Posing and Then Answering the Right Question in the Health Care Debate
The business model of our health care system is a jackal. If you grind down its teeth you neither shrink the jackal’s ravenous appetite nor curb his predatory bent. So why persist in seeking to reform this beast? Rather than profit health care should be designed to reward prevention, efficiency and safety. It is time to euthanize the jackal.
* The wrong question to ask:
How can we curb spending and control health care costs?
* The right question to ask:
How can we eliminate perverse incentives?
Simply put: Since each and every one of us is at risk to becoming sick or growing old and infirm, health care and long term care ought to be viewed as utilities rather market frontiers. Indeed, this is as it sensibly is much the world over. We do not scream “Socialism!” when government bodies construct roads, schools or sewage systems that benefit everyone. An outcry against socialism might be appropriate where the government attempts an incursion into beliefs and activities that are genuinely private and personal such as religious expression, the creation of art, or sexual activity.
The following is but a partial iteration of all too common examples of perverse incentives within our health care system:
- Acupuncture, a modality is known to be a safe, inexpensive, preventive, and powerful means of care for numerous conditions. It succeeds by alleviating pain and suffering while also addressing a condition’s root causes and connecting the dots between seemingly unrelated ailments. Rather than rewarding acupuncture’s broad based, holistic effects, conventional medical research not only ignores acupuncture’s broad benefits but actually punishes this blessed modality for the broad range of its clinical effects. This is because drug research erroneously validates only reductionist hypotheses and explanations.
- Our Drug Culture demanding new pharmaceuticals annually is at the root of numerous evils. New marketplace drugs are no improvements on the old, but merely serve to renew patent ownerships, thus building in escalating costs. Additional evils include a bias against holistically oriented medical research, a perverse incentive to addict multitudes of individuals to potentially harmful vaccines, and hormonally based drugs, drugs for dubious conditions such as Attention Deficit Disorder and meaningless conditions such as shyness. The drug culture promotes an idiocy that our immune system is at odds with our well being as in the inculcated fear of fever, which means only that the body has mobilized against a pathogen. It promotes a view that drugs rather than an active lifestyle, sound nutrition and stress reducing activities are indispensable to health. Most perversely of all, the general public ultimately is obligated to subsidize the advertising costs attendant to its own brainwashing as these are passed along to the health care consumer.
- Insurance cannot be reformed given our health care system’s dependence on profit. Don’t get me started! There are no profits attached to reimbursing for the future benefits attached to preventive medicine, or securing the needs of individuals with “preexisting” conditions. Insurance incentives are to accept premiums from healthy individuals and avoid the currently or potentially sick except at extortionist rates. Because insurance executives and physicians sit on the boards of insurance companies insurers persist in economically irresponsible behaviors such as not reimbursing for safer and less expensive modalities s such as acupuncture and homeopathy while pushing people into more dangerous interventions such as surgery and its necessary aftercare.
- The Demise of Public Health. Growing up in New York City I still recall the existence of public health infirmaries in various neighborhoods. One by one these vanished for much the same reason that the auto industry succeeded in destroying New York’s efficient and energy-clean public transportation trolley car system. At various times in our history the American Medical Association has gone to court in order cripple public health medicine, meaning the appropriation of public monies for one-on-one health care. As a result, American public health care has remained dwarfed: it covers only vaccinations and quarantines. In other countries such as Great Britain, public health care has grown until it has finally formed the foundation of a national health care system. This allows doctors to treat in hospitals and public settings where because they are on government salary they need not be pharmaceutical industry puppets and remain freer to practice sensibly.
- Long Term Care. Because our system rewards the delusional belief that none of us will ever grow old, or that the elderly are always someone else’s burden we are incented to become taxation misers, asset hiders, government and social service agency despisers, and poverty-stricken family member impersonators. Treating long term care as a utility would cost each of us pennies on the dollar a month. It would properly remunerate and adequately train the hardworking caregivers in whom we trust the desperate needs of our infirm parents and relatives. This change in perspective would serve to humanize our culture while restoring its economic and moral sanity.