Webloggin » Bad Medicine

I saw Michael Moore with Jay Leno the other day. I was impressed by how very fat he was. He’s not just pleasingly plump, he’s morbidly obese, barely-can-walk fat. Some might think he’s a heart attack waiting to happen. If that were to be the case, he’d be rushed to the hospital in a hi-tech ambulance, be given hi-tech tests, and probably receive hi-tech surgery. All of that made me think about some of the reasons American health care is so expensive, and it’s not just insurance company greed or lawyers.

For starters, American doctors are the best trained in the world. Unlike doctors in most (all?) other countries, who start their medical training right out of high school, American doctors first have to complete their undergraduate education in pre-med courses, where they have to place in the top percentages of their classes to qualify for medical school. Not only does this give them a good practical science education, it means they’re more mature when they finally get to medical school. Medical school, of course, is a four year program. After that, they all have to do a one year internship, which qualifies them to become prison doctors. If they want to go beyond being a prison doctor, they have to continue their training. For the more basic medical practices — internal medicine, pediatrics, etc. — they have to complete a two year residency in their field. However, if they aim higher, after the two year residency, they have to complete either a longer residency (such as surgery), or even go on to a longer fellowship in their chosen medical specialty, such as cardiology or neurosurgery.

In other words, your average American surgeon, after leaving high school, has put in a minimum of twelve years of training. Taking all this into account — their stellar undergraduate grades and their lengthy training — you can’t then pay them Soviet-style wages. We can decide, of course, as a matter of public policy that our doctors are over-trained, and lessen the whole cycle, but we can’t take our current crop of hyper-educated people and reduce them to a secretary’s wages.

The next thing that distinguishes modern American medicine is that it is so high tech. Fifty years ago, for diagnosing patients, your average doctor had a clunky x-ray machine, a few simple blood tests, and his own five senses. If he was able to diagnose something, he had three treatment options: a small arsenal of pills most of which, with the exception of newly discovered antibiotics, were useless; surgery; or doing nothing.

Nowadays, of course, our doctors are science machines. Diagnosis takes place using every type of test and scan scientific ingenuity could create, with the number of tests available growing annually. Treatment involves a panoply of medicines and surgical options unimaginable even thirty years ago. And even putting the fear of lawyers aside, when you have the ability to diagnosis and treat at this level, you’re going to try to do it that way. After all, an EKG is a much better way to find out what’s going on than a stethoscope, and an MRI is better (and safer) than an old-fashioned x-ray. Certainly patients expect that their doctor will use the best equipment, tests and techniques on them. So people who complain about the high cost of medicine, at least when it comes to today’s medical sophistication, are like people who buy a fully equipped SUV and then complain that it’s more expensive than a horse and buggy.

The last thing that distinguishes modern American medicine, not just from treatment in the past, but from treatment elsewhere in the world, is the speed with which treatment is available. I could dig through myriad articles and studies to prove the truth of this statement, but I’m heading out soon, and won’t. I’ll confine myself to citing one article about Canadian medical care (h/t: Earl), and a few anecdotes.

Anecdote 1: When I was living in England, my friend’s mother had a bad hip. She was a candidate for a hip replacement. As you know, in America, that would have happened in days or weeks. My friend’s mother was placed on a list, and spent the last years of her life in a wheelchair, in tremendous pain.

Anecdote 2: Also when I was living in England, I kept hearing people talk about something called BUPA. It sounded like Tupperware, but when I asked, I learned that it was new-fangled medical insurance (this was in the very early 1980s). Inquiry revealed that middle class people who could afford it were buying BUPA and opting out of the national health care system as fast as their wallets would carry them. In other words, given a market choice, they couldn’t escape NHS fast enough.

Anecdote 3: A very wealthy cousin of mine lives in Germany. When she was diagnosed with a major abdominal problem, she was so frightened of the top German doctors who had bungled her care for years, that she hired an ambulance flight to America to have surgery there.

Anecdote 4: Another cousin of mine in Israel was born with congenital eye problems. No one in the regional hospital to which he was assigned was capable of treating them. Nevertheless, the public health care system refused to allow him to obtain treatment in another hospital, which had a staff member who could care for his eyes. His parents ended up spending hundreds of thousands of dollars of their own money to restore and preserve his sight.

I recognize that American health care has problems. Right now, we have a situation where the majority of people get pretty damn good care, either by comparison to historic precedent or care systems in the rest of the world. However, a significant number, but by no means a majority, can afford only basic care, but gets screwed by insurance company for more expensive care. And a clump of people, about 1/12 of the population, has no regular care at all, and gets by on emergency rooms, which is bad for them and expensive for us. Obviously, it’s not perfect.

But is it any more perfect to be in a system where everyone gets mediocre care from poorly trained doctors, using less sophisticated equipment, in systems so overloaded that even life saving treatments are denied? That’s toddler style medical care, with someone out there making the decision that “If I can’t have it, nobody gets it.”

Given the choices, I’d much prefer to fix our system so that it offers the best care for the greatest number of people, rather than jettison it entirely in favor of the socialized medicine that has proven to give the most mediocre care to the greatest number of people.

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