By Russell J. Andrews, Special to CNN
Editor’s note: Russell J. Andrews is a neurosurgeon who has been a U.S. Army flight surgeon, a clinician and researcher in both academia and private practice and a medical device developer with NASA. He is the author of ‘Too Big to Succeed: Profiteering in American Medicine.’ The views expressed are his own.
Medicine is big business in America. Nearly one fifth of our GDP is spent on health care – 50 percent more than any other developed country. Yet by many measures we are not getting value for money. Even nearby Cuba, which spends less than one-tenth as much as the U.S. per capita on health care, has outcomes that are as good or better: life expectancy is just as long, and the infant mortality rate is actually lower. Health care in the U.S. is on an unsustainable course, and costs cannot continue to increase while outcomes continue to deteriorate.
This crisis has been blamed on greedy malpractice lawyers, drug companies, health care insurance companies and doctors who over treat patients by practicing defensive or wasteful medicine – unnecessary tests are ordered and unneeded operations are performed. And there is something to all of these. Doctors have failed to address this health care crisis, so other groups offer solutions – notably economists and political commentators. Not surprisingly these proposals represent the expected economic or political views, namely: “Which reform will rein in burgeoning health care costs?” and “Which reform will be politically acceptable?”
Medical students since ancient Greek times have sworn to uphold the Hippocratic Oath. Yet nowhere in the Hippocratic Oath is money, financing or making a profit mentioned. Medicine is a unique relationship between two people, one born of a person’s need for the skills of another person to live and be healthy. Even more than the teacher or the religious leader, the physician bears a responsibility that transcends financial gain. That responsibility to uphold the Hippocratic Oath has been lost in present-day American medicine.
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Runaway costs and deteriorating patient outcomes are symptoms, not causes, of the present health care crisis. There are two primary factors at play: (1) the exchange of the unique long-term doctor-patient relationship (where the doctor assumes personal responsibility for the patient receiving the best care possible) for impersonal “corporate medicine;” (2) the morphing of American medicine from a function of humanitarian society into a revenue stream for health care professionals, drug and medical device companies, hospitals, and insurance companies. In essence, we have transformed health care in the U.S. into an industry whose goal is to be profitable, and the health of the patient is not really in the equation. Imagine if such a transformation from a societal good into a profit-making industry occurred in public safety (police and fire), clean air and water or basic education?
True, many incoming medical students have humanitarian motivations (an M.B.A. or a law degree is a quicker route to financial success than medicine). However, corporate America begins invading the physician’s professional “genome” early in training. Academic medical centers are as challenged as community hospitals in making financial ends meet: the faculty member who does not maintain the revenue stream is likely to be let go. The same is true for a physician in private practice – remaining economically viable is a full-time job (leaving less and less time for actual patient care) as for-profit insurance companies work ever harder to reduce their expenses.
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The family doctor who follows you over time and place (“from womb to tomb,” and in both the office and the hospital) is being replaced by compartmentalized corporate medicine. In-hospital care is assumed by a team of hospital-based physicians (“hospitalists”). Hospitalized patients may see three or more different hospitalists in a 24-hour period – and still others if they remain hospitalized over a weekend. Indeed, one hospitalist group has impersonalized this to the point where the patient’s doctor is whoever happens to hold the “hospitalist pager” at the moment.
It is sobering how the for-profit “virus” has “infected” health care in the U.S. medical students learn that physicians must forego “the joy of healing those who seek their care” to survive in the profit-driven medical environment. Direct to consumer (patient) advertising – at present largely limited to prescription drugs, although ads for surgical procedures are appearing – clouds the physician’s ability to prescribe what is truly best for the patient. Physicians are forced to prescribe treatment plans that place the financial health of the system (including the doctor’s own “financial health”) ahead of the physical health of the patient.
