Saturday, March 7, 2009

The Three Transgressions

Last week I went to work with a sinus infection. Hardly the worst ailment in the world. My nose alternated between being stuffed up and runny. My throat hurt. It was uncomfortable to breathe and swallow. All in all, not the most debilitating medical issue in the world, but it still worried me. Because I, like millions of Americans, do not have health care of any sort. In the face of these masses working every day with illness trying to get by, a sinus infection is little cause for complaint. It did, however, give me reason to pause. As I stood out in the cold to unload a pile of scrapped theater scenery, as I walked through a cloud of sawdust, as I swept up mounds of dust and garbage, I thought long and hard about how we came to this as a society.

And I realized we do it to ourselves. The transgressions are our own. Three transgressions, actually. But more grievous errors regarding the well-being of this society I cannot imagine.

1: We Make Health a Business

This is the most glaringly terrible practice we have in regards to our own health and well-being. We're talking about people's lives. We're talking about their ability to go on each day and continue to work and provide for themselves and their families. Does this sound like a field which should involve meetings about next quarter projections and profit margins? No. It's actually the most terrifying part of our society. Not racism, not poverty, not hunger; the idea that we have made a business out of whether or not people live or die.

I would like to trust pharmaceutical companies. I would like to imagine that there's a board meeting happening right now where men in expensive suits are sitting in a darkened room with a projector running, the scent of smoke and sweat in the air. I dream of a time when these corporate executives spend long evenings pouring over endless research documents hoping that they can be the first company to produce a cure for cancer. Or AIDS. Or herpes. Or the common cold. I would like to. But I just can't imagine a corporation working towards the goal of putting itself out of business.

The sheer and complete backwards nature of our pharmaceutical system is that we have founded an industry worth hundreds of billions of dollars to make sure we never get quite healthy enough to stop buying their products. It's far more profitable for them if HIV remains a condition controlled through expensive drug cocktails. They are in the business of control, not cures. Control gives them a steady revenue stream. Cures ensure a cash flow disappears forever. Which do you think is part of their business model?

The only upside to this is a good deal of research regarding cures for diseases is actually funded by our federal government and carried out by private institutions. Of course, when something looks promising, it must undergo years of trials before it can be approved by the FDA - an agency notoriously riddled with scandal from officials on the take by major pharmaceutical corporations.

2: We Do It To Ourselves

There's a story everyone knows about the old lady who spilled coffee in her lap and sued McDonalds. No one told her coffee was hot. McDonalds admits their coffee is served at especially extreme temperatures, but everyone in the world should be aware that coffee is hot. If you spill it on yourself you will get burned. The woman won millions against McDonalds, and now the fast food chain denotes "Warning: Hot!" on all of their styrofoam coffee cups. That's the most famous of the second of our three transgressions. Frivolous lawsuits.

Doctors work hard. From the moment they decide to become a doctor, they go through unfathomable effort to achieve that goal. College consists of biology, anatomy, physiology, chemistry, biochemistry, organic chemistry, and more. Then comes the MCAT, the most difficult standardized test ever devised. Once that hurdle is cleared, it's off to medical school, where you spend four years devoid of a social life. You study the mind-boggling number of human illnesses, injuries, and genetic disorders. You sleep little, as days are marked by classes that leave your brain swimming and your body smelling of formaldehyde. Then comes internship. The on-call room. 48-hour shifts. Residency. 10 years after you began you're finally where you wanted to be.

Then someone sues you for malpractice. And it all goes down the drain.

As a nation we are actually suing ourselves out of proper health care. As the cost of malpractice insurance skyrockets, so to does the cost of medical bills as doctors struggle to keep up. General practitioners are vanishing at an alarming rate as more and more doctors specialize to make more money. This is not to disparage them - the cost risk involved with being in general practice just isn't worth it anymore. And it's our fault.

Yes, if a surgeon leaves an instrument inside of you, he was irresponsible. You should be recompensed for the danger you were placed in. But if he doesn't? If you walk out of the surgery with slightly less mobility, but alive, do you sue? If you have to give up running marathons but the trade off is you get to keep both legs, do you feel the hospital is to blame? Fear of being sued dominates hospital mentality, because we don't seem to realize what we're doing. When we go after millions of dollars for what in the long run amounts to an inconvenience for us, we're taking those millions of dollars from a hospital. We're taking them from sick children and cancer patients. We're draining them out of MRI machines and ultrasounds. We're stealing from each other because we feel wronged.

