Best in the World?
What would you say about a product that receives giant public subsidies, costs twice as much or more as its main competition, and ranks 49th in quality worldwide?
Most businessmen would say you should be out of business. American leaders declare that product the best in the world.
The businessmen may be right. In a shorter time than we think, the US, may be out of the competition.
The product is American health care. Recently the CIA ranked the US 49th in overall lifespan.
There are many superlatives that can be applied to American health care – the biggest, the most elaborate, the most sophisticated of any in the world. What is less commented upon is its crippling effect on the American economy.
The Biggest Tax You Never Heard Of
In 1972, John Knowles, head of Massachusetts General Hospital, wrote and edited a series of articles called “Doing Better and Feeling Worse.” He pointed out that American health care was already 5% of GNP, and its rapid upward growth would soon bankrupt the American economy. Today health care is 17% of GDP, $2.4 trillion a year. Countries like Britain, Germany, and Holland have a health care system that costs about half as much per person and universally produces better results. Their populations live years longer. Perhaps as significant, their measures of healthiness at any given age generally leave us in the dust.
What could we do with that extra 1.2 trillion dollars year? Get rid of the federal budget deficit? Rebuild our infrastructure and educational system? Or perhaps we could recognize what our health care system is – a huge tax to the economy and particularly American business, which has to pay a lot of it through employer-based health care. Not only is the cost huge, but possessing a population less healthy than that of other industrialized nations also creates an enormous tax on our economic competitiveness.
No wonder large American corporations are now mainly hiring new workers overseas.
There are many reasons we got into our health care mess. One of the most important is that American health care operates much like sub-prime mortgages.
Why the Health Business resembles Sub-Prime Mortgages – The Strange Case of Dr. Midei
Dr. Mark Midei was what many hospitals call a “clinical hero.” A well regarded Baltimore cardiologist, he became expert in performing cardiac catherizations. He was so successful that one day he put in over 30 coronary artery stents, devices meant to prop up clogged arteries.
This made him a hero to Abbott Laboratories, which according to the New York Times paid $2,159 for a pig roast at his home two days later. He was also a hero to St. Joseph’s Hospital, thrilled at the huge number of referrals he brought to the hospital, which recently paid a $22 million dollar fine for illegal kickbacks to him (of course the hospital admitted no wrongdoing.) He was less of a hero to Federal investigators whose “independent experts” determined 585 out of the 1878 stents he placed within two years were unnecessary.
Midei became a consultant to Abbott when he left his private practice –“It’s the right thing to do because he helped us so many times over the years,” one Abbott executive wrote.
Yet Midei was not the highest user of stents nationally, or even in Baltimore. Less than a third of his stent emplacements were considered, after the fact, unnecessary. And without the stents cardiac catheterizations can still cost $40-50 thousand each, and represent the last of a series of expensive procedures cardiologists use for diagnosing and treating coronary artery disease.
You can break the bank without even cheating – just follow the rules and –
Follow the Money
American health care is about profits, and profits come from procedures. If you are a doctor who is making money for herself, her family, her hospital or medical group, and you get paid 5-40 times as much per minute to do a procedure than do a physical or counsel a patient of how to avoid illness, what do you do? The decision becomes even easier if your employer sets “targets” you must exceed to keep your job.
The answer is pretty simple – you do what’s necessary to keep your job – which also increases your income. Everybody’s happy – your spouse, your accountant, the hospital and the medical group. Better yet, the standards needed to use and perform expensive tests and procedures loosen over time. It makes it faster to pay off those million dollar machines.
The end result is a fee-based for-profit system without limits – just like sub-prime mortgages in their prime. And if we keep the system as it is, we may face a larger financial debacle, including bankrupting Medicare, which can then overwhelm the government. Yet well before that happens, our medical care system may help convince many of our most competitive companies to put more and more of their operations overseas.
Health, not Healthcare
At present, most attempts at “health reform” will neither reform health nor fix the gaping economic problem. These feeble political procedures are more akin to restitching the deck chairs on the Titanic. Medicare “cuts across the board” will not stop procedure filled medicine but encourage it, as more procedures will prove necessary to keep hospitals and medical groups financially solvent, while across the board cuts will further undercut the primary care and cognitive medical groups that might actually improve health results. These days general practice docs are more valuable as business “referral sources” for large medical groups than as independent practitioners who might eventually try to keep the population healthy.
The point is the issue is health, not health care. Our national debate has not even begun to deal with the real problem – getting and then keeping the population healthy, able to live longer and happier and become more productive.
Obtaining such results may have little or nothing to do with health care. Britain has seen that the differences between its healthiest and unhealthiest population groups can be halved by the amount of green space surrounding the unluckier group.
This means that setting up parks and planting trees can save far more lives and heck of a lot more money than performing more cardiac catheterizations.
Yet as a nation we’re nowhere near acknowledging the radical approaches that will be necessary to regenerate American competitiveness. Bismarck recognized in the 1880’s that a healthy population is necessary for a healthy economy. We’re 130 years late.
But we may start to learn. Recently, Shanghai 15 year olds ranked best in the world in reading, science, and mathematics. Comparable American students ranked 17th in reading, 23rd in science and 31st in math.
That compares with 49th in lifespan – even more opportunity for improvement. It’s time for regeneration in American health, education, and economic prowess. And regeneration, if it’s given half a chance, is something our own bodies know how to do already – and from which we can still learn.
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