Dr. Nortin M. Hadler is a medical professor at UNC at Chapel Hill. I happen to be reading his book Worried Sick. It’s just one of the books he’s written critiquing the health care system, including an upcoming work on how “citizen patients” need to assess the health care system, including both its costs and effectiveness.
For instance. consider cardiology. Hadler begins Chapter Two of Worried Sick:
Interventional cardiology and cardiovascular surgery are the cash cows, if not the engines driving, all that is indefensible about the American health-care delivery system.
He point out how much-hyped heart procedures that have failed to prove scientifically that they do much if anything to save lives. He concludes, “I submit that interventional cardiology and cardiovascular surgery have written one of the bleakest chapters in the history of Western medicine.”
He makes a similar critique of the current medical treatment of diabetes, high blood pressure, and much more. To sum up, perhaps overly simply, the health system often “medicalizes” problems or pains that are basically normal aspects of aging, or just life in general, or things we have little real ability to “cure.” Then many of the cures are no better than the complaint, or even worse. (For example, the Vioxx scandal.) If nothing else, the plethora of “cures” undermines our ability to simply cope with physical complaints, or the life stresses that do so much to cause our ills.
Also, the pharmaceutical and medical industries too often pervert research to push their own expensive procedures, devices and pills.
He’s not anti-medicine, of course. He asserts that it’s more important than ever to work closely with your own doctor to find the right treatment. And this means that which will keep you healthy longest — rather than making you a worried “patient” burdened with treatments.
First, Worried Sick persuaded me to ask more questions in the future when my health is at issue. It’s not a matter of statistics; it’s a question of what I am willing to risk, what I can cope with, and the kind of life I wish to leave. Only I can take responsibility for that choice.
Second, one thing Dr. Hadler stresses is that the personal interaction between doctor and patient is vital. The drug companies, the medical establishment, the government all too often create worries and put patients through ordeals that have nothing to do with real health. It’s personal physicians who can counter that — if they can.
Third, though Dr. Hadler addresses the question in passing, it’s obvious that, if he is correct, Americans undergo and thus pay for billions of dollars of medical care that is of little use, or is even harmful. That wastes billions. Which is money, obviously, our society no longer has.
So, to go beyond Worried Sick, what will Obamacare do?
If the patient-doctor relationship is vital to making sensible decision, Obamacare will obviously make this difficult if not impossible. Government bureaucracy will set strict rules that doctors dare not disobey.
Now, Obamacare supposedly will save money. But will it? Big Pharma cut a deal with the politicians to get this passed. Ditto for much of the medical establishment.
What Obamacare does is politicize care. Some see death panels, and that is a risk. But also a danger is that political pressure will induce the health care system to mandate care that isn’t needed.
That is one danger of our “don’t pay as you go” system: Convinced we need or deserve something, we demand it. It is easy to imagine elderly voters pressuring the nationalized health care system to give, say, heart surgery to anyone with any symptoms, no matter how minor, or how dubious the procedure. And it is equally easy to see patients being stampeded into getting the surgery, even if they don’t really want it. After all, there will be few alternatives. The friendly physician who can help a patient cope, and provide mild but effective treatment, will go the way of the house call. Doctors will become bureaucrats in white coats. And of course with the entire national government behind the drive, how many individuals can resist?
In effect, “Uncle Sam wants YOU to get heart bypass surgery. Whether or not it really helps you have a better, healthier life.”
Of course, resources are finite. Which means that effective but unglamorous treatments and coping mechanisms will get shunted aside.
Eventually, of course, such a system must collapse, as surely as the market for “no income, no job” mortgages had to. What we will be left with then is a matter for deep concern.