Beyond Sicko
Because this was happening a short taxi ride from the White House, I half expected someone from Dick Cheney's office to burst in at any moment, grab the microphone and proclaim the conference kaput, dissolved like an inconvenient parliament.
"I think this may be the best day of my life," Dr. Julie Gerberding, the director of the Centers for Disease Control and Prevention (CDC), said at the opening of the 2008 Leaders-to-Leaders Conference she convened the other week, along with the country's state and county public health officials. The agenda: To build a bottom-up coalition to change how America deals with health, to shift our focus from health care to healthiness and to the bigger social factors that determine our national healthiness.
Over two days, I heard so many encouraging ideas from the conference stage that didn't reflexively demonize public policy-making as nanny-statism that, well, as I said, the whole thing left me looking nervously over my shoulder for political-correctness enforcers from The Cato Institute or The Heritage Foundation.
As one speaker after another pointed out, America today ranks first among industrial nations in terms of how much we spend on health care, but last in terms of how healthy we are as a country. Pick any national metric of healthiness -- life expectancy, infant mortality, birth weight, chronic diseases incidence -- and America's comparative performance is in the cellar. It's true even when you adjust for European populations' relative homogeneity: if you only count white Americans, we are still the low man on the healthiness totem pole.
We Americans spend more than 90 percent of our health dollars on health care (on doctors, hospitals, insurance, machines, pharmaceuticals and the like), but it turns out that only 10 percent of how healthy we are as a nation is determined by what those health care dollars buy.
How can that be? What could possibly determine whether America is among the industrial world's healthiest nations, if not the thing we're all clamoring for: universal heath insurance? The answer -- and this isn't a political opinion, it's an epidemiological finding -- lies in the social determinants of our physical condition. Determinants like income, class, education, racism, the availability of public transportation, land-use policy, environmental policy, participation in the political process and a host of other factors that don't depend on our genetic makeup or our propensity to take personal responsibility for diet and exercise. Determinants that flow not from luck or individual choices, but from laws, regulations and priorities set at all levels of government and in the private sector as well. (If you want an alarming eyeful about this, check out the new California Newsreel documentary "Unnatural Causes.")
The way we currently think about health in America -- about health care, that is -- is completely understandable. We all want access to the best possible health care for our parents, our kids and ourselves, and we want it to be affordable, and we want plenty of choices. What's astonishing is that even if we covered all the uninsured's health care, we would still likely rank at the bottom of industrial countries for healthiness. The major causes of our country's healthiness or unhealthiness are all upstream of the things that send us to doctors and hospitals and pharmacies. The causes are poverty, and stress, and the amount of control and autonomy we have at our jobs, and whether there are showers there, and what they put in the vending machines. The causes are access to early childhood education, and to day care, and whether schools are built near asthma-breeding freeways. They are whether your neighborhood offers public libraries and public transportation and walking trails, or public dumps and liquor stores and fast food franchises.
"I had a colonoscopy the other week," the CDC's Dr. Gerberding told the 400 public health officials, business leaders and nonprofits she was hoping would sign on to a "healthiest nation alliance." "Actually," she added, "I was billed for two colonoscopies, though I'm sure I only had one."
Clearly she's not unaware of the madness of our present health care system. No one facing a family medical crisis wants anything but the best possible treatment at that moment. No one should lack access to quality health care. But prevention is even more important to the country as a whole than treatment is, and the free market alone hasn't and won't deliver the level of prevention we need.
To me, the underlying reason America has fallen so far behind in the healthiest nation race is the exhausted dogmas that have dominated public discourse for something like 30 years -- Horatio Algerism, social Darwinism, the magic of the marketplace, deregulation is good, government is bad, pull yourself up by your own bootstraps and devil take the hindmost.
We now know what America looks like when those kinds of ideas rule, and not only in the health sector. I'm glad that, at long last, public officials are finding their voice to express politically transgressive thoughts, like the idea that income inequity and racism are bad for America's healthiness.
I just hope that the Ayn Rand Society doesn't get on their case.
This column first appeared in The Jewish Journal. If you'd rather read about Angelina Jolie's ob-gyn than find my other JJ columns, click here.
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There is no money in healthy people. But sick people are great business.
When was the last time we actually CURED something? Polio?
Privatized health care continues to find new and more expensive ways to treat everything, and new and more expensive ways to shuffle the papers. But they don't care about our health. They want sick people because that's what makes money.
And coming up with new illnesses like restless leg syndrome, bladder control, etc.
Now you don't have to go to the bathroom within 24 hours. Can you even fathom how stupid
this is and the implications later on?
