Dr. Jeff Kane: Getting our money’s worth in healthcare
Raising the subject of healthcare inevitably cranks up the arguments: Obamacare, single-payer, private insurance, who’ll pay and for what. A subtler but more difficult issue, though, is healthcare’s very purpose. Unless we address that, we’re headed toward bankrupting ourselves with little benefit, no matter what our payment plan.
Let me explain. We Americans made a billion medical visits in 2018 and walked away with prescriptions seven out of ten times. We’re getting plenty of healthcare—and paying more for it, by the way, than patients in any other developed country—so why is our national health declining?
And declining it is. Our infant mortality rate, a standard marker of a country’s overall health, now ranks 55th best among nations. Our life expectancy famously rose over the past century, but dropped in each of the last several years.
We’re less healthy because we address illness’ end-stage manifestations while ignoring its causes. As your doc I might be able to patch up that organ that fizzled out, but why it fizzled is literally none of my business. This narrow focus essentially band-aids patients and then returns them to the same conditions that brought them in in the first place. We may as well try cleaning the creek without considering the pig farm upstream.
Let’s look at how this works. Life expectancy, for example, is decreasing mainly due to deaths from drug overdoses— a number that in 2017 was twice that of motor vehicle deaths. A further drop in expectancy results from an increase in liver disease, principally alcoholic cirrhosis. Add the rise in our suicide rate, up by a full third since 1999. (In contrast, during the same period the global suicide rate declined by almost 30%.)
Drug overdoses, alcoholism, and suicide: endpoints of misery. The numbers shout that a lot of us are mortally unhappy.
The happiest folks, the ones at the other end of the spectrum, don’t self-destruct, and many of those in-between do, but slowly. In the early 1970s 15% of us were clinically obese, thus risking several serious illnesses. By 2008 34% of us were obese. In the early 1970s no states had an adult obesity rate greater than 25%; now thirty-two states do. Ninety percent of Americans eat more sodium than is recommended for a healthy diet. (Reducing personal sodium by 1,200mg per day could save up to $20 billion a year in hypertension treatment and other medical costs.)
I could mention other dietary hazards, insufficient exercise, immersion in stress and pollution, on and on, but you get my drift. In lemming numbers we’re damaging ourselves and then asking healthcare to clean us up. That institution responds as it’s now tooled, with glamorous technologies at prime expense. But even the most impressive imaginable machines can’t amend a lifestyle any more than we can glue together a broken promise. Too often today’s healthcare amounts to enabling illness-causing behavior rather than increasing health.
So what’s to be done? We can start by recognizing that this frustrating situation stems from a cultural delusion. We act as though much of our behavior isn’t under our control and in any case needn’t be our responsibility since medical panaceas, as marketing tells us, are constantly in the pipeline. “Ask your doctor,” the ads may as well say, “if this medication will repair your life.”
It’s astonishing that our current healthcare system sees illness as occurring in a vacuum. Sure, some of it may be random, but a great fraction results from personal choices and inequities. So augmenting health can’t be just up to docs. Hopefully, the recognition that our national health is declining will encourage all of us to see beyond simply who will pay and for what.
Jeff Kane is a physician and writer in Nevada City.
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