There A Mean Streak in the US Mainstream?
Questions About Healthcare That Need Answering
| Here are some basic facts and sensible ideas -- plus how Europeans see Americans. We trim, blend, and append four 2009 articles from: (1) Huffington Post, Aug 24, by Marcia Angell, MD, Harvard Medical School, author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It; (2) Dr. Polly Cleveland, Aug 29; (3) Huffington Post, Aug 25, by Dr. Andrew Weil, Founder and director of the Arizona Center for Integrative Medicine, author of Why Our Health Matters: A Vision of Medicine That Can Transform Our Future; and (4) The Independent UK, Aug 24, by Mary Dejevsky. |
- Health Reform: Throwing Good Money After the Bad
This year we will spend roughly $2.5 trillion on health care, more than twice as much per person as other advanced countries. Most of the total is funneled to private insurers and entrepreneurial providers who take 15-25% off the top before paying providers. If we spent the same percentage on overhead as Canada, we would save about $400 billion this year.
Medical facilities provide too many services for the well-insured and too few for the non-insured. Most doctors are paid for piecework. Specialists receive very high fees for expensive tests and procedures. All advanced countries have the same technologies. But unnecessary tests and procedures cost Americans probably hundreds of billions of dollars per year.
Most proposals would leave the present wasteful and inflationary system essentially unchanged, and simply pour more money into it.
Massachusetts has nearly universal health insurance, but the state has the highest health costs on the planet and costs are growing rapidly. It may become too limited in what it covers or too expensive to actually use. Health insurance and health care are not the same thing.
Nearly every other advanced country guarantees universal care. Not only are expenditures much lower in other advanced countries, but health outcomes are generally better. They have more doctors, nurses, hospital beds, doctor visits, and longer hospital stays. There are waits for some elective procedures.
Medicare is a single-payer program. The Veterans Health System is very much like the UK's. Both deliver better care at lower prices than our private system. If Medicare were extended to everyone, doctors should be salaried.
- Getting Health Care Incentives Right
Most HMO patients are there by choice of their employers, not their own. In some states, there is only one HMO. Dividing costs per capita has failed in HMOs due to lack of competition.
Let’s provide every citizen with a fixed, age-adjusted federal voucher to cover the services of a primary care physician / medical service advisor. Primary-advisors would compete with one another to offer the best service for the voucher.
For starters, neither primary advisors nor catastrophic insurers could refuse or drop clients.
- The Question No One Asks About Healthcare
Mainstream American "health care" moves us no closer to robust, resilient health. It is a symptom-focused disease-management system. Paying for our current system with taxes would exacerbate poor health and bankrupt the nation in the process.
Instead, let’s maximize our innate self-healing capacity first whenever possible to both facilitate recovery and keep us whole and balanced.
The National Board of Medical Examiners should included questions on health promotion, thus schools would quickly add them to their curricula.
A toxic environment can make people sick; no amount of medical intervention can protect us. The health care community must lobby against pollution.
The media showers us with images of kids devouring junk food and adults popping pills for transient discomforts. The sophisticated American marketing talent that pushed us toward unhealthy behaviors might be marshaled to move us all in directions that are more consistent with good health.
- A Mean Streak in the US Mainstream
How can one of the biggest, richest, and most advanced countries in the world tolerate a situation where, at any one time, one in six of the population has to pay for their treatment item by item or resort to hospital casualty wards?
The unpalatable fact for Europeans is that universal healthcare is an article of faith only for bleeding-heart liberal Americans. The US left is still quite a bit further right than in most of Europe.
Most fear that extending insurance to the poor will raise premiums and bring rationing. The principle that no one should be penalized financially by illness is trumped by the self-interest of the majority, then rationalized by the argument that health is a matter of personal responsibility.
There is a mean and merciless streak in mainstream US attitudes, which tolerates much more in the way of inequality, deprivation, and suffering than is acceptable here, while incorporating a large and often sanctimonious quotient of blame.
JJS: Easier for Europeans to say, since many still have strong uni-ethnic identities -- one big family sharing an all-embracing social program. Yet the pressure to conform is stronger, too. For balance, it seems one big key to cutting costs is to end the monopolies of doctors, who exclude nurses and doctors with licenses from elsewhere, and of drug companies, who buy up traditional cures and whose patents preclude competition. Competition cuts costs in other arenas. Why not in the medical profession?
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Jeffery J. Smith runs the Forum on Geonomics.
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Also see: High Medical Costs In Part Are Supply Driven
Just Cause for Great Alarm
Public health does not follow from conformist psychiatry |
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