Don't forget AAD and all the other attention "disorders" children suffer from now that they watch TV 24 hrs. a day.
Is it any wonder we're the fattest and least healthy. We're being slowly poisoned. A steady diet of high fructose corn syrup, aspartame, pesticides and fluoride will do that.
Published on Wednesday, February 2, 2005 by Reuters
Half of Bankruptcy Due to Medical Bills -- U.S. Study
by Maggie Fox
"Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness."
The average bankrupt person surveyed had spent $13,460 on co-payments, deductibles and uncovered services if they had private insurance. People with no insurance spent an average of $10,893 for such out-of-pocket expenses.
She said many employers and politicians were pressing for what she called "stripped-down plans so riddled with co-payments, deductibles and exclusions that serious illness leads straight to bankruptcy
Your average politician will NOT FIX ANYTHING! Big money and corporate lobbies have them under control. We cannot vote any incumbant back in! And NO, not even the only good one out there.....
I, too, want to vote them all out of office for they are all corrupt to their very core. And we keep voting them in over and over. But we are in a deadlock here, we cannot vote someone out because that would put the opposite party in power, you see where I am going with this. We do not want another
Republican in office but the crook of a DEM is in office. This voting syste, is rigged.
"We Americans spend more than 90 percent of our health dollars on health care (on doctors, hospitals, insurance, machines, pharmaceuticals and the like), but it turns out that only 10 percent of how healthy we are as a nation is determined by what those health care dollars buy. "
So you are what you eat. If you are sedentary, do not exercise, smoke, drink excessively, fail to get annual checkups, eat excessively and the wrong food, live a high stress life style, you may be subject to forces that have nothing to do with republicans. Get over it.
Hey folks - facts are facts - as long as the Senate and Congress keep fanny-kissing the lobbyists,
there will never be healthcare reform. Making our health system better - starts with voting out
all those old goats in the Senate and Congress - November is just a few short months away.
Preventive medicine, or "wellness," needs to be incentivized. Right now, it often isn't.
I had a colonoscopy, routine screening as recommended by authorities for someone at my age. But I was informed by my health insurer that they don't pay for routine colonoscopy screening. I was forced to pay for it out of pocket. (Fortunately, my test result was negative.)
I asked their representative, "But what if the test had been positive, and I really did have colorectal cancer?" She replied, "In that case, we would have paid for the test as part of your cancer treatment.
In other words, currently, the financial incentive is for me to get cancer. That's the only way my insurer will pay for the tests.
I asked their representative, "But what if the test had been positive, and I really did have colorectal cancer?" She replied, "In that case, we would have paid for the test as part of your cancer treatment.
__________
I've had similar insurance issues. How stupid is this? The cost for a colonoscopy is far less than the sum cost of the colonoscopy and treatment for colon cancer.
If otherwise insured adults can't afford the cost of the colonoscopy or decline to have it because of the cost, they might then develop a life-threatening illness that could have been avoided with a test a few years earlier.
So why won't this insurance company pay for the test? Because their actuarial studies have shown that it will cost them less to have a couple of percent of their customers develop avoidable colon cancer than it would to have everyone take the test.
Look at how we now discourage frivolous med mal claims. We limit the amount that valid claimants with good cases can recover. go figure. it is really just protection for those who did screw someone up and of course for their insurance (malpractice) carriers.
Nationalize healthcare now. And while we're at it, we should nationalize oil and gas and the mortgage lenders (putting them back the way they were before this mess of 'privatization' and bail-out guarantees). And regulate the reckless speculators too while we're at it. These people make little contribution to society (the NIH & universities do more research than the so-called healthcare industry) and profits are going UP with regards to big oil too. How much freakin' money do these pigs need before they get the rug pulled out from under them? Of course, we all know what will happen. Healthcare will get subsidies as execs collect massive paychecks for very little work or contribution to society. Big oil will charge whatever they want and pay off their political pals to drag their feet on alternative energy and Fannie and Freddie will repeat itself every few years and get bolstered by the very taxpayers they screw in the first place, thus effectively 'double-taxing' Americans (a favorite term used by Dubya with regards to the Inheritance Tax or the capital gains tax). How many chances do these people need before the public realizes that the market must be watched, regulated AND taxed so that they do wreck havoc upon society? I'm guessing we need a depression and even then I'm starting to doubt that things will change. Especially since just saying 'socialist' grabs headlines as with McSame's use of term as a derogatory with regards to Obama.