Medical research and drug and device development also aren’t immune to the profit motive. Many examples exist of millions of dollars wasted in the development of drugs or devices that in the long run were doomed to fail. Competition in medical drug and device research is not like competition in the cellphone or automobile industries. Consumers quickly determine which cellphones are best for them. Health care consumers (i.e. patients) cannot determine if a novel (expensive) drug will be beneficial for them, nor can they predict if their artificial hip or lumbar spine fusion will provide many years of improved quality of life. There are “lemon laws” if your new car fails to perform – but there is no trade-in available for a “failed back.” And again, the profits are privatized up front (to the physicians, the hospitals and the drug and device manufacturers), while the losses are socialized later on (disability payments and the other societal costs of a person who cannot work).
Fortunately, there are signs of health care reform that put patient before profit. The PCMH (patient-centered medical home) places the physician-patient relationship at the forefront of a team providing full-service medical and social service care. The EPMA (European Association of Predictive, Preventive and Personalized Medicine) brings together medical societies, medical research institutes and university hospitals and medical corporations from around the world to address, comprehensively, medical challenges such as diabetes, cardiovascular disease and neurological disorders. Unlike the U.S., European countries provide basic universal health care for their citizens and are not controlled by for-profit insurers and hospitals.
Yet ultimately, the only way true health care reform will happen here is if the voting public in the U.S. rejects the unsustainable course of for-profit medicine. We must lobby our elected representatives in Congress and locally, demanding change. The public must exercise their democratic duty to make their views known – through emails, letters and the ballot box. We don’t just owe it to ourselves to do something – our lives depend on us doing so.
Excellent article CNN ! The author is honest and points the right way in Health Care in the US.
I kissed my way up to VP at a health insurance company. Now I take over $600,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $113,700 level. Now I only pay 1.2% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.
In reading this article it became apparent that the author has no depth of understanding of the problem facing health care in the US. He gives a superficial overview that has been in every article written in the media since this topic gained attention. Yes, I know the author is a neurosurgeon, unfortunately the precision necessary for that vocation doesn't translation into a cogent argument since he missed many important points. This is highlighted by what he uses as a beacon of hope.
Putting the burden of change on citizens is not going to bring about change and show that the author is out-of-touch with the real problems facing healthcare today. The author also fails to mention any positive reform that will be brought about from the ACA. Some how I feel that was not an accident.
This is clearly a case of someone who needs to take a few courses in health systems before writing a appearing as an expert.
So, what important points did he miss? The author only seemed out of touch to me when he said a law degree or an MBA is a path to financial success- nope, not anymore they're not.
Really? I think he hit the nail on the head. We don't have a health system we have a medical industry. The purpose of the medical industry is to maximize profit, without any requirement to deliver benefit. A health system is there to keep people healthy. He's right that it isn't sustainable too. This is part of the 1% issue. The rich don't care that the 99% will in many cases be driven to bankruptcy in old age by medical bills, not their problem. Education, health, police, fire, ambulance, military, water and probably electricity should all be non-profit.
God bless the little people!
I feel the same way, little. What makes me mad here is that this President Obama never hesitated to sent four F-15 to Egypt while poor people in this country need medical care. We Americans need to take care of our own instead of trying to rule the whole wide world!
What I find so ironic with your comment is if you want to put down Obama be honest and just say you hate him. He is the only present in my lifetime to address health care. It is people like you that are screaming at him over that as well. His solution will need adjusting over time for sure, BUT damn it is a start…..
for cryin out loud, people! The neurosurgeon is right! single payer would absolutely put the bigwigs in insurance, pharmacuetical companies and execs in other high places out of business! One of the reasons I voted for Obama is that he had the best chance of actually making a difference! True, the new law needs some help, but somebody had to start this ball rolling, and I am so grateful that he did! (and all those people that work for and with him) (And all those wonderful people in the senate and house who voted with him) We need a huge transformation in our health care system, and it will hurt big time to get it done. But folks, it has got to be done! Where else but the US is the place to
get it done right? Who else but US citizens to do it? We can, you know, Yes WE CAN!!
Reblogged this on AMISTAD and commented:
"Even nearby Cuba, which spends less than one-tenth as much as the U.S. per capita on health care, has outcomes that are as good or better: life expectancy is just as long, and the infant mortality rate is actually lower. Health care in the U.S. is on an unsustainable course, and costs cannot continue to increase while outcomes continue to deteriorate."
