Health care system serves moneyed interests

By THOMAS A. PRESTON AND AARON KATZ
GUEST COLUMNISTS

A few months ago, James, a 73-year-old retired plumber, went to his doctor's office for a flu shot. First a nurse took his blood pressure. It was so high the nurse asked him to wait to talk to a doctor about what to do about it, but no doctor came to see him in three hours, so he left. Two weeks later he had a devastating stroke -- the kind due to very high blood pressure.

How did this entirely preventable catastrophe happen in the country with "the world's best medical care"? Truth is, our "system" serves moneyed interests first and real health care needs second. Some well-off people get a lot from the system, but about 44 million Americans -- most of them working folks -- with no health insurance and many of the millions more who have paper-thin insurance get substandard or very poor care.

Our health care is grossly too expensive. We now pay $1.55 trillion a year for health care, $5,440 per person and nearly 15 percent of the national economy. That's about 50 percent more than in Canada and other industrialized nations. And for this great expense more of our children die before their first birthday and, as adults, our life expectancy is shorter than in most industrialized countries.

Our wasteful and inefficient system is set up for profit-making, not to take care of patients in need. We call it a private system but it's not a free-market system. Most funding comes from public money (including Medicare, Medicaid, Veterans and the $200 billion in tax breaks for coverage sponsored by employers), not directly from consumers. Also, companies recoup what they pay for employee health insurance by charging more for their products, and we all pick up this tab as consumers.

How we pay for health care violates the rules of standard economics and introduces great waste. Most doctors get paid piecemeal, so the major incentive is financially perverse -- to increase income by doing as much as possible, especially high-income procedures (surgeries, CT scans). Clinics, hospitals, and drug and medical product companies fuel these often unnecessary and potentially dangerous practices from which they profit.

In our unmanaged system doctors are most likely to do what they can bill for, and avoid what is not billable. Those who pay an extra $50-$2,000 monthly fee for "boutique" medicine get attention. James needed 10 minutes of a doctor's time but got no attention.

The system has even perverted physician education and medical research with financial conflict of interest on many levels. Physicians and researchers on the pay of companies "test" those company's products on patients and report their findings at medical symposia to which companies send physicians "all-expenses paid." We all pay for these wasteful practices, in insurance premiums rising 20 percent per year, in taxes, and in the higher prices for goods and services that businesses charge to recoup the costs of health insurance.

At least half our population is liable to the sort of poor care James got, with potentially similar catastrophic results. We need health care that is less profit-driven, eliminates waste and gets more for everybody. All incremental efforts to nudge our present system toward more efficient and universal coverage have failed over the past 25 years and can only keep failing while costing ever more.

We outspend all other health systems in the world, so there is plenty of money already in our system -- we just need to re-allocate where it goes. The government now finances about 60 percent of costs, so "getting government out of health care" is unrealistic. And a market-based system in which everyone pays for their own medical care is unacceptable because millions of us would go bankrupt or die early.

At one-seventh of our national economy, the health care industry has too much self-interest and is too powerful to change itself or allow marginal changes that don't at least maintain its profits. The solution is to change the way we finance our system and replace the present inequitable and inefficient private system with some form of publicly financed health insurance to fund a private delivery system in a way that serves everyone's needs. The electorate needs to drive Congress to action.

Thomas A. Preston is a physician. Aaron Katz is editor in chief of Northwest Public Health. Also contributing to the column was Dr. John P. Geyman, professor emeritus of the Department of Family Medicine at the University of Washington.

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Years ago, when I worked in a pharmacy, my boss told me that cancer can be cured. However, there is no money in the cure, so drug companies prefer to NOT cure the disease. Patients must take an active lead in their care and not just blindly accept what their doctors tell them. Informed patients create competent doctors.