Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
1 Aug

Deconstructing Healthcare in America – a Modest Proposal

I’ve been giving a great deal of thought to our system of healthcare lately. Frankly, I am disgusted not only by the perverse waste of money (we will spend 2 trillion dollars – that’s 17% of our GDP – next year on health related expenses), but also by the obscene lack of success our current system has in helping people achieve, maintain or regain good health. We are getting sicker and sicker as we continue to spend more on healthcare.

While we rank number 1 worldwide in health-related spending, we rank 37th in overall health performance. Sure, Americans live longer now on average than we did 20 or 30 years ago. But the truth is we are only surviving longer, because we are most certainly not thriving longer. Drug companies are keeping us alive just so they can pump more meds down our throats while they pump up their own bottom line. And we are now told that the generation in grade school today may be the first – in centuries – not to outlive their parents. Something drastic has to be done soon. This current system is beyond repair. But if you are one of the 45 million uninsured Americans, for whom the thought of getting sick is, well, sickening, you already know that.

As I’ve been reading all the pre-election political proposals to fix our current “healthcare” system, I am struck by the fact that they are trying to fix something so badly broken that it simply can’t be repaired. Even Michael Moore’s new film “Sicko” doesn’t get to the heart of the problem. The assumptions upon which the current system are built are outdated, obsolete, and illogical. The system requires a wholesale reevaluation and rebuilding from the bottom up, including our rights, our responsibilities – and our reasonable expectations. If virtually every other developed nation (and several underdeveloped) can take care of their sick, we certainly ought to be given the chance.

With that in mind, I would like to offer a “modest proposal” to overhaul the U.S. healthcare system into one that, in my opinion, would do a much better job of caring for its sick and making sure the rest of us stay healthy. I realize that what I’ll be suggesting is a radical change and one that may irritate more than a few professionals who currently operate within our existing healthcare system. Nevertheless, this discussion is vital and I can no longer sit back and watch the system and its patients self-destruct. We gotta talk.

While the problems with today’s healthcare system are many, I have chosen a few to illustrate why we need a massive intervention:

1) Let’s start with the patients. Americans have lost all sense of personal responsibility. We want to blame anyone or anything but ourselves for our illness or condition. Furthermore, we have ceded all control of our health to the people in the white coats. We tend do whatever they say because we hold them in such high esteem. But doctors (like lawyers and accountants) do not have answers. All they really can offer are opinions and advice – only slightly more educated than our own and often biased by Big Pharma, medical supply companies or the fear of being sued. As a result, we way spend too much money on unnecessary visits, drugs, tests and procedures.

2) There aren’t enough doctors in the U.S. One report suggests that as baby boomers start needing even more care, there will be a shortage of close to 200,000 doctors as early as 2010. One of the reasons for this shortage is simply because it takes far too long (usually 7-10 year) and costs far too much to train doctors. Furthermore, most doctors have to pay for this training themselves, often incurring huge student loan debt. It’s not unusual for kids these days to incur six figures in debt simply to get through a regular four-year degree – you can see the problem for the youngsters who desire to go on to medical school. As a result, and to compensate for all this, doctors have to charge too much money for too little service, and then hope that some day they will be reimbursed by the for-profit insurance companies. This doctor shortage is also why when you really need to see one today, the earliest available appointment isn’t until two weeks from Thursday. It would be funny if it weren’t so tragic.

3) The current system depends on private insurance companies to reimburse all costs. This profit-driven insurance-based medical reimbursement system is fatally flawed on several levels – and always has been. The basic business model of any insurance company is to do everything possible to collect premiums and then do everything possible to deny coverage. Therefore, people who need medical attention are frequently denied expensive (but often the most effective) treatment or, alternatively, people with pre-existing conditions can’t get insurance coverage in the first place – when they are the ones who need it most. As a result, insurance companies often dictate the most critical medical decisions more than the physicians. It’s just so wrong.

Rat bastards!

4) The majority of conditions for which people seek treatment can be better treated (and in most cases cured) with lifestyle intervention and education, yet our system of medicine would rather treat symptoms with drugs and/or surgery. Obesity, diabetes, heart disease, osteoporosis, arthritis, digestive problems, asthma and a wide range of other conditions often respond far better to diet and exercise or environmental changes than to even the best “state-of-the-art” pharmaceutical interventions. But doctors are under the gun to meet payroll, pay the rent and pay off the student loan, so they limit office visits to eight minutes and move on to the next patient. Under these circumstances they are far more inclined to prescribe meds than they are to spend 45 minutes or an hour to fully “describe” a lifestyle change that could cure the condition. Of course, they are even less inclined to follow up on any educational visit. What’s the incentive?

