicine is as subtle as it is complex, comprised of suffering and hope, science and compassion. Never mind that the examination room, spare though it may be, is routinely an emotional crucible.
No, doctors and patients are simply agents engaged in the transfer of a product.
According to the contemporary vocabulary, health is what a “provider” sells to a
“consumer.” Shame on us. Hippocrates is spinning in his grave.
If Congress members were to ask the people on the ground, the plain, old citizens who are sick and those who care for them, they'd learn why we're paying far too many bucks for ridiculously little bang.
Surgeon-writer Atul Gawande explained this failure incisively in the June 1 issue of The New Yorker. In an article that has become required reading for White House staff, Gawande demonstrated that we simply use too much medical care.
We demand more than we need, often encouraged by the press releases that avalanche us with the latest breakthrough, that medical miracle just over the horizon. Most of these wonders don't pan out, yet the repetitions subtly persuade us that there is or soon will be a pill or procedure for virtually anything that can go awry. We want to believe this, of course, and genuine advances do occur, but most of what we hear is flat-out sales pitch.
Consider the magazine ads and TV commercials you've seen by the score:
“Nervous? (Or insomnic? Depressed? Itchy?) Ask your doctor if this is the right medicine for you.”
Some of these hawkers are, sadly, physicians and other professionals who, having noticed the enormous rushing river of healthcare dollars outside their door, have learned to dip their ladles.
Mesmerized by magical but unrealistic promises, too many of us assume our doctors will make us right no matter what, so we don't take care of ourselves. We eat super-processed foods that offer weight without nutrition. We ingest nicotine, alcohol and chemicals with impunity. We get too little exercise, tolerate abusive relationships, and lack tools to handle stress.
When I ask my medical colleagues what fraction of their patients are being treated for self-caused problems, they uniformly answer in the majority. We're talking here about diagnoses like obesity, hypertension, Type II diabetes, accident proneness, emphysema, alcoholism, and so on, the results of sick-making lifestyles.
More than a decade ago, cardiologist Dr. Dean Ornish and his staff at the University of California, San Francisco, showed that clogged coronary arteries could be cleared with a simple, but intense, program combining diet, exercise, meditation and support, the cost of which was a few thousand dollars. Compare this to a four-way coronary bypass operation costing a quarter million dollars.
Yet, who's going to make big bucks pushing lifestyle change when entire industries, many thousands of jobs, are vested in bypass operations?
Maybe it's easier to just get the operation, especially if someone else pays for it. But sooner or later, we'll need to rethink that strategy because as costly as health care is now, you ain't seen nothing yet.
In 1960, $1 of every 12 spent for anything in the United States went toward health care. By 1980, health care's share was one of every $7. Today it's close to one in five. At this rate, we'll eventually buy nothing but health care: We'll live in packing crates and shop in dumpsters, but at least we'll enjoy the most opulent health care technology in history.
No matter what reform scheme inhabits today's Congressional pipeline — single-payer, government-subsidized private insurance, or something else — we're headed toward national bankruptcy unless we alter the conversation. Instead of just talking about who'll pay for what, we need to begin discussing personal responsibility, effective health education, and exactly what we as members of a democracy owe one another.
In fact, I was the only one identified as either a patient or health care practitioner.
What can we possibly be thinking when we omit health care's obligate participants from the reform discussion? The current Congressional hearings involved numerous representatives from the insurance, hospital, and pharmaceutical industries, but hardly any patients or practitioners. Evidently, Congress is convinced that the health care crisis is exclusively economic.
Seen through that lens, health care is a commodity like pork bellies and winter wheat. Never mind that medicine is as subtle as it is complex, comprised of suffering and hope, science and compassion. Never mind that the examination room, spare though it may be, is routinely an emotional crucible.
No, doctors and patients are simply agents engaged in the transfer of a product.
According to the contemporary vocabulary, health is what a “provider” sells to a
“consumer.” Shame on us. Hippocrates is spinning in his grave.
If Congress members were to ask the people on the ground, the plain, old citizens who are sick and those who care for them, they'd learn why we're paying far too many bucks for ridiculously little bang.
Surgeon-writer Atul Gawande explained this failure incisively in the June 1 issue of The New Yorker. In an article that has become required reading for White House staff, Gawande demonstrated that we simply use too much medical care.
We demand more than we need, often encouraged by the press releases that avalanche us with the latest breakthrough, that medical miracle just over the horizon. Most of these wonders don't pan out, yet the repetitions subtly persuade us that there is or soon will be a pill or procedure for virtually anything that can go awry. We want to believe this, of course, and genuine advances do occur, but most of what we hear is flat-out sales pitch.
Consider the magazine ads and TV commercials you've seen by the score:
“Nervous? (Or insomnic? Depressed? Itchy?) Ask your doctor if this is the right medicine for you.”
Some of these hawkers are, sadly, physicians and other professionals who, having noticed the enormous rushing river of healthcare dollars outside their door, have learned to dip their ladles.
Mesmerized by magical but unrealistic promises, too many of us assume our doctors will make us right no matter what, so we don't take care of ourselves. We eat super-processed foods that offer weight without nutrition. We ingest nicotine, alcohol and chemicals with impunity. We get too little exercise, tolerate abusive relationships, and lack tools to handle stress.
When I ask my medical colleagues what fraction of their patients are being treated for self-caused problems, they uniformly answer in the majority. We're talking here about diagnoses like obesity, hypertension, Type II diabetes, accident proneness, emphysema, alcoholism, and so on, the results of sick-making lifestyles.
More than a decade ago, cardiologist Dr. Dean Ornish and his staff at the University of California, San Francisco, showed that clogged coronary arteries could be cleared with a simple, but intense, program combining diet, exercise, meditation and support, the cost of which was a few thousand dollars. Compare this to a four-way coronary bypass operation costing a quarter million dollars.
Yet, who's going to make big bucks pushing lifestyle change when entire industries, many thousands of jobs, are vested in bypass operations?
Maybe it's easier to just get the operation, especially if someone else pays for it. But sooner or later, we'll need to rethink that strategy because as costly as health care is now, you ain't seen nothing yet.
In 1960, $1 of every 12 spent for anything in the United States went toward health care. By 1980, health care's share was one of every $7. Today it's close to one in five. At this rate, we'll eventually buy nothing but health care: We'll live in packing crates and shop in dumpsters, but at least we'll enjoy the most opulent health care technology in history.
No matter what reform scheme inhabits today's Congressional pipeline — single-payer, government-subsidized private insurance, or something else — we're headed toward national bankruptcy unless we alter the conversation. Instead of just talking about who'll pay for what, we need to begin discussing personal responsibility, effective health education, and exactly what we as members of a democracy owe one another.
Jeff Kane, MD, lives in Nevada City.
