What is good health care?
Dr. David Gratzer, a psychiatrist in New York, gave a lecture at the Heritage Foundation back in 2006 entitled “How Capitalism Can Save American Health Care.” He makes a good case for changes that he proposes would greatly decrease the cost and improve the delivery of health care here in the US. It’s worth a read, if you want to take the time. Dr. Gratzer and his wife, also a physician, relocated from Canada. He’s also the author of “Code Blue: Reviving Canada’s Health Care System.”
So I would posit that he’s given health care more than a little thought. My guess is he moved to America for the same reason that most immigrants move to America, opportunity. The American dream.
But I would like to explore that dream and then use that exploration to refresh the view of health care.
The first thing that comes to mind for me when I hear the term “the American Dream,” is freedom. That, I think, is the cornerstone of the American Dream. All else pales in comparison to that.
But what is sold in these times as the American Dream is not freedom at all, but bondage wrapped in the illusion of freedom that gives a distorted view of the bedrock of what it is to be an American.
What is sold as freedom both here and abroad is a house in the suburbs, a Mercedes in the driveway, a new kitchen when the color gets old, a condo in Aspen and a boat in Miami. And the best way to get to that level of consumerism is free and unfettered capitalism. And once you’ve bought into that model of the American Dream, it creates a box that restrains free and unfettered thinking. Capitalism is the engine that drives this economy, and I would posit that capitalism in health care is the reason Dr. Gratzer and his wife moved to America.
I think capitalism has stolen the heart of health care in America.
As I remember growing up, doctors were always respected members of our communities, they generally made a better living than others, at least in the Midwest where I grew up. But they knew us as people. They knew our families, our family histories. They knew I played baseball and stuck cotton up my nose when I took a high fly on the beak trying to emulate Willie Mays.
I could be wrong, but it seems that back then, medicine wasn’t about the money. It wasn’t cheap, and health insurance was just starting to be the preferred way to pay (see Dr. Gratzer’s excellent exposition on that), but medicine was about helping people who were suffering from trauma or disease that defied home treatment. And there was a lot of home treatment.
As health care became more and more a business, and a big business at that, the focus shifted. Capitalism is about making money, not about helping people heal, or even more important, it’s not about helping people stay healthy.
Capitalism is about making money.
And that is the wrong model for health care.
Capitalism has given us the four-minute doctor visit and the five hundred dollar cotton swab buried in the twenty pages of miscellaneous billing for surgery. It has given us millions without adequate care. Not millions without good care, or great care, but just…care.
There is no care in Health Care. There are millions of dollars to be made.
This is not an indictment of individual doctors and nurses. They are doing what they can in a system that puts the dollar ahead of any other consideration. That’s the point of capitalism. The investors need to see a return on their investment. It’s a great system for a lot of things. It’s not a great system for people.
Tracy sees it in dentistry; her daughter, a brand new nurse practitioner called in tears yesterday because she sees it in hospitals; her fiancée, a pharmacist sees it in his clinic.
I see it in my 4 minute visits, at an adjusted $337, with my surgeon. Capitalism in action, doing what it does best.
There is a better system for health care.
It’s called single payer and it’s based on the theory that underpins all health insurance. It’s called spreading the risk. And in order to do that, the larger the number of people in the pool, the lower the cost to each individual. We all need to go to the doctor some time. Most of us. Insurance at it’s best allows everyone in the pool to cover the costs of visits to the doctor for everyone else, by paying in a little at a time and sharing that risk.
That’s a very good idea.
But as insurance became more and more a big business, the dictates of capitalism required the insurance companies to lessen the risk to their investors, so they only insured those who were healthy enough to meet their minimum requirement. Just makes sense, for business. They eliminated coverage for people with pre-existing conditions. Just makes sense. As a capitalist business model, they decided that bringing children into the world was a disease, or condition that should be avoided, or a risk that should be avoided, and they didn’t cover pregnancy unless a couple was willing to pay more in case they became ill with pregnancy. Just makes sense. It’s business.
So the coverage pools shrank. Insurance companies needed to maximize profits, so the fine print on policies got smaller and smaller, and pages were added. Now we have thousands of health insurance companies competing for healthy folks who really don’t need to see the doctor. Makes business sense.
But what makes the most sense for health care is for everybody to be in the pool. Spread the risk over the whole 300 million or so Americans. That’s a big pool, and by any actuarial method you choose to use, it should lower individual costs overall.
It’s not very profitable, so those who are now profiting from the health care industry hate the idea of a single-payer system.
They want to label it socialism, or government health care, or anything at all to scare consumers away from considering what is really the only way out of the spiraling costs we have here in America.
Of course it would be huge and cumbersome. It could still be some sort of public/private hybrid. I don’t pretend to know what it would look like, but I know there are people out there smart enough to figure it out.
If only those who were profiting handsomely from the system as it is would let them. This system has nothing to do with the American Dream. It’s not consistent with American values I cherish. I think we can do better.
Health Care should be about care, not profit.