5) Pharmaceutical companies, medical equipment providers, hospitals and even a few doctors have a vested interest in keeping their patients ill. You’d think that a successfully “cured” patient should represent a major victory in strict medical accounting terms, yet a cured patient generates no income and no profit. Type 2 diabetics are a good example. Drug companies view a diabetic as the perfect patient – a 20, 30 or 40 year income stream generating $500 to $1,000 a month. The longer they live with the disease, the more additional drugs they’ll need and the more profit the company will make. In fact, the drug company has zero interest in the patient altering his or her lifestyle (and as I have said here often, type 2 diabetes is an entirely preventable and curable condition). They just need to keep them alive.

Moreover, when the market on one disease is tapped out, our friends in pharmacology manufacture new ones: “restless leg syndrome”, “social shyness”, “erectile dysfunction” and “PMDD” are not diseases, but they represent huge profit centers for doctors and pharmaceutical companies who see a lifetime stream of income from patients taking their prescription meds month after month, year after year.

6) The fear of lawsuits causes many physicians to assume a “cover your ass” approach to avoid any potential implication of liability, however remote. Medical malpractice has become a huge industry as personal injury lawyers seek outrageous settlements for even minor mistakes or misdiagnoses. Many physicians leave the business because they can’t afford the malpractice premiums, and they fear the one multi-million dollar mistake that could ruin them. As a result, doctors resort to generalized “standard of care” methods even when those standards have been proven ineffective. For example, there is no good evidence that statin drugs lower the risk of death from cardiac events when cholesterol is between 200 and 250, while there is compelling evidence that diet and exercise interventions dramatically reduce deaths in that same group.

Nevertheless, most physicians prescribe statins and spend minimal time aggressively outlining lifestyle changes because statins are the “standard of care” for high cholesterol cases and because there’s safety in knowing that’s what most other physicians are doing. A physician who does not prescribe statins might be subject to a lawsuit if his patient died of heart problems because, shunning statins, he had tried but failed to get the patient to follow his diet and exercise advice. Fear of lawsuits is also why your doctor will sometimes run hundreds or thousands of dollars worth of diagnostic tests “just to be on the safe side.” You might think your insurance company pays for it all. But those costs are passed on directly to you and everyone else via annual insurance premium increases. God forbid the insurance companies should have an unprofitable year.

These are just a few of the problems with the current system. There are many more. These problems will not go away with the kinds of compromise proposals offered by politicians today. Forcing business to cover the costs of employee healthcare is ludicrous. Other than worker’s comp coverage, by what logic is it the obligation of business to pay for the bad luck, unfortunate genetics or unhealthy lifestyle choices of its workers? The single-payer system that has been often proposed has many merits, but is continuously shut down by Congress. Government guaranteeing the profits of private insurance companies using taxpayer funds is viewed as a misuse of taxpayer money. Yet there is a strong argument that perhaps the time has come for government to step in and do something drastic to fix this mess.

When it comes to business and economic models, I’m one of the biggest Freidman free-market proponents you will ever meet, but sometimes the basic needs of the people require that the government get involved. You could even argue that in the 21st century, given the health tools science has provided us, access to quality healthcare has become a constitutional right (provided you are willing to take personal responsibility for it). It has become my opinion that access to basic healthcare for all, like defense, fire departments and interstate highways, should be viewed as a public good, not as for-profit business with corporations’ profits favored over the health of our poorest citizens.

Yes, I’m advocating a federally funded and federally driven program that would allow anyone of any means access to basic healthcare at little or no cost. Now before you get all Republican on me, let me explain that I am also in favor of keeping parts of the current system for people who prefer and can afford a private medical system. After all, cosmetic surgery, Botox, stomach stapling and Viagra still need to be made available to those willing to spring for it.

It’s not often you’ll hear me suggest that government could do a better job than for-profit industry, but there are so many players in the current healthcare system that require a profit at the expense of the sick – and who have so shamelessly lobbied Congress to allow them to continue this charade – that the concept of “free-market forces” left the building with Elvis decades ago. For example, according to a 2003 study we spent almost $300 billion on “administrative costs” associated with medical experiences in one recent calendar year. From the patient point-of-view, that’s $300 billion of your hard-earned dollars completely wasted.

