I see so many current problems in so many aspects of our society arising from the supreme focus on profits when capitalism is allowed to run amok without any social constraints.
Our healthcare industry values patients only as consumers and manipulates us to “need” moneymaking services like surgeries, or lucrative products like the latest medications.
In An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, author Elisabeth Rosenthal, MD, argues that our health care system focuses less on health and more on profitability — and supports the premise with compelling anecdotal illustrations of what is wrong.
Although they exaggerate for emphasis, her “economic rules of the dysfunctional market” target the issues with remarkable precision; for example:
- More treatment is always better, and a lifetime of treatment is preferable to a cure.
- Amenities and marketing matter more than good care.
- There is no free choice; patients are stuck buying American.
- Economies of scale don’t translate into lower prices; more powerful providers can simply demand more.
- There is no such thing as a fixed price for a procedure or test; prices will rise to whatever the market will bear and the uninsured will pay the highest prices.
In the second book,Mistreated: Why We Think We’re Getting Good Health Care — and Why We’re Usually Wrong, Robert M. Pearl, MD, calls attention to disturbing realities, e.g.:
- Medical error still accounts for close to 10% of all American deaths.
- The lack of universal use of interoperable electronic records still leads to duplication of effort and errors.
- Physicians continue to be paid on volume rather than the value of the services they provide.
- There is inadequate focus on prevention.
- There is an opioid addiction crisis that stems, in part, from deliberate actions by pharmaceutical companies.
In the latest of his incisive books,Prescription for the Future: The 12 Transformational Practices of Highly Effective Medical Organizations, Ezekiel J. Emanuel, MD, refutes the notion that reforming the health system goes well beyond skirmishes over the Affordable Care Act.
He suggests that it is about resolving two fundamentals problems —
- underperformance of the system on practically every metric and
- unaffordability of health care for individuals, businesses, healthcare professionals, and the government.
My fear is that everyone — individuals, businesses, the healthcare industry, governmental leaders, and policy makers — is ignoring the symptoms of a chronically ill system because of the sheer exhaustion that comes with a toxic political environment and a deeply entrenched status quo.
Author: David Nash, MD, MBA, is founding dean of the College of Population Health at Thomas Jefferson University in Philadelphia, and a board-certified internist renowned for his work in public accountability for outcomes, physician leadership development, and quality-of-care improvement.