TRUE HEALTH CARE
The headline in the January 31 Springfield News-Leader “Hospitals Pressured to Change” addresses only a tip of a bigger than Titanic iceberg. Today the problem it addresed is one great CONFLICT OF INTEREST! This conflict has been going on for 100 years and it was accentuated in the 80’s with no comment from the News-Leader. The Washington Post carried a front page article about the unique situation in Springfield, Missouri, where St. John’s had taken over almost 300 physician practices, telling physicians that either they could sell their practice to the hospital or leave town! No comment in the News-Leader.
TALK ABOUT A CONFLICT OF INTEREST!! Next the hospitals started their own insurance plan, designed to support the hospital first and their hired physicians secondly.
Two non-profit hospitals have profitable income which may be at least equal to the 15% of profit-making insurance companies. Now we have indentured physicians expected to order lab tests and X-rays at hospital facilities which charge 2 to 3 times what private labs charge! The peculiar conflict between the two local hospitals may be unique to Springfield, but the overall problem with Medical Disease Care is nationwide.
The “problems” with American Medicine have been building for 100 years. At the beginning of the last century, there was no medical insurance. Average income was $5000; physicians made $7500 and government employees made $11,000. Medical bankruptcy was unknown. Soon, with the help of the greatest industrial crook of the 20th century, John D. Rockefeller, the AMA assumed virtual control of medical care, closing half of medical schools, half of hospitals, abolishing homeopathy, and beginning a 50+ year attack upon chiropractic and osteopathy.
The evil empire of medical insurance was established in Dallas in the 20’s by Blue Cross. Ten years later its cousin, Blue Shield, set in motion a requirement that one be hospitalized in order to have insurance coverage! The first major advance in medical care took place with the discovery of antibiotics in 1928, but they did not become significantly available until the early 40’s. In the 40’s President Truman made one of his greatest errors. Being unable to get national socialized medicine passed, he and Congress doubled the number of hospital beds and medical students. That further encouraged medical insurance to cover mainly hospitalization.
In 1950 Thorazine became the first major tranquilizer and the Darth Vader father of scores of other brain and personality changing drugs. That albatross has now led to hundreds of mind-altering drugs which often create more complications than help. This is true of many prescription drugs-high cost and high complication rate, mistakenly called “side effects”.
In 1963,President Johnson was pushing Medicare. I wrote him a letter suggesting that government intervention in medicine would bankrupt the country. He sent the FBI to spend a week attempting to have me fired from my position at Western Reserve University. That failed and less than 2 years later Medicare became law. Interestingly, this led to grey flannel suited MBA’s taking over hospital administration, which had been done only by nurses and physicians. Costs zoomed. Medical expenses, which had been 4.5% of GNP, became within 5 years 12% of GNP. Headlines around the country screamed about the crisis in medical costs. Today medical costs are 17% of GNP and AMERICAN HEALTH IS WORSE THAT IT WAS IN 1965!! In 1967 I did a survey of patients at one of the finest hospitals in America, Lutheran in LaCrosse, Wisconsin. Two- thirds of the patients were in hospital, not because of medical need, but because it was the only way their insurance would cover!
In the 70’s Dr. Thomas McKeown wrote one of the most important books on the subject THE ROLE OF MEDICINE. He emphasized the fact that 92% of all improvements in health in the 20th century came from pasteurization of milk, chlorination of water, adequate handling of sewage, and adequate protein. Dr. Franz Inglefinger, editor of the New England Journal of Medicine, wrote a stunning editorial on that book in which he suggested that 80% of illnesses are self-limited or not curable by modern medicine, 10% are miraculously cured and 9% are made worse. “Thus, we wind up barely on the positive side of zero”. Shortly after that Dr. John Knowles wrote in “The Responsibility of the Individual”, that 99% of us are born healthy and become unhealthy because of human misbehavior. He emphasized that 80% of illnesses are the result of unhealthy behavior!
Early in the 80’s Paul Starr wrote THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE, essentially predicting worse to come. Early in the 80’s Medicare instituted one of the most stupid rules ever, Diagnosis Related Groups (DRG’s) so that essentially an ingrown toenail was given the same time in hospital that was given to gangrene of the foot! After all, both involve the foot. The private profit-making insurance mafia quickly followed suit. By the late 80’s an editorial in the New England Journal of Medicine summed it up “DELAY, DELAY, DELAY, DENY. By that time physician overhead had grown from 40% to 60% of income. And bureaucratic paperwork required 10 pages for every one page of medical notes! Another error of the 80’s was allowing advertising of prescription drugs on TV. Physicians have more than enough difficulty determining which drugs to prescribe. There is no way a lay person can make a rational decision about a prescription drug without significant information from a physician.
Today, we have one of the unhealthiest countries in the world, with by far the highest costs. The insurance mafia is one of the greatest enemies of health and it creates more conflict and stress than any other single industry. Medical costs bankrupt more individuals than any other cause. And according to the JAMA in July, 2000, the third leading cause of death is the American Medical System! Having hospitals compete in this quagmire is ridiculous, just as ridiculous as their owning physician practices. Ultimately there is a solution:
1. We need a SINGLE, NON-GOVERNMENT, truly NON-PROFIT Medical Insurance Corporation, carefully controlled by the public, with revolving trustees to insure no insider manipulations. Every American must be included in this coverage.
2. We need to stop the confusing and aggravating menace of lawyer driven malpractice insurance
3. Prescription drugs need to cost in the U.S .no more than they do In Canada!!!!
3. And, of course, we could PREVENT 80% of illness if people were not:
- Overweight or obese
- Smokers or drug abusers
- Couch potatoes
This would be TRUE HEALTH CARE! Today we have mangled, poorly managed disease care with serious ethical conflicts of interest.