My proposal is a two-tiered healthcare system which offers government-sponsored healthcare to everyone (we’ll call it “public healthcare”), yet still allows for private medical practice as we know it today to be available to those who prefer and can afford it (“private healthcare”). Anyone of any means could access the public healthcare system with minimal co-payments (which could be reimbursed via tax credits for low-income patients). There would be no private insurance involved in the public system at all because taxes would cover almost all expenses, but the private system would still largely depend on private insurance reimbursements. For those who wonder how or why a two-tiered system could work in this country, look no further than the US system of retirement planning which offers social security to everyone (and mandates taxes to insure it), yet allows those who prefer and who have the means to set up additional private retirement accounts (IRAs, 401ks, defined benefit plans, etc) with tax benefits and almost unlimited upside.

The public system would work much the same way that the armed forces work today. In fact, it could be its own branch of service. Prospective medical students who elected to go through the public system would enlist and would be trained within that system. Their entire training, as well as room and board would be free (paid for with tax dollars), and in exchange for the training, they would guarantee to provide at least eight years of service within the public health sector compensated at a reasonable rate of pay (let’s say $80,000 a year, comparable to a public defender). After eight years of service, they could elect to remain in the system (with an increase in pay) or they could go into the private healthcare system and hang out a shingle (remember how most commercial airline pilots came out of the military?). Nurses, physicians’ assistants, exercise and diet coaches, even administrators could all be trained within this same system. All this could even take place within today’s current armed forces structure with added pay incentives for actual combat-readiness training, but might be more effective as a stand-alone service branch.

With regards to the growing shortage of trained doctors, my system would fix that in relatively short order. This does require a major re-evaluation of what it takes to be a doctor. Bottom line: it shouldn’t take eight years to train a competent specialist like it has up until now. Aside from general practitioners and Emergency Room docs, almost all medicine is specialized today (just tell an orthopedist you have a GI problem and see how fast she runs the other way). I would argue that you can train a smart pre-med college grad 90% of a chosen medical specialty in under two years and have him or her be perfectly competent to begin supervised practice on real patients. After all, most diagnoses theses days are done by computer modeling anyway – not by the actual physician. I don’t wanna say a monkey could do it, but let’s get real.

If a condition is not immediately obvious to attending physician today blood, urine, stool and saliva samples are sent to labs and returned with nice distribution curves and all the relevant data with which to make a cogent diagnosis. CAT scans, X-rays, MRIs and other imaging techniques allow almost anyone to spot a problem and begin treatment.

Even surgical techniques no longer require years of practice with a supervisor looking over your shoulder. Surgeons today can be quickly trained using computer simulators. Ironically, most new surgeries these days are taught to older surgeons by 30-year old medical sales reps (who most definitely are NOT doctors) shilling the latest stents, shunts, implants and titanium joints. The idea is to train more doctors quicker and pay them less. Pure and simple. Those doctors who wish to charge more for special services could either train and operate within the current system or enter that system after their years of public service. But as we have seen in the private system, most of our healthcare money goes to greedy middlemen (insurance companies, pharmaceutical companies, bureaucracy-laden hospitals, student loan collectors) or to wickedly non-productive overhead (office rent, administrative staff, malpractice insurance). As a result not much of our health dollar flows through to provide patient services. That would change radically under my system.

The public system would rely on generic drugs wherever possible and would negotiate very favorable pricing on brand-name meds when those are absolutely necessary. Drugs would only be prescribed when truly medically necessary (sorry, no Viagra or recreational Oxycontin) and elective surgeries would usually be discouraged. Experimental drugs would be allowed if they were the only recourse in critical cases, but only with patient permission and waiver, adequate supervision, and oversight from a restructured FDA. The more expensive drugs would be used on a “pay-for-performance” basis, where the drug company would supply them, but would only be paid if they worked within acceptable parameters.

Education would be a major focus of the public health system. The current for-profit system is based on maximizing treatment as opposed to maximizing prevention. Under the system as it is, we will never make progress preventing or curing the lifestyle diseases that threaten us the most: diabetes, obesity, heart disease, stroke, arthritis, even some cancers. In most cases these respond very favorably to lifestyle interventions, but no one is willing to spend the time or energy to educate. Under my proposal, doctors would be paid for their treatments, but would also incentivized for successfully weaning their patients off meds and for having their patients achieve medical milestone numbers such as losing a certain percentage of weight or bringing fasting blood glucose to under 100 for two successive visits.

