Has The Health Care Industry Lost Its Moral Compass?

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By Lissa Rankin, MD

Monday, December 17th, 2012

Medicine is filled with good people doing the best they can to operate in a bad system. In my experience, most people in the health care industry are doing their jobs well. They just don’t realize that their job descriptions are just plain wrong.

In the U.S., we spend 2.7 trillion dollars per year on health care. Elsewhere, the average health care expenditure is $3,000 per person per year. In the U.S., it’s $8,000 per person per year. We spend more than $300 billion per year on pharmaceuticals, almost as much as the whole rest of the world combined. Yet our life expectancy is ranked at #50 in world. 49 countries are more successful at living long healthy lives than we are, and they do it at a lesser cost to boot.

Dartmouth University even did a study examining regional differences in how much it costs to care for a Medicare patient. They found that Medicare patients in Miami averaged a cost of $15,000 per patient per year, whereas Medicare patients in Minneapolis averaged about $7,000 per patient per year. The patients in Miami were getting significantly more medical care, and many more Medicare dollars were spent, yet the Miami patients did not have better outcomes and actually were more likely to die sooner than the Minneapolis patients.

20% of patients take up 80% of health care dollars, usually from chronic illness, repetitive hospitalization, and morbid obesity, yet this increased spending of health care dollars doesn’t improve the life expectancy of these patients. 

Not Health Care – Disease Care

I blame our system for going about it all wrong.  As Andrew Weil said in the documentary film Escape Fire, “We don’t have a health care system. We have a disease care system.”

There’s no incentive in the way the system is set up to prevent disease. Doctors don’t get paid if they spend an hour teaching you how to eat a healthy diet, exercise regularly, prevent work stress, alleviate loneliness, invest in healthy relationships, and focus on positive belief.

The reality is that our for-profit health care system is set up to reward physicians who order tests or do procedures, not the ones who spend time talking to their patients. And yet talking to patients is the #1 best thing a physician can do if he or she really cares about helping patients heal.

If a cardiologist spends 5 minutes with you and then puts a stent in your heart, he gets paid about $1500. If he spends 45 min talking about preventative health, he gets paid about $15. This fee-for-service model the U.S. has embraced rewards physicians for delivering more care – for ordering more tests and performing more procedures, which leads to overdiagnosis and overtreatment, when the best thing we could do is reward physicians who devote themselves to helping patients live optimally healthy lives so they can avoid lab tests and procedures.

The Risks Of Overdiagnosis & Overtreatment

According to a 2011 study, 30% of health care dollars are wasted and don’t improve outcomes. And it’s not just that medical dollars get wasted. Such overdiagnosis and overtreatment can do immeasurable harm.

187,000 patients die each year from harmful health care, defined as medical error and nosocomial infections acquired within the hospital, often the result of infection from drug-resistant bacterial strains that exist only in hospitals. While modern medicine, especially in the realm of trauma care, saves lives that would have been lost a century ago, the reality is that modern medical care is the 3rd leading cause of death, just after heart disease (#1) and cancer (#2.)

Our health care system is seriously broken. Yet, those in power do not want the system to be fixed. Most of the money in health care dollars is going into the hands of medical device companies, HMO’s, and pharmaceutical companies, not doctors or hospitals. These companies have powerful lobbies and big budgets to ensure that Congress doesn’t enact laws that limit their power and profits.

For example, we all know that a nutritious diet is essential to good health. As Hippocrates said, “Let food be your medicine and medicine be your food.” Yet, our government subsidizes all the wrong things – grains and corn, not carrots, beets, and kale.  Imagine if low income people could get cheap organic produce! How much easier it would be for poor families to drink green juice and eat salad.

What Happened To Our Integrity?

When medicine became a for-profit business and we decided that good health was a privilege, not a human right, we lost our moral compass. Insurance companies don’t care about patient outcomes. They care about profits and are legally obligated to bow to their investors on Wall Street. And pharmaceutical companies don’t care about helping people heal – they care about making money so their stock goes up.

As described in Escape Fire, Steven Nissan MD was doing a Google search about Avandia, a 3-4 billion dollar drug for diabetes, and he discovered that, in the clinical trials for Avandia, there were more heart attacks in the Avandia group – a 30% increase, in fact. Yet the company failed to disclose to the FDA, the physicians, or the patients that taking Avandia would increase heart attack risk by 30%. The leading cause of death in patients with diabetes is heart disease, so having a widely-prescribed diabetes drug that increases heart attacks by nearly 1/3 is a public health catastrophe. Yet through some crazy twist of politics, the drug got fast tracked through FDA approval, and in 2006, Avandia was the #1 selling diabetes drug until someone finally got wind of the study results and blew the whistle. The company settled a lawsuit for $3 billion.

When Will We Start Doing The Right Thing?

Lobbyists are ruling health care in Washington, mastering spin to scare people into voting against their own self interests. They’re so masterful and it’s so stealth that you may have just done this in the last election without even knowing it.

Yet things must change. Dr. Dean Ornish said, “We spend so much time in medicine mopping up the floor around the sink that’s overflowing without turning off the faucet.”

It’s time to turn off the faucet and stop the hemorrhage that’s bleeding health care of its heart. The solution is not more tests, more drugs, or more procedures. The solution requires physicians to spend more time with patients engaged in the art of healing and educating patients not just about diet, exercise, getting enough sleep, and taking your vitamins, but also the other factors I’ve included in my radical new wellness model the Whole Health Cairn. To be wholly healthy, you need to do more than care for your physical body. It’s also essential to be healthy in your relationships, your work life, your creative life, your spiritual life, your sex life, your financial life, your environment, and your mental health.

Are You Ready For Change?

 

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