Healthcare reform

Obamacare Distracts From the Real Issues Plaguing Healthcare

Caduceus Medical Symbol chromeThe calamitous launch of the Obamacare web-site has been an embarrassment to the administration, and a rallying cry for Republican opposition to the landmark legislation.  Yet, within short-order, even detractors acknowledge that the web-site will be fixed, the vitriolic rhetoric will subside, and Obamacare, however flawed, will become part of the national healthcare landscape.

The real danger of Obamacare is not so much what it does, but what it fails to do.  After all, improving access to care for millions of Americans would seem to be a good thing in a wealthy, developed nation…unless that access is to a fundamentally dysfunctional system desperately in need of meaningful reformation.

Our system is terribly broken, and Obamacare, despite its 2,000+ pages of text, fails to address the core issue plaguing American healthcare – the issue of insatiable greed. While pundits pontificate on Obamacare’s failure to launch, our nation is spending more than $7 billion per day to fund a bloated, dysfunctional system that, at times, seems to exist more to line the pockets of the few, than to meet the health care needs of the many.

Greed has driven our nation’s healthcare bill from a paltry $12.7 billion in 1950 to $2.7 trillion in 2013. It has catapulted healthcare to the top of the hit parade relative to GDP expenditures…accounting for approximately 18 percent of our nation’s gross domestic product.

 Greed versus Value

Yet despite the escalating costs of care, we pale by comparison to other nations in the value our system delivers.  Just ask Arnold Relman, M.D., Editor Emeritus of The New England Journal of Medicine, who opined::  “Considering that we spend so much more on medical care than any other advanced country, we ought to expect health outcomes to be at least as good, and our citizens ought to be at least as satisfied with the system. But we can claim neither.”

After spending thirty years working within the healthcare system, I can attest to the fact that the American healthcare system is without peer when it comes to creating wealth for certain stakeholders.  You need look no further than the profits of the pharmaceutical, biotech, and medical device manufacturers for proof.

The real question we should be asking is: Why does our society allow an unparalleled level of profiteering to occur within the healthcare industry? Why should we pay $10 for an aspirin and $500 for a bottle of saline (saltwater) when we are hospitalized?  Part of the answer can be found by looking at the strength of the medical-industrial complex.

The Medical-Industrial Complex

The first reference to the medical-industrial complex was made more than 30 years ago by Barbara Ehrenreich. Ehrenreich borrowed a potent phrase from Eisenhower’s 1961 farewell address to the American people, in which he warned of the dangers of the growing “military-industrial complex:”

This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence — economic, political, even spiritual — is felt in every city, every State house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

As is evident from this quote, Ike did not merely coin the term, but also admonished the American people to be wary of the growing clout of the military-industrial complex.

The very abuses that Eisenhower envisioned occurring within the military-industrial complex are today rampant within the medical-industrial complex. Such abuses drive-up costs of our care at the expense of quality and accessibility.  Proof is rampant. Here’s a teaser:  According to a report published by OpenSecrets.org: “Total annual lobbying in 2012 for pharmaceuticals and health products, which includes: medical products, dietary and nutritional supplements, etc. = $234,104,389.” What kind of influence does $234 million buy one?

When will we take off our blinders and redirect our focus from the red herring that currently taunts our highly divisive politicians, and instead focus on an issue desperately in need of a solution – the issue of rampant greed?

Until then, we will continue to be mired in political rhetoric regarding our current attempt at healthcare reform that has little to do with true reformation of the delivery system.

 

Obamacare: The Good, the Bad, and the Ugly

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When my friends ask me to translate the 2,000+ pages of legislation constituting the Affordable Care Act (ACA), aka Obamacare, into a sound-byte, I stammer and stutter looking for where to begin. In the end, I tell them about the Good, the Bad, and the Ugly.

The good news is that ACA eliminates some reprehensible insurance practices of the past. No longer are people uninsurable due to pre-existing conditions. Gone, too, are lifetime limits covering insured, health care expenditures. Plus, subsidies/stipends and new qualifications for Medicaid should make it far easier for tens of millions of Americans to access the system (assuming we have an adequate supply of physicians).  Achieving this level of expanded access is a major accomplishment. The only problem is that it is widening the funnel to let more people into a highly dysfunctional health care system.

What’s “bad” about Obamacare is its fundamental failure to address the core dysfunction rife within American medicine. The American health care system is astonishingly expensive, remarkably variable in quality, and incapable of stemming the rising tide of chronic illness in our population. Greed is endemic in medicine, and the prices charged for health care services are incomprehensible to consumers.

Journalists are now latching onto the issue of cost, as illustrated in a New York Times article entitled: “How to Charge $546 for Six Liters of Saltwater,” as well as in Steven Brill’s comprehensive exposé, “Bitter Pill,” that appeared earlier this year in Time Magazine.  These articles are likely to resonate increasingly with consumers who have to pony-up hard-earned dollars to cover higher deductibles and co-pays.

The “ugly” of Obamacare is the way we, as a society, have responded to the new law. Yes, it is fundamentally flawed, but it does contain meaningful social reform. We need to see it for what it is – not through the distorted lens of political polarization. We can then have an intelligent discussion about what problems Obamacare will solve; what new problems it may create; and what additional reformation needs to occur to stem the rising cost of health care while improving its quality, safety, and accessibility.

If ever there was a time for an objective debate about the next steps in reforming our $2.7 trillion health care system, it is now!

 

Please let me know your thoughts via e-mail: johnleifer@aol.com