These goals can only be achieved when the patient is educated, understands the mechanisms and then takes responsibility for her health. Under my proposal, specialized health educators (maybe those who didn’t fully qualify for the medical training, but who exhibited the interest and the intellect) could be trained within the system and then deployed to schools or assigned to work with physician groups to do hands-on small-group diet, exercise and stress-management coaching. The success private clients currently enjoy working with personal trainers could then be made available to those who currently have no hope of ever gaining access to the true secrets of health and wellness.

Within the public system malpractice and medical “mistakes” would not be subject to the same litigation system we see in private medicine today. Instead, a 3-person panel of experts would hear cases and, upon finding gross or willful negligence, could choose to award reasonable costs according to a set schedule. This would ensure that any patient harmed by the system would be looked after, but would not be awarded lottery-like sums from aggressive tort-lawyers impressing overly sympathetic juries.

In the best of all possible worlds access to a public health system would bring the realization that there are no more excuses. We must each take responsibility for our health and realize that if we don’t make the lifestyle changes necessary to heal, we give up our right to complain or blame “the system” for leaving us behind or for not taking care of us. As we’ve seen with the current system, there’s only so much modern medicine can do at any price.

There, I’ve said it. Give it some thought and let me know what you think. In my opinion, without serious dialogue and outrageous ideas like this, our health will continue to deteriorate until we are a bankrupt, obese, diabetic, arthritic and Alzheimer’s-ridden nation with no good prospects for the future – and no good memories of the past.

Further reading:

Most Popular Posts

Primal Health

Sponsor note:

This post was brought to you by the Damage Control Master Formula, independently proven as the most comprehensive high-potency antioxidant multivitamin available anywhere. With the highest antioxidant per dollar value and a complete anti-aging, stress, and cognition profile, the Master Formula is truly the only multivitamin supplement you will ever need. Toss out the drawers full of dozens of different supplements with questionable potency and efficacy and experience the proven Damage Control difference!

Subscribe to Mark’s Daily Apple feeds

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. This is a fantasic post! I agree with about 90% of what was said. As a future doc, I am a little scared myself, but have to assume that change is coming. This, or free market, is THE way to go.

    Tara wrote on January 24th, 2009
  2. Are you suffering from benign prostate hypertrophy? Then don’t worry because Avodart has brought for you a complete solution for this. With the use of this you can heal your enlarged prostate problem.

    プロペシア wrote on May 18th, 2009
  3. You make vaild points. I even agree with many of them. I do take exception with some however.

    1)Shorter Training times for doctors. I feel you are wrong here. One of my attendings once said that he could teach a monkey to do surgery. This is true. The problem is not the mechanics but everything leading up to and after the surgery.
    Sure I could order an MRI and determine that a tendon is ruptured, but what then… Which of the numerous procedures would be most appropriate for that patient. Following the surgery an infection develops (accepted rate in orthopedic surgery is 1%). Which antibiotic should you use. Should you go back to the OR and do an incission and drainage? These are just a few of the questions that can and often do arise. Only doctors who have seen these complications in the course of a rigorous residency training program will be able to handle them properly.
    You do see providers such as Nurse Practicioners and Physician Assistants who have generally shorter courses of training who do an excellent job, most of the time. But its when the you know what hits the fan that you want a doc who has seen it all and is comfortable with his skills.
    2) You mentioned a system where people were discouraged from elective surgeries. This sounds nice on paper. “Great no more of those silly elective surgeries to gobble up our healthcare dollars”. But when it is you who has chronic and unrelenting pain from a severly arthritic ankle, or hip you may feel differently. I could easily envision a scenario where the “single payer” doesn’t outright say no but rather strings the process along so long that people live with crippling pain. I’m not even saying this is wrong per se. At the end of the day you only have so much money to go around. But I gaurantee that those who have mone will have that bad ankle or hip fixed. They may pay out of pocket, but it will still be done. In a way this almost seems worse to me. I have a friend who practices in Spain he told me that in the morning he sees his state sponsered health care patients and in the afternoon the self pay or private insurance patients. Wait to be seen in the AM 6 months, wait for the PM 6 days. Oh and if you live in England dont bother getting Renal Failure after age 60. The nationalized health insurance doesn’t pay for Kidney dialyisis for the old or infirm. (in other words you die) This might sound ok on paper, and ultimately that is what you have to do if you only have so much money, but when it is your mother, father, brother, wife you may feel differently.

