Health-Care System Needs Healing

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.

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  • Fred Vaughn

    How do I subscribe in Canada? The site does not list anything except the states.

  • Diane Fennell

    Dear Mr. Vaughn:

    Thank you for your interest in Diabetes Self-Management. Canadian subscriptions cost $36 per year in U.S. funds. To subscribe, please call our customer service center at (800) 234-0923.

    Diane Fennell
    Web Editor

  • greg

    Don’t be so certain that other countries with national health care have better health. Rationing simply allows the sickest people to die so that the remaining population appears to have better health. The U.S. system for all its flaws does take care of everyone, yes EVERYONE. The uninsured go to emergency rooms. Absolutely unsuitable and needs improvement, but they do get health care.A national health care system would ration care so the sickest ( Type I diabetics for instance) would simply die younger to reduce the cost.

  • Robert Ference

    I never understood the concept of insurance as a funding method for wellness AND “typical” disease treatments like flu, cold, mumps, broken bones, etc.

    I can understand buying insurance to offset risk from something catastrophic: atypical cancer, cardio vascular, neurological diseases or intense life preserving procedures.

    I suggest we start thinking & dialoging along these separate tracks. By factoring health care into a small number of of dissimilar parts, we might come up with very dissimilar ways to fund ranging from public to private and retain quality of service.

  • michael tingle

    If this country can bail out GM and Chrsyler with our money why cant they do something for healthcare..Care about stupid plastic cars with batteries or gas and healthcare goes right down the tubes. Stsrt taking care of our country first did we every get payed back from WWII on all the rebuilding we did Those countries needed us did we get compesation. the end later

  • David Spero RN

    Thanks Robert and Greg for these comments. Robert, I think you’re on to something about not lumping colds and major auto accidents into the same plan. But I think a national health plan that encourages people to manage their own health as much as possible would be a good thing. Cut down on heroic treatments of hopeless cases, encourage people to take care of themselves, and it will be easier to pay for the actually useful medical care.

    Greg, I’m afraid there’s no evidence for anything you wrote in your comment. It’s true that national health plans won’t put comatose patients with multi-system failure in the ICU for months, running up million dollar bills, as we do. Some of those people will die. But people with illnesses like Type 1 diabetes, to use your example, get better care in places like Canada and France than most get here. All the statistics show that, on average, people live longer, much longer, where there is universal health insurance.

  • Keith

    If you were to ever be part of the national health system you most certainly would not want it here. If it did why do so many Canadian subscribers come to the US for treatment of long term medical conditions and for surgical procedures they have been on the waiting list in excess of 2yrs, with pain and suffering not considered.
    It simply does not work efficiently any more than the various state medicaid programs work.
    We do need to have a more affordable system, however, not at the expense of the quality care.
    The government is not motivated to get you treatment, they will however trip over dollars to save pennies.. National health is not the solution but more affordable health care with some price caps on treatments and prescriptions is..
    Seem strange that in every country in the world but ours that there is generic form for one of my meds, but not here.. the same with many medications.
    Speed up the FDA and get things moving with some responsibility and accountability.
    More competition, better results and less cost the simple solution.

  • David Spero RN

    Keith, I appreciate your comments, but all the evidence is against you. For example, you wrote:

    “…some price caps on treatments and prescriptions is [the answer]..
    Seems strange that in every country in the world but ours there is generic form for one of my meds, but not here.. the same with many medications.”

    Keith, can you not see the connection between privately-owned, for profit health insurance, and the high prices? Pharma, the hospital and insurance industries will not allow “price caps.” They try to prevent use of generics, because they make so much more money on brand names. You’re making the single-payer argument for me!

    Also, people in countries with national health plans are NOT dissatisfied, according to all the polls I have seen, like this one from Fox News and WebMD. Americans actually report much longer wait times to see doctors than people in other countries. Don’t believe the hype!,2933,136990,00.html

  • A. spero

    Most often by the time an uninsured person gets to emergency it is truly an emergency costing far more then early intervention would have. A few days in ICU wil cost thousands of dollars. In the long run we probably pay far more for the care of the uninsured then early free care would have cost. As a school nurse the most difficult part of the job was pressuring parents to provide innoculations for children in cases where the family did not meet poverty standards for assistence but still did not have enough money to pay for the shots.

  • Mohamed Arif

    Why am Insurance at all? Can’t the Govt. provide health care directly to its subjects, by opening and operating effectively health centers and hospitals?
    We know for sure that insurance companies make huge profits by retaining money form the healthy and spending pittance for the selective sick.
    Why not the state take over the completelte responsibility of providing the health care to all its subject thereby saving the profit of Insurance companies and spreading for the poor sick?

  • Gary Hanshue

    We DO NOT NEED National Health Care. I agree that the current insures could change the way they do business. I believe this begins with the drug manufactures. Quit wining & dining the doctors and their staffs with the sexy little ladys that come into the Dr’s. office on a steady basis. Quit paying for the Dr’s only education seminars after their degree is obtained. I for one am tired of paying for these “services” with higher cost of both medicine & office visits.

    Let the media do their job and expose these “wrongs”.

    The government (which is us) does not need to run health care – They can’t run themselves why would you want to take that chance and let them run our health care? By the way – is congress and the senate as well as Obama making themselve exempt from their proposed and continously running this down our throat we need it program???

    If it is needed right now you better look at it closely – if it sounds to good to be true then it is!

  • Karen D

    I’m greatful that my type 1 daughter and I live in a country (Canada) with a national healthcare system. Upon her diagnosis she received care in hospital (a small, rural hospital to boot) within hours and referal to our choice of a number of diabetes teams (pediatric endo, dietician, diabetes nurse educator)for the next week. She visits her team 4X per year and we have 24 hour on-call telephone service with a pediatric endocrinologist and nurse. This excellent care doesn’t cost us anything above our monthly healthcare fee of less than $100 for the whole family! We also have coverage in our province for insulin pumps for children up to 18 and all prescription medications/syringes/infusion sets etc., based on income level – in some cases covering 100% of these costs. If this is government ‘controlled’ healthcare I’m all for it as are most of my fellow citizens. Do Canadians travel to the US for surgeries/tests – indeed this does happen. Often the costs of these out-of-province procedures are covered by the Canadian system that can be short technicians or sometimes be hampered by waitlists. Are type 1s underserved by our universal system? Absolutely not. If a family or individual has fallen on hard times for whatever reason their monthly healthcare fees are waived and prescription medications dispensed without charge and they are treated at the same hospitals/clinics as everyone else. The physicians are paid regardless – by the healthcare system that covers all its citizens. Is the system perfect? Certainly not, but it is worth a second look by US administrators and citizens who wish to improve the health of all Americans.