I practice medicine in a large US city where I teach residents and students. I care for over 8,000 patients per year. The statement that the hippocratic oath is lost in medicine today is untrue. The oath simply states that medical professionals who commit to it will perform medicine for the 'good', do no harm unto their patients, practice non-judgmentally, and maintain confidentiality. These are the main commitments in the oath. This remains 4 of the major tennants of medicine today- bring benefit to the patient, do no harm, do not judge and never tell others about your patients. Please don't scare the public into believing physicians do not practice these ethical values with serious intent.
I'm sure you would have time for internet comments if you actually practiced medicine with a lot of responsibility at a large hospital. Also, I think you'd need to be able to construct a sentence to get into medical school- " This remains 4 of the major tennants of medicine today- bring benefit to the patient, do no harm, do not judge and never tell others about your patients."
The truth should "scare us." I have experienced the fact that "doctors" want to do unnecessary procedures and unnecessary tests for profit.
And even Marty MaKary who wrote "Unaccountable – What hospitals won't tell you." tries to warn us – not scare us. He is a surgeon at John Hopkins and he cares about the little people.
You scare me because you aren't telling the truth.
I wish the author just would have came out and said "we need universal health care." Because we flippin' do.
Let patients determine price of healthcare
Yes, I have posted on Facebook and blogged on my wordpress blog about this very issue for the past 4-5 years. Many of the statements and comments in this article I have stated myself so it is no surprise that I agree with the thrust of it.
Please research H.R. 676 and learn how a national government financed healthcare insurance plan can save our economy and provide the medical financing that our population needs.
Can we start this whole clean up of health care with our mouths? Meaning I have shelled out over 8 thousand dollars in Dental Copay's with insurance that is available even for Government employees. Health care itself while expensive from a monthly contribution point is not as painful when I actually go to a doctors appointment. The copay is reasonable and the medication generally not too bad in price. But these damn Dentist and Dental office companies are getting fat off the people.
Yes, about 90% of them are shysters and they create problems, do unnecessary work, and they don't reallly reveal the best preventative care. They are trained in dental schools how to get the most profit. I know this from experience.
WOW. What amazing insight the author brings to this problem. An issue almost all of us think is in need of improvement can be fixed (probably) when millions of us have a change of heart and priorities. Who is this guy....Solomon. Other than 320 million of us having an epiphany and completely re-inventing our healthcare system, does the author have any immediate practical suggestions? As soon as you figure out a blueprint for convincing physicians to work for $60-80,000/year, all hospitals to become charitable or non-profit and devise a workable, single pay reimbursement system perhaps then you can fill in the blanks. Let me make the suggestion that the US spends a proportionally larger percentage of its GDP on healthcare because: we choose to and we are an unhealthy society...approximately 60% obesity. Our healthcare cost is "unsustainable" in the sense that many believe we have reached the upper threshold of taxes we are willing to pay to support any and all government systems. If we are willing to increase our tax burden and re-allocate resources it is not necessary to re-invent our healthcare system...improve it, maybe, but not turn it on it's head. The suggestion that the US needs to follow the economic model of Cuba is insulting and laughable. If the healthcare system is better in Cuba and here it is the only thing that works as the balance of the Cuban economy is in shambles and has been for decades.
Medicine for profit with it's perverse incentives, it's code of silence, it's dangerous doctors who are protected by hospitals administrators is not a good system. Read "Unaccountable" by Marty MaKary because he cares about us little people, The book might save your life.
I have a friend who was recently determined disabled. He doesnt qualify for medicare just yet but was told he is covered under medicade. HOWEVER he does have a co~pay. That co~pay is $926.00 a MONTH! That is 75% of his income and totally ridiculous. It would be cheaper for him to buy his meds off the street. Is this because of Obamacare?
This is obviously written by someone with no more than superficial knowledge of healthcare.
We doctors continue to do the best we can for our patients.
This mindless rant adds nothing .
Sound to me like to enjoy your profits more than you care about your patients – very sad, and frightening.
If US healthcare / doctors are so dangerous and greedy, then don't use it. We Canadians love to come to the US for your 'bad and dangerous care'.
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