    In conclusion I dont know the right answer. The path we are on isn’t great but proposed plans dont inspire much confidence in me either. HMO’s and managed care were supposed to reign in health care in the 80’s and 90’s but worked too good. Doctor’s didn’t want to participate anymore and people didn’t want to either. I fear a state sponsered system wont do any better.

    Dr. Hamilton wrote on June 5th, 2009
  4. I would end with a word of caution…

    “A government big enough to give you everything you want
    Is a government big enough to take away everything you have.”

    Gerald Ford

    Dr. Hamilton wrote on June 5th, 2009
  5. Go to Europe and try out the socialized health care there and come back and tell us about it. I’ve been and my relatives have been and we had to utilize it. Not something I would want to experience again. Health care is a right, free health care is not. People have no right to demand that professionals give them services for free. And if people want to stay out of doctor’s offices, then maybe they should take better care of themselves. And funny how those same people always manage to have money for a cell phone, television, computer, hair appointment, new car, make-up, new clothes, whatever but health care seems to be at the bottom of the need to have list. Besides tort reform is what we really need, not socialized health care. Bigger government is never the answer to any problem.

    Suzanne wrote on September 19th, 2009
  6. Being from the UK, I have always lived in a place where healthcare was “free”, in as much as you didn’t need to pay an insurer to cover you should you need treatment. As a result, it seems alien to me and others here that people would be against their government providing this facility. As a talk show host over here recently commented “Only in America can a President say he is going to make healthcare accessible to all… and then watch his popularity scores plummet”.

    Here we do sort of have a two-tiered approach. Everybody has access to the NHS(National Health Service)and, if you want to pay extra to someone like BUPA, you can opt to have private cover… the main benefits of which are that you can leapfrog waiting lists and private clinics are nicer to look at (the surgeon you see will do private and NHS work so quality of care is no different, although you will probably be treated to a one-bed room).

    Everybody who works in the UK obviously pays PAYE tax which (in addition to council tax, VAT and various stealth taxes) covers the stuff that tax generally covers (plus our politicians ridiculous expense claims). We also pay National Insurance at a fixed percentage of gross income on a monthly basis which covers the NHS.
    So, it’s not really free – I pay around £250 a month towards it currently. If it made people feel better, we could privatise the NHS and we could all pay that £115 to a non-government body… but the problem then is that people would get blase about it, stop paying and then be up a creek when they fell over or developed cancer.
    My view is that by having it as a government body which we basically pay another, separate tax on, we are protected from ourselves (the human tendency to say “it’ll never happen to me” and therefore try to save a few quid by not paying).
    People who are out of work get their NI paid by their dole money – I do however, think that the scum in this country who are long-term dole-ites (by which I mean the lazy sods who won’t work, not those who can’t due to medical/mental problems or caring responsibilities) shouldn’t have access to the “free” service for anything other than emergency treatment.
    As I said, growing up in a place where this has always been the case (under 18’s go free by the way), it seems strange to me that people do not want their governments to provide this safety net. I remember watching the movie John Q a few years back and, not knowing any health system other than ours, I could hardly believe the predicament they were in. I have always seen the US as a bit of a trail-blazer and the ultimate modern country but on this issue it seemed miles behind! As I said earlier, this is by no means meant as offence – just the view of an outsider looking in. Our NHS is by no means perfect (it’s always being bitched about over here) but when there is an emergency you can not knock it.
    Incidentally, our healthcare workers (surgeons through to nurses) have their training paid for by the NHS and work for the NHS on qualification for a set period of time before making the decision to go private, stay as they are or combine the two. A lot of private clinics have an NHS contract where they commit to seeing a certain amount of “free” cases (which they are paid to do by the NHS, which is paid for by us, through the NI).
    A couple of people above made the comment that you should not expect professionals to give their time and skills away for free which I agree with to an extent… but I have always felt that if someone was embarking on a career in healthcare, then you’d like to think they didn’t have money as their primary motivation. Everyone deserves to be compensated for their time/services but if the system Obama is proposing is anything like ours, they will be!

