The debate is heating up over the future of health care in America, but this is a subject I’ve been thinking about for a long time. As a publisher in the health field, a new member of the board of a very large hospital (the Lehigh Valley Health Network), and a health “consumer” who has helped my mother navigate the system, I’m starting to understand where we have gone wrong. And we have gone wrong. Unless we address these five issues, we will never really fix the situation, only complicate it even further. The problem is clear: We spend more money than any other country on health care, and we have some of the worst “outcomes.” Why?
1. We have too many specialists and not enough primary-care physicians. Dr. Robert Martensen, in his new and very excellent book A Life Worth Living, confirms what I have always suspected and heard: People who rely on primary-care physicians as their doctors live longer, healthier lives and have fewer procedures done (in other words, spend less money). But we have a shortage of primary-care physicians in this country, because we reward specialization by paying specialists more money (thus, more people want to become specialists).
2. Doctors in the United States are paid 5 times more than doctors in other countries. In other countries, becoming a doctor is seen as a way to serve others and make a decent living. In America, it’s seen as a way to get rich. How did this happen? The same way that things went so wrong on Wall Street—a combination of generally accepted greed, deregulation, and entitlement confused with capitalism.
3. Hospitals are incentivized to make profits from filling beds, insurance companies are incentivized to deny payment to people who need it most, and pharmaceutical companies are incentivized to sell more drugs. If people were healthy and relied on preventative medicine, it would be much harder for hospitals, insurance companies, and pharmaceutical companies to make ever-increasing profits and grow every year. Growth, rather than healing people and helping them live longer and healthier lives, is equated with success.
4. We the people are so fixated on the knee-jerk debate of socialism vs. capitalism, private sector vs. public sector, big government vs. “small” government, that we have forgotten our responsibility as humans. It’s much harder to really dig in and understand all sides of a problem, and come up with solutions, than to listen to “pundits” spouting off and shouting at each other from cardboard platforms that don’t really mean anything. The real issues are much more complicated and convoluted than any ideological stand. And hospitals, insurance companies, and pharmaceutical companies would much rather people stay on superficial and polarizing topics than look behind the curtain. Here is a direct quote from A Life Worth Living:
“In America, which we think of as the realm of “private” medical care, approximately 50 percent of our total expenditures on health care come from the public purse. Moreover, our public half is as large in percentage of gross economic output, and larger in per capita expenditure, than what citizens of ANY country spend, public and private combined, on their health care. Yet in terms of average life expectancy, “quality-adjusted life years, and so forth—U.S. rates lie at or near the bottom in comparison with economically advanced countries and on a par with some developing nations, such as Costa Rica.”
5. We are in denial about death. Because we are constantly looking for “positive outcomes” as opposed to recognizing that we are all mortal, there is an intricate dance of denial, miscommunication, and false hope that leads to artificially extending life in ways that are painful, degrading, and expensive. The truth is we all die. Some people have better deaths than others. Our goals should be to live life fully and die quickly and peacefully—all, hopefully, surrounded by a loving family.
Until we face all five of these issues, we will continue our grotesque track record of being the biggest spenders and the biggest losers when it comes to how we care for our health, and, ultimately, how we live and die.