I don't feel every malpractice case has been frivolous. Certainly not. But I do feel that we as a society, from the people who file charges to the lawyers who vigorously encourage us to do so, have completely ignored who we're really hurting. Our children, our neighbors, and ourselves. It helps no one when we take from medical care.

3: We Think We Need Universal Health Care

We don't. We really don't.

People repeatedly point to Canada as an example of universal health care in action. Everyone, regardless of class, receives free health care provided by the government. Seems like a good system. Until you take into account the fact that the wealthier Canadian citizens don't like sitting in line for six months, so they come to America for care. Meanwhile, the poor are still left waiting for treatment that in many cases comes too late due to the backlog of patients. The problem is not universal health care, it never was. It's that on top of our first two transgressions, we keep demanding this of a government that can't possibly provide it.

The wealthy will always have a greater advantage than the poor. That's the benefit of being wealthy. Until we convince the government that a war on drugs is about as useful as a war on pancakes and switch to a war on poverty, nothing will change. Insofar as health care is concerned, let's review. We let massive corporations be in charge of our medicine. We sue our health care providers to the point that they can't afford to treat us any longer. Then we tell the government we want them to make this all free. Well, maybe they will. And maybe six-hour stopovers in the waiting room will become six months. Or six years, seeing as how our population is much greater than that of Canada.

We don't need universal health care, and when we demand it we obfuscate the true issue and give politicians another way to avoid dealing with it. Should the government be doing more to lower costs? Of course. But they can do it by breaking the backs of pharmaceutical companies and passing legislation protecting doctors from frivolous malpractice suits. They can do it by educating the public so that those suits which do see court have juries that fully understand what is at stake and can make rulings accordingly. We need changes as a society on how we approach health care. Making it free for everyone will only put a tremendous burden on our government, again taking money from other programs that desperately need the funding, and only weaken our health as a nation in the end.

Have I said anything new? I don't know. Perhaps not. But therein lies our fourth and final transgression, the one that is not listed in the first three because it applies to far more than simply health care.

We don't do anything about it. We never ask the right questions. We never seriously pursue the real answers. We never become outraged. We never act. And so things remain the same, or get worse, as those who benefit from our complacency grow rich on our silence.

There's our problems, laid out for us, clear as day. So, who wants to be the first to change?


ali d said...

THANK YOU for this. You have succinctly and intelligently argued points I have been trying to pin down for about a year now. I'll have more in-depth and thoughtful comments soon, but I wanted to make sure the appreciation was here asap.

Damo said...

Seriously, very well said.

1. Disdain for profit-motive in pharmaceutical industry?


2. Frivolous lawsuits shootings ourselves in the foot?


3. Bottom line should be the health and quality of life of our people?


Not sure about "universal health care". It honestly hasn't been my deepest issue of study. For my thoughts on health care, refer to #3.

To that I'd also add that health-related research and development is a critical marker of human progress.

All we have as humans is our ability to learn new concepts and apply them to the world around us. Profit-"motivation" is a funny term because it actually slows us down. Somewhere along the way the means became the end and the whole human race learned that selling themselves was the only way to be free.

Carrie Crawford said...

Strangely enough, this has been on my mind for the past week or so. It all started with seeing a "walk for (breast) cancer" commercial, which got me thinking about how research facilities and cancer clinics would be completely out of business if an actual CURE were to be found. There is such an array of symptoms for the pharmaceutical industry to make money off.

I remember talking to my Dad about this a few years ago, which was the first time I'd ever had my eyes opened to the idea that it even could be within human nature to turn something as good and noble as the health care industry into a business venture. Who sees an old man doubled over and dying and asks the question, "what's it worth to you?" Or worse yet, "How MUCH do you love your husband/wife/child/mother/father?" The quality of our lives should not ever include our financial situations when weighing our options.

Having said that... I agree that Universal Health Care is certainly not the answer. Being that I come from an entirely english family and from having lived there for a few years, I have first-hand knowledge of such a system. I'm all too familiar with it's flaws:
- The huge waiting lists, nevermind how immediate a threat your illness/injury poses.
- "Standardized care" has actually turned into lowering standards.
- Perhaps this is already obvious from the waiting lists... but there are never enough beds. And what does this mean for patients? Get 'em in. Get 'em out. Even if "out" doesn't include them fully walking. Sometimes this doesn't even include them breathing. If you have a serious illness, by the time you get a bed, it's too late. The hospital then only serves one purpose for you as a place to die. (With family members who went out like this, I'm perhaps a little bitter.)
- The elderly receive poorer quality care than someone who could continue to serve society once they get out of the hospital.