    Welshcaveman wrote on September 20th, 2009
  7. There are several issues with your post. One, the United States is not the U.K. I doubt you can get Americans to pay 70 – 90 percent or more in taxes. Two, Health care is a profession that many, especially physicians pay exorbitant amounts out of pocket to become qualified for. An MD can spend anywhere from $300,00 to a million for a good education, and then then malpractice will eat up a good chunck of your yearly salary after that (over $100,000 a year). You also have to take into consideration that they spend anywhere from 6-12 years on their education so the time investment is considerable as well. My brother is a physician. He spend 8 years in school, then residency and paid $600,000 for his education. He is now paying over $100,00 a year for malpractice insurance in private practice. It is ludicrous for anyone to feel that a person who invests so heavily of his personal time and finances receive little to no compensation by way of their efforts. As it is qualified doctors are becoming harder to find. I would only expect to see fewer and fewer qualified doctors if they were expected to work even more for less. Simple math. And frankly, to expect any professional to be completely selfless is well, selfish. Do you also expect plumbers to work for free out of love of their profession and dedication to providing service to the public? I don’t see Obama shying away from his yearly salary even though he is independently wealthy and should as a generous human being be grateful just for the opportunity to be of service to his country. I see how that works, let health care professional be selfless in their pursuit while everyone else receives whatever their profession can generate. On top of all this, the free health care is not free, it will cost tax payers about $2500 a year to receive substandard service which most who have any means will opt out of and be forced to pay another 3-600.00 a month for adequate health care. You will pay more than what you pay now for the same care. I was in Dublin Ireland two years ago and experienced socialized health care first hand. We were taken to emergency when I injured my eye. We waited for 5 hours to get in to see a physician. The facility was incredibly depressing and run down and the staff was disorganized and rude. I still shudder when I recall the experience. And I know that wait periods for operations can be as long as two years. Socialized health care costs in many ways. It is hardly a bargain or a good option when you really do the math and take the consequences into consideration.

    Bigger government mean more legislation. If the government had it’s way, supplements would only be administered through a physician, and no preventative health care would even be allowed (Chiropractors fought for years to get what small amount of coverage they receive now). I doubt we would have access to Mark’s supplements either. These are only accessible because of persons like myself who actively fight against government regulation and control of natural health care. As it is now, the real cancer clinics who offer real cures are forced to operate outside our borders in Mexico. The problem with quality health care in this country has always been the limited access to it, not the cost of it. It’s not the government waging campaigns to get and keep raw milk on the selves. The longest living people on the planet live in villages with virtually no health care or health care facilities. Good health is all about taking responsibility for one’s own health. Medicine, socialized or not, should not be the solution to our health woes. Sorry for any errors as I typed this up quickly.

    Suzanne wrote on September 20th, 2009
  8. yeah,You also have to take into consideration that they spend anywhere from 6-12 years on their education so the time investment is considerable as well.

    tax marketing and operations coaching wrote on November 21st, 2009
  9. Mark, I sympathize with you greatly. I see the problems with the our health care system…but you are mistaken. Just as you constantly criticize CW in relation to primal living, I must criticize the type of CW that you have shared in this article. As a bit of an economists, I suggest looking at the source of a problem before attempting to fix it.

    Why are patients irresponsible? Because they either have government health insurance or they have insurance that is very highly regulated by government. People pay for less than a fifth of their healthcare out of their pocket. Consider the implications of this. Remember that the corporate stranglehold over insurance is only possible because of lobbying. You yourself just said,
    “It’s not often you’ll hear me suggest that government could do a better job than for-profit industry, but there are so many players in the current healthcare system that require a profit at the expense of the sick – and who have so shamelessly lobbied Congress to allow them to continue this charade – that the concept of “free-market forces” left the building with Elvis decades ago.”
    Can you not see that your problem is not freely acting individuals, but the vehicle of the state? You have identified the source of the problem: Congress and its capacity for being lobbied.

    Why are there not enough doctors? Because the AMA was founded for the specific purpose of controlling/reducing the supply of doctors to guarantee higher incomes. They were only able to do this, surprise, through the vehicle of the state. I am not saying we should get rid of the AMA. But I am saying (as you point out) that there are plenty of smart premeds who could do better than spend 20yrs in school. Get rid of the legal power of the AMA and there will be (as there were before) a greater variety of training for medical professionals.

