the healthcare fiasco, and what you can do to stop it

The united states faces a health crisis. This fact borders on insanity. We paid 2.1 trillion dollars for healthcare in 2006, enough to cover care for everyone in the country,

In the last 20 years, the span that covers my career to date in medicine, I saw a system that tried to save money by installing “watch dogs” (ie HMO’s) to curb the costs incurred by doctors who, it was believed, were causing high costs by ordering tests, hospitalizations, medications. Instead of costs going down, they have risen to an extreme that is breathtaking. There is a direct link between the higher cost of health care and the larger presence of health insurance companies in the system.

There has been a concerted effort to try to force medical care into a capitalist model. Doctors are service providers, patients are consumers.

Pharmaceutical industries have emerged as some of the most powerful companies in the country. In 2004, the top 10 fortune 500 companies were pharmaceuticals, and they made more than the remaining 490 combined.

People are fatter, sicker and take more medicines than they ever have, and at a younger age. Why? Most of the health problems we see are completely preventable with diet, exercise, sleep and emotional wellbeing, what I consider the cornerstones of health.

We could call lack of exercise, overeating and eating the wrong food, anxiety and poor sleep “lifestyle choices” and blame our patients for not taking care of themselves. We could say that government intervention is inappropriate, socialistic coddling, and keep going as we have been.

Or we could step up and do our job.

Are we physicians first doing no harm?
Are we willing to be relegated to writing pills and watching the health of our country disintegrate around us?

There are answers. Some of them require enormous changes in our attitude as a country. We need to stop blaming people for being poor, helpless and unhealthy. We need to stop defining progress in medicine by how many new medicines we design or diseases we discover, and start measuring our successes by how healthy our country, our collective patients, are. We need to recognize that most people do not want to be unhealthy, they do not want to have to take pills. They do not want to ignore their health.

There is no better time for us to doubt that the capitalistic, free market model applies to healthcare. We see that even within the marketplace, greed and fraud guide decisions when money is to be made, and collapses the system. Presently patients are uniquely separated from the system that considers them “consumers”. Their reason for seeking help is to promote their optimal health. Meanwhile insurance is allowed to and is set up to deny care whenever possible. Furthermore, I have serious suspicion that health insurance companies are violating anti trust laws. Patients do not have true choice when comparing insurance options, which do not seem to vary between “products”. Without competition, insurance companies all seem to increase their rates and decrease their options in synchrony. Most ridiculous, insurance companies are beholden to shareholders. What, then, stops them from increasing their rates continuously, since shareholders’ only interest is profit, and profit is made when patients pay premiums?

Pharmaceutical companies profit most when they sell medications for chronic conditions. Their incentives are not for people to be healthy enough not to require pills. It is chilling to watch their profits rise in step with the fall of our collective health.

Patients do not have choices when they are sick. They are not consumers looking for flip flops or a dvd player.

There are huge impediments to people staying healthy.

It starts early.

Mothers with poor nutrition have babies with shorter stature. These children do not tolerate generous diets, and are more prone to obesity from the start.

Children no longer walk or bike to school. Infrastructure that favors fast cars over pedestrians, makes it dangerous for children not to take the bus or be driven. Gym class is often removed from the curriculum. School lunches are often not healthy. Fast food and processed food are more available and affordable than healthy food.

Environmental toxins such as brominated fire retardants, bisphenol A and even sunblock (oxybenzone), alter metabolism. In addition to other serious long-term effects, these chemicals promote obesity starting in infancy.

The trend continues throughout life. There are limited opportunities for people to walk or bike to destinations. Our infrastructure requires driving everywhere. This is not a small issue. It is defining.


Insurance costs too much.
The Pharmaceutical industry earns too much.
Too many people cannot get healthcare.
Too many people are obese.





These are the answers.


We need national healthcare.
The pharmaceutical and health insurance industries will be the big losers if we implemented national healthcare, and we must anticipate that they are the primary opponents that have been keeping this issue dead. They have powerful lobbying and deep pockets.

Physicians need to face the relationship we have with our income. We need to face the fear we have that national healthcare will affect our income. There are doctors who are profiting from the present system. I can only assume and hope that there are many more who are extremely disturbed by our present situation.

I suspect though that physicians are torn by our unique situation. We are highly educated, pay dearly for our education, and anticipate good pay for our work. I would argue though that there is ambivalence here –how much is enough, how much is too much? At our best we are motivated by what is best for our patients. Personal benefits of our jobs include intellectual stimulation, gratitude from and relationships with our patients, interactions with our colleagues, and a special standing in society. Financial gain is a complexity. For physicians to get on board as a group to support national health care, we need to feel taken care of. We need to feel completely involved in setting up the system so that we are orchestrating it, but are answerable above all to our patients.

National healthcare means the federal government, as the ultimate representative of “the people”— can link the savings of simplifying health care by making people need it less (diet, exercise, sleep, emotional well being) with the costs and ultimate savings of, believe it or not, a transportation system. If we took a fraction of what we paid as a country for healthcare, and put it toward a well-designed public transportation system, we would address critical issues simultaneously:
Reducing carbon footprints
Emphasizing a village structure to towns, to allow centralization that allows people to walk and bike to most destinations, and link villages with trains or busses.
This can do so much more than just improve health and decrease healthcare costs, but that is absolutely the most important aspect of such a plan.

Get the medical system out of this capitalistic free market model, and stop worrying about what health insurance companies are going to do if we don’t need them anymore. We are bending over backward to figure out how to entice health insurance to cover patients properly, instead of acknowledging that they provide a service that we must question the need of.

Prevention must embrace common sense. When left alone people can be healthy. If people are allowed to do the things we know keep them healthy, they will probably stay healthy and not need our “care”. Whereas in the past people might fret that this lack of consumption of our goods could impede our economy, I think we finally see that this balance of consumption and commerce is really being funneled primarily to the small number of very rich people. There will always be illness, and there will always be room for innovation. We should not hesitate to promote health simply because it seems as though healthy people will compromise our economy. Really, how frightening is that?