The American health-care system is gravely ill, and it’s making our whole society sick. Health care in America costs from twice to six times as much per capita as the other countries that spend the most for health care. For these trillions, we get worse health outcomes. Diabetes treatment is the perfect illustration.
All our health-care problems — the costs, the bad results, the millions of uninsured — come from the same root cause. We make health-care decisions based on profit, rather than on effectiveness. The result is a focus on sophisticated, expensive, technological treatments that don’t do much good, while basic, cost-effective care isn’t funded.
In my book Diabetes: Sugar-Coated Crisis, I cited an article in the The New York Times called “In the Treatment of Diabetes, Success Often Does Not Pay.” Article author Ian Urbina reported on four highly successful diabetes self-management centers that opened in New York a few years ago. Three of them are now closed.
“They did not shut down because they had failed their patients,” wrote Urbina. “They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications. ”
“Insurers,” he continued, “will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.”
Insurers pay very little for a nutritionist visit, but they will pay for dialysis, which costs many times more. According to Urbina, more than 100 dialysis centers are operating in NYC, while the diabetes centers that could prevent kidney failure are closing.
Insurers often don’t pay much for test strips to help people manage their blood glucose. But they will pay for coronary artery bypass surgery, which is hundreds of times more expensive than self-management training and has very mixed results.
“It’s almost as though the system encourages people to get sick and then people get paid to treat them,” said a former president of Beth Israel Medical Center in New York.
Because brand-name drugs are much more profitable than generics, drug companies keep coming out with new drugs. According to Marcia Angell, MD, former editor of The New England Journal of Medicine and author of The Truth About the Drug Companies, few of these new drugs represent improvements on older ones. And many times they are less safe, as users of diabetes drugs in the glitazone class are aware.
The health-care system has become like a cancer, eating up the healthy parts of the economy and dragging everyone down. U.S. employers pay millions more in health premiums for workers than employers in other countries. This expense makes American products uncompetitive. Health insurance costs have driven companies out of business or offshore, costing millions of jobs.
What Can Be Done?
The obvious solution, the one many other industrialized countries have, is some kind of National Health Insurance Program. Having a single large pool of insured people helps in several ways.
First, everyone is covered. Administrative costs are greatly reduced and money now being taken out as profit will remain in the system. It becomes possible to track and compare outcomes, to see what procedures and approaches work. Prices are reduced because the single large plan has so much purchasing power. We can provide proactive care that prevents complications, instead of trying to repair expensive damage after it’s done.
You can only figure out cost-effective care when all the costs and benefits come out of the same pot. As it is now, what one part of the system sees as a cost and tries to minimize (say, the need for surgical repair of damaged retinas), another part sees as a profit center and wants to maximize. You can’t win that way.
Physicians For A National Health Program have detailed the hundreds of billions of dollars National Health Insurance (NHI, often called “single payer”) could save, money that would more than cover the costs of insuring everyone and lead to better results. But we keep hearing that single payer is “off the table.”
We need a bigger table. The insurance companies threaten us with questions like “How would you like to have a government bureaucrat between you and your doctor?” They want us to ignore their paid armies of bureaucrats standing in front of doctors’ offices with stop signs. They say NHI would take away patients’ choice. Actually, it will give us much more choice than the current HMOs and PPOs do.
They warn us about the months of waiting for elective surgery in places like Canada. Well I’d rather wait a few months for surgery, even in severe pain, than to go bankrupt paying for it! The system would be paid for by taxes. That’s a drag, but paying $1500 a month or more for premiums drags even harder.
President Obama says he has three priorities for health-care reform: control costs, maximize choice, and cover everyone. These are good priorities, but I have to tell him, Medicare already does those things! I’ve had Medicare for five years, and they’ve never restricted who I could see. I don’t see why we can’t have something like Medicare for everyone. That’s what other countries do.
Obama’s alternative is to keep the present system but include a “public option.” That is, people could buy from a private insurer or buy into something resembling Medicare. The insurance companies are up in arms about this. They say it’s unfair for them to have to compete against a huge government agency.
I say, “Unfair to whom?” Health-care should promote public health at a reasonable cost, not enrich corporations and billionaire executives. If they can’t compete, they should fold their tents and go. It’s not our problem.
I’m encouraging Diabetes Self-Management readers to get involved. I suggest calling your representatives in the House and Senate today to advocate for single-payer health care, and if that is “off the table” for them, to push for a strong public option.