Monday, August 27, 2012

THE GLOBAL HEALTHCARE CUL DE SAC


I’ve written here ad nauseam that no matter what healthcare policy the U.S. pursues—the the Affordable Care Act (“Obamacare”), old-fashioned fee-for-service, national single-payer, or the mishmash we currently suffer under—healthcare costs will eventually bankrupt us.

When we take a disciplined, knowledgable look at why healthcare is so grotesquely expensive, the usual suspects—doctors’ incomes, hospital billing practices, malpractice issues, nonpaying patients—fall by the wayside. Sure, they exact some cost, but are dwarfed by a single megaproblem: we grossly overuse medical technology...and there’s new hi-tech coming down the pike daily, with ever greater price tags.

We hear about growing lines of patients awaiting services in the U.K. and Canada, and now the same sort of news is emanating from Cuba and China. Check out http://news.yahoo.com/cuba-campaign-takes-free-health-care-142839515.html?_esi=1 and http://news.yahoo.com/chinas-chaotic-health-care-drives-patient-attacks-131133300.html?_esi=1.

Cuba’s system is entirely socialist, meaning the government owns the facilities and employs the practitioners. Besieged by increasing costs, Cuba's health sector has already endured millions of dollars in budget cuts and tens of thousands of layoffs, and it became clear this month that Raul Castro is looking for more ways to save. A media campaign is now discouraging what it terms “frivolous” medical visits. Its theme, on posters in clinics and ads on state TV is, “Your health care is free, but how much does it cost?”

China’s system is, surprisingly, more and more market oriented, with patients covered by private insurance. Demand has so grossly expanded that facilities are insanely overcrowded, doctors glaringly overworked, and patients infuriated to the point that several have murdered their doctors. Said Yanzhong Huang, an expert on China's health reforms at the Council on Foreign Relations, “The supply cannot catch up with demand, you have long waiting times, doctors on average spend five minutes with patients and don't have time to communicate well with their patients, and that creates problems." Does that sound familiar here?

According to an expert at the World Health Organization, much of dissatisfaction with healthcare occurs when “…people don't know the limitations of medical care and they expect that if they pay, the cure will come.” That should also sound familiar.

I don’t see any way out of this dead end except stopping, quieting down, and redesigning healthcare after publicly exploring its most basic questions: what is healthcare about, anyway? What do we mean by “illness,” “treatment,” “suffering,” “healing,” and “cure?” How are body and mind related? How are lifestyle and illness related? What’s the doctor’s responsibility? The patient’s? The caregiver’s? What happens when they meet, and what should happen? When is it okay to die? What level of care do we owe one another?

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