We Caused the Health Care Crisis

Our health care problem is that our costs are high yet our care doesn't make us healthy. There are many parties to blame for this, but the real problem is rarely identified. 

As I wrote here

I'm no hypochondriac, but my doctor has always brushed off most complaints I present to her. She rarely even orders tests. A few years ago, just when I was about to deem her callous, she said something interesting. In response to whatever hazy symptom I was reporting, she told me "Look, I could test you to see whether you have a brain tumor, but what will probably happen is they'll find no tumor but something else will be noticed that will call for lots more tests, and, inevitably, procedures. I try to keep my patients the hell out of the machine so it doesn't kill them."

It's pretty well-established that VIPs, with clutches of physicians monitoring every vital process, enjoy worse health than patients with less doting and expensive care. The reason is that each test, each medicine, each procedure, each hospital visit carries some degree of risk. The more you're in the system, the more risk accrues, just as costs accrue.

The solution is, clearly, less of all that. But American health care always moves toward more. We can blame the lawyers (doctors, fearing malpractice lawsuits, order excessive tests and anxiously try to be proactive on every complaint), we can blame big pharma (they bribe doctors to prescribe more), or we can blame insurers (who pay doctors on what amounts to a commission basis). But, really, the problem is us. Because while it's undeniably true that less attention, less care, less tests, less procedures, less drugs is better, and would, in the end, make everyone healthier, that scenario would mean a few people suffering or dying unnecessarily (e.g. the instances when people come in complaining of a headache, and it really is a late-stage brain tumor). And while we're able to reconcile that sacrifice in the abstract, it's a different story when we're talking about our sons, daughters, and parents.

There are places in this world where life is a little less valued; where it's not considered an affront to one's human dignity to kick the bucket as a result of drawing a short statistical straw, and sparkling vibrant perfect health is not deemed a birthright. It could be argued that in 21st century America, life is more valued than our society can afford. It breaks a taboo to say so, as we're fundamentally unable to staunch the thought of loved ones dying a death (or suffering a debilitating affliction) that's remotely preventable. The alternative, of invasively tracking down each and every long-shot symptom, is not the best course, medically or economically. But we just can't brook the necessary outcome. And that is the stone in the pond which has produced all the evil ripples.

One under-reported ripple is entrepreneurial physicians. Read this superb New Yorker piece on just how bad it can get when doctors "come to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers." But even this is an effect, not a cause. Some doctors are indeed greedy and callous. But others are just trying to make an honest buck in a system weirdly stacked against them. Office visits where patients are simply told to take two aspirin and call in the morning are paid in the low two digits. Should doctors principled enough not to over-prescribe and over-test be forced into poverty? 

The system's the problem. And the system, ultimately, has come about from a dysfunctional, self-destructive coupling of two otherwise noble American ethics: 1. each life is sacred, and 2. the consumer is king.