Fifty years ago it mattered only a little whether you were rich or poor when it came to health care. True, the rich could afford to have a doctor attend them, while the poor relied on family or self-trained healers for treatments that often did as much harm as good. But in reality, even the rich had few options when it came to cancers, or serious accidents, or heart disease. There were no trauma units or burn centers, no chemotherapy, no artificial hearts or limbs, and surgery and anesthesia were primitive. The key to a long and healthy life was good genes and good luck. The rich perhaps suffered more as their diets led to diabetes, liver failure, gout and a host of issues caused by over-indulgence and lack of physical labor. Rich or poor, health care primarily consisted of nursing and kindness at the end of life, generally from a family member.
Today we care about our health because there is actually something we can do about it. Cancer and car accidents don’t care whether you’re rich or poor, but now the access to treatment options can make the difference in outcome. We’ve come to expect access to preventive care which gives most people peace of mind, and can catch potential issues before they become life-threatening. We have drugs that can save a life, stop an illness or improve our daily functioning. Surgery has become a fine art form so that body parts can be repaired or replaced in case of malfunction or injury. Resultant life expectancy has soared as a result, and we have come to expect a long and healthy life. The poison in the apple has now become the fact that many people cannot afford to take part in these life altering processes.
The current health care model rewards testing and procedures over outcomes. Financially responsible health care delivery does not readily fit a good business model. Consider cardiology as an example. If hospital A secures the funding to create a cardiology center, it creates a market for cardiology services. Everyone wants a healthy heart; people inherently understand the relationship between heart health and a longer, better life. There’s no great science involved – heart stops, life stops.
In addition, there is an array of heart interventions available: diet counseling, smoking cessation, exercise, EKGs, angioplasty, valve replacement, even a heart transplant. Each of these requires staff and facilities and is certainly an income earning module for a business. Add to the mix that most insurance will readily pay for heart procedures, and you have a great business.
What happens then when another hospital, most of which are now for-profit institutions, sees the cardiology model of hospital A and wants a share of the market? The business model says “Do the research, see if there are customers and providers to support it, build it and they will come.” Now what happens to the first unit when there are only so many people who need the services? Is it possible that they will create more tests, buy new machines, increase marketing to show how desirable their product is? If the insurers will pay for it, a profit can be made in both centers by creating new demand.
With amazing options for health care now available, and a for-profit industry that looks at humans as customers for those options, is there any doubt that a profitable business model for health care is driving up costs?
The second part of the picture is health insurance, also now in most cases a for-profit industry. The premise of any insurance is that a large pool of members contribute moderate amounts of money over a period of time. Most members will never incur costs that equal their contributions. A few will incur costs far exceeding their contribution. The goal is to have enough money invested so that claims can be paid for those who need it. It is that fear of catastrophic costs that first prompted people to purchase health insurance.
Like the health care provider business model, insurance companies evolved into a for-profit industry. A few short decades ago major medical expenses were the only ones covered. Regular doctor’s visits were totally out-of-pocket. Then insurers realized if people were willing to pay for the unexpected, then perhaps they would be willing to pay for life improvement also. At the same time, it became clear that preventive medicine could be the key to a longer healthier life. Insurers presented the HMO model with physician ‘gatekeepers’ who would be paid a retainer (capitation) to see patients on a regular basis and identify an issue before it became serious.
With insurance premiums greatly subsidized by employers and a greatly reduced out of pocket expense for patients, there was no reason not to seek preventive care. Improvements in technology and drugs made it possible to restore people to good health, and good health became the norm, and demanded. The types of interventions increased, as did profits for the business model for health care delivery. As insurers became for-profit, they needed to either increase revenues or cut back on expenses, otherwise they would go out of business. Premiums spiraled up, health care costs driven by technology and demand spiraled up, demand for perfect health went up, and here we are.
I greatly admire Congresswoman Gabrielle Giffords and her struggle to overcome a life altering injury. Her recovery has been hailed as miraculous, unprecedented; she is even considering running for re-election. However, I have to wonder what her outcome would have been without the red carpet health plan afforded our elected officials. Many news features have commented on her state of the art surgeries, physicians and rehabilitation centers. Her husband was able to retire from his job to be with her as an advocate and supporter.
I do not begrudge Ms. Giffords any of her care. But what if she were a woman from Detroit or Little Rock, injured in a senseless drive-by shooting? Would she have access to the finest care and rehabilitation? Even if she were not poor, perhaps employed at a small company which could only afford a health plan with a huge deductible? Where would that $10,000 come from? Could her husband retire with a great pension to care for her? Would she ever hope to be rehabilitated enough to resume her career ? I doubt Congresswoman Giffords would say that she was more deserving of health care than another innocent victim, yet the affordability of health insurance makes all the difference in the world.
The third part of the health care triangle is the consumer, ourselves. Individuals need to take responsibility for their health, actually paying attention to advice on everything from smoking cessation to seatbelts to exercise. There are totally preventable illnesses that we must not bring upon ourselves. We also need to realize that neither the health care system nor insurance can prevent illness or death, and we need to carefully consider what treatments and interventions can truly alleviate suffering and improve quality of life. And then we need to demand that all people have access to reasonable, rational health care so that every Congresswoman and factory worker, farmer and banker, student and scientist can look after themselves, avoid preventable illnesses, receive life-saving care when needed, and remain active, productive members of society for their lifetime.
For-profit businesses are good. They allow our nation to be creative and prosperous, rewarding ideas and hard work with a fulfilling way of life. But we must get away from profit as the only reward, especially where that profit is generated by a roll of the health-care dice. The quality of U.S. healthcare is excellent. It should not be limited to only those who have a particular skill set where they can command employment that offers great benefits. It is time for providers, insurers and individuals to come together to craft a plan that is fair to all, to allow all of us to benefit from the technology and care that allows us to be our best.
