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America’s Health Care System: It is Not a Jobs Program

In a New York Times op-ed article, “We Can Be Healthy and Rich,” Ezekiel Emanuel writes about the impact of the health care system on our larger economy and points out that there are many vested interests in the status quo of high health spending.

These high health costs are not geared toward the public good, but rather the economic impact of the massive spending.

He rightly states:

“Health care is about keeping people healthy or fixing them up when they get sick. It is not a jobs program.”

According to the Council of Economic Advisers, reducing health care costs by just 1 percentage point every year would lead to a 4 percent increase in G.D.P. by 2030. In today’s dollars, that would mean an extra $600 billion for our economy and an extra $7,000 for the average family.

Various comments by readers illustrate many views on his article and a number of additional perspectives.

The United States- A Third World Health System?

By Brian L. Grant, MD

This rather long feature article from the New York Times magazine is worth a read on many levels. It is an in the trenches view of the reality of life for too many American’s, and some creative efforts to import a system that had value in Iran to the poor of Mississippi. The article “What Can Mississippi Learn from Iran?” notes that 84% of our health care dollar is spent on treating and managing chronic conditions. Interventions that impact these conditions pay off in reduced morbidity and expense.

Health care does not exist in a vacuum but rather in a larger social context. The article raises many questions about poverty, equity and humanity. What are the implications of promoting our current system over other alternatives that recognize human shortcomings and work within existing social contexts? Imagine how the U.S. appears to those in countries as disparate as Iran, France, Great Britain, Canada and many more that provide health care as part of the social contract?

Compare and contrast the crying needs and resource shortages described in this article to the context that many Americans, provider and patients alike exist in – where technology, procedures and interventions reign, all too often driven by factors other than clear evidence, and frequently administered not based upon clear and compelling need, but rather by the ability to pay or the desire to be paid. There is nothing inherently wrong with profit, but should it be the driving factor in a health care system any more than it should be the driver for education or other social needs and goods?

Read more here: “What Can Mississippi Learn from Iran?”

Full Face Transplant a “Success”

 

A man referred to only as Rafael was the recipient of the first full face transplant. The operation, which was done in March, was performed by 30 Spanish doctors in Barcelona. Mr. Rafael underwent the transplant after nine previous operations failed to help his neurofibromatosis, a genetic disorder that caused benign tumors to grow on his face.

Magnetic Brain Stimulation Fights Depression (for now)

When weighing electroshock treatment, one’s mind typically drifts to practices seen in popular films rather than curing depression, but studies going on right now are looking to change that. While all parties may not agree regarding the ethics of such treatments, the facts are in: 14% of patients recovered from depressions in the first trial and 30% in the second.

The big question is what to do next. Doctors can’t agree on how long treatment should last or what sorts of drugs to pair with treatment.

Silk Brain Implant Could Aid Spinal Injuries, Epilepsy

Reuters posted a very compelling article about a silk chip that adheres to the brain that has the potential to help people with epilepsy or spinal cord injuries. The water-soluble silk dissolves onto the brain leaving only the electrodes behind. Going forward, this technology could have the potential to help other disorders like Parkinson’s Disease and Multiple Sclerosis.

Benefit for Uninsured May Still Pose Hurtle

With the passage of health reform, we are now seeing frequent reports of its shortcomings. The new legislation still relies upon a private insurance market and the expectation that individuals will buy insurance or suffer penalty. People, especially those with lower incomes, will behave rationally and in what they perceive to be their economic interests. This many for some include preserving scarce cash today, and not focusing on an uncertain and expensive need for future health care. Rather than argue that people should behave responsibly and address future health issues with insurance, this article, from April 20 in the NY Times, and the individuals describes speaks for itself.

“Wellness” – A Word I dislike

The New York Times Magazine of April 18 carried this article that addresses one of my pet peeves – the abuse of our beautiful language. Actually the article is too kind to the word, focusing on the first use and evolution of the term. What benefit is there to a word that has a perfectly fine equivalent called – health?

Wellness has become a buzzword and a marketing term to promote all sorts of expensive maneuvers and services, often in the workplace, to improve the health of individuals, often involving incentives, paid consultants and the like. I have yet to see a scholarly report that establishes the effectiveness of such programs and their cost benefit. I believe it most likely that those who wish to be healthy need no external incentive or program, and are already taking care of themselves, and those who can’t or won’t engage in healthy choices in their lives are unlikely to be significantly persuaded by a workplace program.

How many people are in the dark about what it takes to be healthy, especially adults in the workforce?

A Remedy for Troubled Doctors

Physicians from time to time have issues impacting their ability to practice. Many of these issues are temporary, relating to health or substance abuse, skill deficiencies and other matters. Others may become permanent. At MCN in the course of credentialing consultants, we review cases where regulatory action has taken place. This Wall Street Journal article describes one program’s approach to assessment and remediation of physicians who have practice issues leading to regulatory action in California.

Managed Care: Get Used to It

From the New York Times on Sunday March 14, this article states the obvious; that avoiding change in the health care system is not an option and that payers will exercise some decision-making and control over what is paid for and permitted. An inherent challenge in any system where the payers are not the consumers is that usual marketplace controls are not present. When we pay ourselves, we generally exercise restraint. In health care it is the rare service that is paid for by the patient. The patient has no particular motivation to not consume, or to shop for price, and the providers have motivation to treat and sell services to the degree that they can be medically justified. An interesting thought experiment would be to imagine a patient seeking or being advised to obtain a given treatment, and then instead of  being given the treatment, they are given the money that the treatment would cost at the place they were considering, and told that they have a choice of getting the treatment, keeping the money and foregoing the treatment, shopping for the treatment at a lower cost and keeping the difference, or  changing the type and extent of the treatment (for example switching from a brand name to generic drug). Obviously the complex nature of diagnosis and treatment would make decision-making a challenge for many. Furthermore, irresponsible behavior combined with the perverse incentive of keeping the cash would mean that many would take the money and not vaccinate their kids, and generally be more resistant to preventive care where they are not currently suffering or in pain. Health reform proposals as best we can tell, are not meaningfully addressing the excess utilization trends that occur regularly.