    Why won’t people change their habits? Because they aren’t responsible. The corporate/state control of healthcare ensures that individuals have little reason for making those good choices (and the undue corporate power comes from its use of the state).

    What’s the problem with drugs? Intellectual property is artificial scarcity. A tangible thing is scarce because by some using it, others are precluded from using it. A system of property rights is the natural response to dealing with the issue of scarcity. In no way do designs (for drugs or anything else) fit this criterion. Thus Big Pharma owes its power to patents, which only exist through the vehicle of the state. Moreover, the FDA is terrible at regulating. It is its nature to approve/not pull drugs like Vioxx (Tylenol, statins, …the list of bad drugs goes on forever), while denying people access to experimental drugs (e.g. a cancer patient who is dying anyway) or other drugs that would anger those who lobby/pad the wallets of FDA people by hurting their profits(e.g. cocaine, MDMA, marijuana, etc.).

    I can go on about this. You really would do better to continue trusting your less than pro-government gut on the issue of health care. If you’re interested, I will email you a paper I’ve just written on how to fix healthcare. I also have knowledge of an enormous variety of sources on many specific things related to healthcare (essentially any question you can pose).

    ChaseW wrote on December 26th, 2009
  10. Just my 2 cents – as a teacher, I find it offensive that it is okay that we work for lower-than-average salaries, compared to others with similar qualifications, but no one cares about that! Doctors can’t get reasonable salaries, but we can underpay the people who provide education to our children?
    Maybe we should fix the socialized systems already in place before trying to add another one. I agree that health care should be socialized, but I think this government has a LONG way to go before it can handle it. Our children are undereducated when they leave public schools, our teachers are underpaid, and I personally don’t want a health care system that is based on similar inefficiency.
    As for all those talking about “6-12 years of education, they should be paid for it” – they should be. If health care was socialized, I think a great idea would be to put any loans on deferral until the completion of a certain term of public service, and the *bam* no more loans. Also, the cost of malpractice insurance would be gone, since the government would be responsible. Doctors would take home what they make, since the gov would pay for the supplies, building, employees, and so on. It really isn’t that bad of a deal.
    Just another point of view. Personally, I wish teachers had such strong advocates as all of you are for doctors. Maybe then we could attract the kind of teacher that would be effective for our children.

    lady_daraine wrote on January 12th, 2010
    • Teachers only work 25 – 35 hours a week and they don’t even work all year long. They are PART TIME workers, and for a part time job, teaching pays pretty dang well.

      When the teachers in my high school went on strike, the only teachers who showed up for work were from china/japan.

      We all asked why they didn’t strike for higher wages too, and they told us that in their countries teaching is a full time job, and that its ridiculous to get paid more for doing way less work. If you need more money, tutor kids or get a second job during the summer.

      On average school teachers in the US are paid $34 an hour, which is comparable to other white collar workers.

      I’m sorry but teachers in the US are not underpaid.

      Lola wrote on August 21st, 2010
      • You are grossly mistaken about how much teachers work. Generally their day begins at 7, and ends at 4. If they have to do after school activities, that can be until 6-7. So just right there is between 9 and 12 hours per day. Then they come home, grade papers, write lesson plans, and continue to have to work. Anyone who thinks teaching is just like any “9-5” job has no idea what they’re talking about.

        Tim wrote on January 25th, 2012
  11. Being a Combat Medic in the US Army, our universal health care for soldiers is already being used and abused so I do not forsee this going so well. That being said I do think that everyone should have access to medical care, and this may have already been addressed but…

    What about a medical care system based more in cash than insurance? As it has been said before it already quickens the process for being seen and drops the price becuase of not having a middle man. This would cause more active patient involvement seeing it come straigt out of peoples pockets and setting aside some cash for “rainy days” and general self acceptance of the fact that your health is in fact YOURS. Of course this being said with the realization of the fact that people with minimum wage jobs would have a hard time procuring funds, but it would be interesting to see how well this would work if a MD would set up a cash only clinic. [also a written document would have to be signed saying something in the nature of I understand any side effects/complications/risk I am taking by seeing Dr. Doolitte]

    This would be a system defined by reviews from patients, almost a yelp for health care.

    However, there is one thing to be taken from the military; SICK CALL. Where at 6:00 am people who generally don’t feel well come to the main clinic, there symptoms are reviewed by a PA (Physicians Assistant) and then seen by a more specialized Physician. This process goes through several hundred people very quickly and gets alot of the grind work of clinics out of the way very early.