So, yes, I'm all for us paying for the health care we receive... but that does not mean that I'm asking that the American people be taken advantage of with outrageous prices of medicine, of insurance, or, hell, of the consult itself. How often do we become so familiar with the waiting room that we know the count of the ceiling tiles, but can't remember the name of the doctor who came in and talked to us for approximately 3 minutes just to scribble a perscription down for the generic "sore throat"? Then come to find out that the brief encounter cost us over a hundred dollars. Nevermind the amount of money we're about to drop on the medicine itself at the drug store.

Now, to hit on something else that you said... I don't feel that the public as a whole should have to stand up to such things. Do we not each have a responsibilty to our chosen fields? How is it that such a large group of people can become so corrupt that not even ONE of them can raise the topic of morality? Why should an entire nation have to yell and scream before these people will do what's right? And why is it... that it must actually have an impact on us before we care whether it's morally right or wrong? It's a survival instinct of ours, of course, to look out for number one. But this carries over to, "how can I ensure my own success? How can I make money for my family? How can I profit off of the situation?" and so on.

You're absolutely right. We do it to ourselves.

I'm done ranting now... promise :)
-- Carrie Crawford

Ozkirbas said...

Pratt 2020!

Stephen said...

Why not try Universal Wii Fits? What better way to get out of a health care crisis than Hula-Hooping our way out?

Jackie said...

I'm curious on your take on public schools then. While I agree for the most part on the first two issues, the last one is the one I disagree with.

Universal Health Care is like public school. Many people in DC know that the public school systems here aren't very good so those that can afford it send their kids to private schools. If they can't afford it, well at the very least their kids are getting some sort of education.

Universal Health Care is the same way. Those who can afford better health care will pay to see private doctors but at least those who can't afford it will still be able to see someone.

The other day I found a man who was very intoxicated with a huge bump on his head that he was bleeding from very badly. If this person was me then I would go to the hospital right away even if I had to sit in the waiting room for hours just to make sure I didn't have a concussion or worse. This man instead refused medical care when the ambulance came. Chances are because he couldn't afford the $200 ambulance ride or the $300 hospital bill. If he had access to Universal Health Care then maybe he would have gone in. Sure its inconvenient but so is prolonged headaches, memory loss and brain damage.

Max Nova said...

I agree with many of Jackie's points. But have a few thoughts of my own.

I don't claim that the British system is perfect, I know it is far from it. But as far as I understanding, those who are rich can buy their own additional service, which is much like private v. public education. Everyone should have a baseline.

Actually it's a lot like social security, everyone gets a baseline, but it would be tough to live off of just social security.

Notice a theme here? Government should be setting a baseline but allowing competition above that.

As for the pharmaceutical industry, I mostly agree with you, Pratt. Take a look more in depth at Paxil, where a lot of studies have been done, and a lot of those that were unfavorable were buried.

And the McDonalds lawsuit is sited way too often without the context. The coffee was actually far far hotter than the average cup of coffee anywhere else. That's why they lost the lawsuit. If you want a good example of an insane lawsuit, go with "The Pant Suit(TM)" where the dry cleaners who were sued were run out of business by legal costs even though the won the case.

David Pratt said...

There are more than enough frivolous lawsuits to cite, I chose the most famous because people would remember it. And I do state in my original post that McDonalds admits their coffee is served at extreme temperatures. I just feel it doesn't matter if it's served at 150 degrees or if they actually throw beans into molten lava; coffee is hot, if you spill it on yourself you'll get burned. No one deserves 30 million dollars for not knowing that.

AZWiner said...

Sorry... i went back to re-read this.

As the son of a physician, I understand severely the hard work of doctors and the silliness of these lawsuits. I fully applaud your first two points.

I guess I'm just looking for a solution though... you DONT want Universal Health Insurance but you DONT want health insurance to be a business.

What DO you want then? That seems contradicting. It's either run by companies or run by the government. OR... if you're looking for more government regulation in company health care.. then that idea sounds very un-pratt/un-republican to me.

I think you're close... but I'm not seeing a solution. But your point about health insurance as a business being wrong is extremely well-put in my opinion.