"America today ranks first among industrial nations in terms of how much we spend on health care, but last in terms of how healthy we are as a country."
Suppose there's a connection, Marty?....
I'm sick of all the talk- we all know how messed up the healthcare system in this country is. For people like me- college students who can't afford health insurance and have been relying on student clinics for years- we are sick of gambling that the worst won't happen and desperately need our wisdom teeth out. January still seems very far away!
Let me summarize: America's infrastructure is in peril. Health is just part of this. Civility and moral is low. Police departments have not enough gasoline. Our jails are full. There is a political right wing, that feed into "everything is fine" populace. Lying is in style, because truthfulness gets you fired. There is no sense of any kind of society.
And, for some reason, just about every head of state or person of means comes to the US for treatment if they have a serious ailment. I doubt it's because we have the worst healthcare in the industrialized world.
State of the art healthcare technology and training, pathetically wasteful healthcare system. Your system covers both extremes.
LOTS of Canadians come here since your waiting list is so long for certain treatments. I wouldn't talk if I were you, eh?
What a stupid argument. We have the best healthcare TECHNOLOGY in the world. THAT's why "every head of state or person of means comes to the US for treatment if they have a serious ailment". AND because THOSE individuals can pay whatever they need to FOR that technology.
We DON'T have the best HEALTH. CARE. in the industrialized world, when upwards of 100 million Americans are uninsured or under-insured, and even those that ARE insured are one major illness away from bankruptcy due to the costs of treatment.
Figure out the freakin' difference. Sheesh.
Hmm. Heads of state from some countries come to the US for medical treatment, sure. But not the countries a rich industrialised nation like the US would like to be compared to. Rest assured that the rich and/or powerful from Europe, Australia, Canada and NZ, for example do NOT come to the US for their medical treatment!
This article is very insightful, and chimes with the sense of unease I always feel about the US lifestyle while I'm visiting (fun though that is in many other ways). Quite aside from huge issues like income and opportunity inequality, there's a strange artificiality to the average US lifestyle which I notice more and more. So much food that doesn't seem to be made from natural ingredients (and way too much of it), driving absolutely everywhere, air-conditioning on all the time. After a week of this, I start to feel consciously unhealthy.
Hmm last time I checked a member of Canadian parlament came to US for cancer treatment because in Canada there was 3 months wait... Caused a big scandal up north..
i have been a primary care physician for 20+ years.
here is the deal, health insurance execs get paid millions, hospitals are inefficient and wasteful and down right dangerous.
malpractice is too high, specialist make too much, we eat,smoke, and drink too excess and do not exercise.
too many of us order too many tests too decrease the chances of being sued, the NIH pays for too much ridiculous research and pharma waste millions bribing doctors, researchers and politicians.
we are all to blame.
take a look at the netherlands system, it works.
"Pick any national metric of healthiness -- life expectancy, infant mortality, birth weight, chronic diseases incidence -- and America's comparative performance is in the cellar. How can this be?"
Three words: Health. INSURANCE. Companies.
Rarely is there a serious problem nowadays that besides being extremely hard to fix, is not also extremely complicated to even understand.
This is not one of them. Get rid of private, for-profit, health insurance companies.
You are so right & all the trolls out there who think their lies will change minds are so wrong. How to get out of the grips of $ doled out to the politicians who could change this is the question. There are many ways (get rid of the 2 party system for one thing!) so honest Amercians must ban together to demand changes are made. There are groups out there working on it.
The new clothes of the emperor. The house of cards has collapsed. Industry shows growth and increasing profits up to the point where it reaches diminishing returns. That is were we decentralize and reorganize, make units smaller and more efficient. Same applies to everything in society. The U.S. is already a large unit/market, whatever you point of view. There are few, out of sight, powers who really pull the strings here and make us dance like puppets. We are not even seeing the puppet show, let alone the puppeteers. International organizations, which includes religious interests, such as churches, businesses, political interests, and even we ourselves make profit, numbers by which we keep score the measure by which we judge our positions. Those who know wajang theatre, or even puppet theatre, can easily translate that idea. In wajang you have shadow puppets which are manipulated by puppeteers, but above and beyond that is something else, these puppets represent some spirit. No, I am not becoming religous here, and it is not my religion. We need infrastructure, new and smaller schools with healthy buildings, public transportation, universal healthcare, community, sidewalks and fresh air. Free speech is not what others allow you to say, it is not pornography or specific demographic group interests. It is the ability to speak one's mind and tell what is what. It is not the absence of censorship, it is the presence of cohesion, community and society and a voice in how we organize,
Bravo Marty!
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