    P wrote on April 4th, 2010
  12. While you do hit the many flaws of our health care system, the government is not the answer. As a financial advisor I work with a lot of people who can’t “afford” my advice. But I still give them my advice and assist them with creating a path to wealth because I’m a good guy. Now lets equate that to the doctors world. Doctors are (usually) some of the most noble people in our society, with a genuine care for their patients. If they had the time (and even some who do not) they do free consultations for people. Their biggest problems, problems you pointed out, are the lawsuits and the personal irresponsibility.

    Lawsuits – lets face it, $200 for a 5-10 minute consultation with a doctor is hogwash. Thats before the perscription cost. Why is it so expensive? because of the lawsuits, they cause malpractice insurance. SO how do we fix this? EASY, make it illegal to sue a doctor for money. You can sue them to get their license revoked, but that’s it. No more free payouts for someone who was mis-diagnosed on a cold. Malpractice insurance crashes to lows, a doctors visit cost goes down.

    Personal responsibility – Once people realize they can’t buy real health, that its something they have to maintain, then will the doctors time be freed up to help those who can’t afford (the much cheaper) insurance.

    You accuse the private sector of being money-whores and while you are correct, your assumption that the government isn’t is completely off base. The department of energy was founded to reduce our dependency on foreign oil in the late 70’s early 80’s. At the time our foreign dependence was (off the top of my head) 25-35%. in 2009 our dependence was somewhere around 80%. yet they continue to get money, why? they have failed at their goal and expanded to areas that they have no business in, the reason… MONEY.

    It’s a PRIMAL truth, those with the gold get treated like gold. those with the gold make the rules. EVERYONE is seeking gold, the money can not and will not be taken out of anything.

    Every american thinks they have the right to top of the line surgeries/procedures, that it’s someone else’ responsibility to make sure they live to see tomorrow. it’s not. it’s your own responsibility. If you are worried about accidents or health issues, BUY INSURANCE. that being said, were I a surgeon and I could keep someone alive by doing a surgery for them but they couldn’t afford it, I would do it for free (or what they could afford) and isn’t that what the hypocratic oath is all about?

    Sounds good on paper wrote on September 30th, 2011
  13. Also, why is it a right to have health care? I mean should it be a right to have a financial advisor? or a personal trainer? how about psychologist? how about a dentist?

    it’s all just a push for more ‘freebies’. i’m all for reforming the insurance industry (which I thought fell to the states) but government run anything is a disaster.

    Sounds good on paper wrote on September 30th, 2011
  14. This article is amazing, so completely true and very well written. I want to “narrate” it from the rooftops!! lol! Maybe one day we will realize this vision for our healthcare system.

    Haley wrote on January 17th, 2012
  15. It’s interesting how this article is still applicable four years later.

    Being in the military, I always considered the armed services healthcare system as a case study in socialized medicine. As with nearly anything that is socialized, it caters to the lowest common demoninator and those who a) invest in their own health and b) do their research tend to get lacklustre results at best. In a system where Motrin is prescribed so often for nearly every ailment that it’s cynically referred to as “Vitamin M,” it’s hard to get thoughtful, personalized, balanced care.

    Anyways, I don’t have a solution in mind for healthcare (and I absolutely dread the thought of insurance premiums for when I get out of the military), I’m not a fan of socializing medicine.

    Alicia wrote on January 19th, 2012
    • Here’s a good lead on the free market, and health care.

      What people fail to realize is that until the government intervened, drove prices up, and quality down, people were much more charitable with the money they had. Doctors were more likely to just give the needy healthcare for free.

      Tim wrote on January 25th, 2012
    • Almost 50 million are urnisuned. The exact thing predicted by insurance people on this format and elsewhere, a couple of years ago, is happening: The Health Reform Act as written by our congress and senate, is making MORE people urnisuned. It will continue to drive the cost of insurance up, and encourage employers to discontinue health insurance coverage for their employers (by making it cheaper to pay the fine, than buy the required coverage). Source: CNN, quoting the CDC.

      Ecuador wrote on December 22nd, 2012

Leave a Reply

If you'd like to add an avatar to all of your comments click here!

© 2016 Mark's Daily Apple

Subscribe to the Newsletter and Get a Free Copy
of Mark Sisson's Fitness eBook and more!