by Dr. Jeffrey M. Lobosky
That the best healthcare in the world is available in America is probably true… for a price. But WHO figures show this country falls far down the league table when it comes to effective universal coverage for its citizens. Our obscenely high infant mortality rate makes us a laughing stock overseas: $2.5 trillion – two thousand five hundred billion – $2,500,000,000,000 every year goes on health and still babies die for lack of care. That viagara must be pretty expensive.
The last four years have found our nation embroiled in a fierce debate focused on health care reform. Certainly, this battle is nothing new, as presidents from Theodore Roosevelt to Barack Obama have struggled to address the delivery of care to our expanding population. But I think that any discussion of the subject must really begin by asking the question why reform is necessary. After all, we have at our disposal an abundance of awe-inspiring technology, a myriad of pharmacological wonder-drugs, the world’s foremost medical schools and research centers, as well as a legion of well trained physicians and nurses to administer care. We hear time and again that America is home to quote-on-quote “the best health care system in the world.”
How did we decide we are the best? What measures do we use to support such a boast? One only needs to look at the World Health Organization’s comparisons among member countries to find cause for skepticism. We place 30th in the world in life expectancy, 33rd in infant mortality and 30th in maternal mortality. As a matter of fact, we finish far below any of the other developed countries on every single WHO index save two: percent of GDP devoted to health and per capita expenditures on health care, where we spend almost twice as much as any other nation. I for one am not sure we’re getting our money’s worth.
For the critics of such comparisons there is other data that reflects poorly on the American system. We now have close to fifty million Americans without health insurance and an equal number of citizens with insurance that is so meager or restrictive that it essentially precludes access to “the best health care system in the world.” In 2007, over 60% of bankruptcies in the U.S. were a direct result of unanticipated medical bills with the majority of those patients (78%) actually having health insurance when they initially got sick. In 2008, over 750,000 Americans were forced to travel to other countries to receive the necessary health care that was beyond their financial reach here at home.
In light of this information, maybe we should rethink our claim of being the best. And if that’s the case, who do we blame? There are certainly plenty of villains to implicate in the failure of our system; just pick one. How about the insurance companies for a start? They have raised premiums far beyond the reach of many Americans, insuring a healthy profit for their investors and eye-popping compensation for their executives. They exclude individuals with pre-existing conditions from their risk pool and pay bonuses to their staffs for finding loopholes or discrepancies in policy applications so they can rescind care in the event that their client develops an expensive illness.
Then there’s our pharmaceutical industry which over the last several decades has emerged as one of the most profitable entities in American commerce. Through their lobbying efforts they were able to encourage Congress to lift the ban on direct-to-consumer advertising and now flood our living rooms with ads extolling the latest drug for everything from heartburn (which of course is no longer “heartburn” but the more serious-sounding gastro-esophageal reflux disease) to erectile dysfunction. They have successfully blocked Medicare from negotiating the cost of drugs so that many seniors must now choose between paying heating bills and buying blood pressure medicines.
Who doesn’t love to blame the trial lawyers, whose ambulance chasing results in the practice of defensive medicine and the ordering of costly and unnecessary tests. They ply their trade in a tort system characterized by a “lottery” mentality that does little to protect patients from negligent care or physicians from frivolous lawsuits. And our esteemed politicians sell their votes to the highest bidder through campaign contributions, and capitulate to the influence of powerful lobbyists. They forget the people who elected them and do the bidding of only those who fund their never-ending efforts to remain in office.
But blame for the demise of health care reaches beyond these usual suspects. Our hospitals have devolved from community assets erected for and by their local populations to large, multi-facility, for-profit chains that answer instead to the community of investors. Patients with the inability to pay face the loss of everything they’ve spent their entire lives building if they are stricken by cancer or suffer a catastrophic injury. And physicians must also assume culpability for the current state of affairs. Because of the constraints of managed care, they ceased being “doctors” and became “providers,” moving patients through as if on a Detroit assembly line. They now rely on technology rather than the art of medicine, since it’s quicker to order an expensive MRI than to take a thorough history and do a physical exam. They find themselves relegating patients to the emergency room or the care of “hospitalists” if they become ill at inopportune times. And increasing numbers of doctors have become entrepreneurs who refuse to provide emergency room coverage for patients but instead open their own surgery centers or imaging facilities, cherry-picking the well-insured and turfing the poor to community hospitals.
Very few critics of our system implicate the American patient in this debacle. They are looked upon as victims. Yet at last count, a third of Americans are obese, 46 million continue to smoke, and at any given moment one quarter of all hospital beds are filled by patients whose admission is directly related to alcohol abuse. As a result, heart disease, diabetes and other expensive chronic illnesses have soared and promise to exponentially increase in the years to come. Don’t ask these victims to exercise, diet, quit smoking or drink responsibly. No, they want a pill or an operation or one of those free motorized wheelchairs. So, if we must blame someone for our failing system there are plenty of candidates.
But can we fix it?
During the last presidential campaign, health care reform emerged as a major issue. All of the candidates weighed in as to what they would do to address this important subject. Candidate Barack Obama clearly delineated his vision for American health care reform. We, as a nation, listened to that vision and we elected him. Shortly after taking office he began in earnest to implement his plan but as soon as he did all of the “special interests” began to rear their ugly heads, circled the wagons and waged war to protect their cherished piece of the health care pie.
We were soon told his “government option,” which would compete with the for-profit insurers for those patients in the middle, was nothing more than “socialized medicine.” We were told that allowing Medicare to negotiate the cost of prescription drugs (just like all of the for-profit insurers are allowed to do) would reduce the resources needed for the industry’s research and development of the new wonder drugs that were right around the corner. Organized medicine balked at the idea of comparative effectiveness research and labeled it “rationing” or “the creation of death panels” and “the government takeover of health care.” During the 2008 election cycle, attorneys donated almost $300 million to presidential and congressional candidates so it should surprise no one that the new law did nothing to address tort reform.
Not surprisingly, public support waned, significant compromises ensued and when President Obama signed the Patient Protection and Affordable Care Act into law in March of 2010 we were left with a bill that bore little resemblance to what Candidate Obama told us he envisioned for health care reform. Reasoned debate was quickly overshadowed by vitriolic rhetoric (on both sides of the political spectrum) and politics as usual replaced true bipartisan efforts to finally address this issue which threatens our very economic sustainability.
The recent Supreme Court hearings of the ACA seriously put the survival of the bill in grave jeopardy. If the Court finds that the individual mandate is unconstitutional then it will sound the death knell for the entire reform effort. Support from the health insurance industry, hospitals and organized medicine was predicated on this mandate and its repeal will surely cause these special interests to withdraw that support. And if the opponents succeed in repealing the law, we may not see a serious attempt at addressing health care reform for several decades. After the unsavory rhetoric that characterized this recent effort, few Americans will have the enthusiasm to revisit it.
It is time for all of us to stand up and be counted. It is our civic duty to demand our elected leaders cease their partisan bickering and put politics aside. The issue of health care reform is far too important for us to allow it to be dominated by the extremes on the far right or the far left. This debate should not be about Sarah Palin or Nancy Pelosi. It should not be about whether one is a Democrat or a Republican. If you don’t like the law, then come up with a better idea. But let’s have that discussion in a civilized and objective manner. This issue, and how we address it, will define who we are as a nation, not only to ourselves but to the world around us for generations to come.
For so many reasons and for so many people, we cannot afford to get this wrong!