On Health Care in America

Stay Well

After experiencing a set of scary symptoms, I called my “primary physician.” Primary, I guess, because I had seen him twice before. I had another Doc, but he went into a boutique, also called a concierge, practice. That’s where you pay physicians a retainer for which you receive intensive care from them and from their staff including same day appointments, all lab work booked and arranged for you, telephone checkups and most of the amenities you might expect in a boutique for the wealthy. Instead of having a typical practice of 2,500, the concierge doctors hold it down to 600 people. Of course, the retainer, close to $1,000, has nothing to do with the costs of treatment. You still pay for that. So being unable to afford this guy, I made my way to this new Doc who is now my primary.
Alarmed by my symptoms, he said rather than my coming in to see him, I should go straight to a specialist. His secretary found me a specialist who was open, and I went immediately to his office. Of course, I had to drive 30 minutes to the suburbs to get to him.
We spoke for about 10 minutes. He listened to my heart, took my blood pressure–“too high” he declared–and had his techie give me an EKG while he excused himself to see someone in another examining room. He returned with a bag of blood pressure medications, samples, which he handed to me. “Your heart sounds fine, your EKG is normal, I don’t know what it is,” he said to me. He then wrote out a series of referrals for four different lab tests, and dismissed me: Don’t call me, I’ll call you when I get the results.
After I completed two of the tests, he called. “You’re fine,” he said. By this time two weeks had gone by and my strange symptoms had begun to fade. I’m fine, I guess.
I have no doubt that most people who read this can match it with doctor/hospital stories that are even more telling about medical care in America.

Why the system doesn’t work

The health care system is built basically on a machine model of the body. This model orients its practitioners to looking at what’s broken, and then to follow a standard treatment modality designed to fix it. The alternative is well known: a focus on health maintenance. Of course, maintaining good health challenges dangerous workplaces, polluted air and contaminated water, toxic environments, and foods drenched in pesticides, irradiated.or genetically modified. We have a mammoth medical bureaucracy, but public health sits at the bottom. Actually, American health care, arguably the most expensive in the world, has not resulted in a higher standard of health for us.
To begin with, there are not enough doctors and other health care workers. Physicians have controlled the size of their guild, typically claiming that too many physicians would increase health care costs. This may be true, but only if they keep at their overheated high salaries. Actually, the US has fewer doctors per person than most Western industrialized countries. Annual health spending per person in the US amounts to $5,267. This is almost two and a half times the median spending in industrialized countries around the world which is $2,193.
Another function of the medical establishment is to control the practice of health care. Well-trained nurse practitioners and physician assistants could easily replace most internists and general practitioners. Instead state regulations, promulgated by the medical associations, control the number and activities of these professionals.
Another part of our being ripped off is a consequence of the fleecing we get from the big pharmaceutical companies. (For one example, Bristol-Myers Squibb reported a second quarter profit this summer of $1 billion–and they paid no taxes.) To guarantee their outrageous profits, the drug companies maintain a phalanx of 3,000 lobbyists. These companies, along with the health products industry, spend more money trying to influence federal legislation than any other industry group. Despite the profiteering which characterizes medical care, or maybe the natural outgrowth of it, relatively little is spent on research, and this despite the fact that the National Institutes of Health subsidize almost 30% of medical studies. Only six cents of every health care dollar is spent on research. Worse yet, only one-tenth of a cent goes into long-term evaluation research. Still worse, one knowledgeable Physician’s Assistant told me, almost nothing is known about drug interactions when a person is taking more than two medications.
Sloppy hospitalization adds to the cost both in dollars and in health. The Centers for Disease Control and Prevention noted in a recent study that as many as two million infections are acquired in hospitals each year. As a result, 90,000 people died who shouldn’t have. These figures, by the way, are based on reported incidents and so are a definite understatement.

Race and Class

Racism intrudes in so many ways into the health care system that it appears as natural as the “for colored only” signs of another era. Blacks and other minorities are not only under- represented among medical practitioners, but they are accorded differential treatment as they enter the system. The discrimination studies have made quite apparent. Blacks are less likely to get life-saving or other genuinely needed treatment than whites--- even when displaying the same symptoms.
There are now approximately 45 million people who do not have health insurance. By all estimates, the number is growing. Without insurance, it is hard to get care, and the poor often wait until their symptoms are so pronounced that their problems become even worse and more costly to treat. The outcome according to one study is that 18,000 people will die this year in the US because they had no insurance.
Some final words of advice: Don’t get sick. And while you are healthy, join the struggle to overhaul this unhealthy system of health care.

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