Monday, March 22, 2010


Apparently Congress is going to enact some degree of healthcare reform this week.

Looking back, it’s surprising we had the system we had till now, since it featured two glaring errors.

One was our neglect of the fact that healthcare insurance corporations exist to make profits, period. They aren’t in the business of providing healthcare. Quite the contrary: since their profits arithmetically equal the money they take in minus what they pay out, they serve their stockholders best by denying and delaying payments. The sooner we remove their ladle from the money stream, the better.

The second error, which continues to thrive, is that we still have no meaningful handle on costs. No matter who pays, healthcare’s expense will continue to rise. In the 1960s one dollar of every twelve spent for anything in the United States went toward healthcare. Today it’s almost one in five, and counting.

Why is American heathcare so expensive? Having been examined more thoroughly than any patient ever was, it’s coughed up this conclusion: we simply use too much. Surgeon-writer Atul Gawande explained this elegantly in an article in the June 1, 2009 issue of the New Yorker. I’m told this piece is required reading for White House staff.

There are a couple reasons we overuse healthcare. One is that we tend to medicalize problems that arise from lifestyle. Too many of us suffer the effects of terrible diet, toxin exposure, poor relationships, and inadequate exercise, and then, instead of changing the way we live, ask doctors to fix us. Obesity, type two diabetes, diet-related high cholesterol, and a host of other diagnoses can be treated effectively with lifestyle change, but we somehow find it more attractive to request expensive, side-effect-rich medications and surgeries.

Another pressure toward overuse is plain old marketing. There’s hardly any illness for which some smart cookie can’t invent a high-tech diagnostic or treatment gadget which healthcare facilities snap up in order to compete for patients. There’s an apocryphal story about a computer geek who heard that a local medical center was offering free digital exams. Just the thing for him, he thought, so he rushed there only to discover “digital” also means “finger.”

Despite this week’s move toward heathcare reform, we’re still stuck with a cultural conundrum. Can we persuade ourselves to back off the often-illusory promises of medical technology long enough to take a good look at how we choose to lead our lives?

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