The Wrong Diagnosis

Even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy.
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I'm worried -- and if I'm worried, you should be, too. The reason I'm worried is that the wrong diagnosis is being made. As any doctor can tell you, the most crucial step toward healing is having the right diagnosis. If the disease is precisely identified, a good resolution is far more likely. Conversely, a bad diagnosis usually means a bad outcome, no matter how skilled the physician. And, what's true in personal health care is just as true in national health care reform: Healing begins with the correct diagnosis of the problem. Washington is working on reform initiatives that focus on one problem: the fact that the system is too expensive (and consequently too exclusive.) Reform proposals, such as the "public option" for government insurance or calls for drug makers to drop prices, are aimed mostly at boosting affordability and access. Make it cheap enough, the thinking goes, and the 46 million Americans who can't afford coverage will finally get their fair share. But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It's impossible to make our drug-intensive, technology-centric, and corrupt system affordable. Consider that Americans spent $8.4 billion on medicine in 1950, vs. an astonishing 2.3 trillion in 2007. That's $30,000 annually for a family of four. The bloated structure of endless, marginal-return tests; patent-protected drugs and "heroic" surgical interventions for virtually every health problem simply can't be made much cheaper due to its very nature. Costs can only be shifted in various unpalatable ways. So, a far more salient question that must be addressed is: Are we getting good health for our trillions? Unfortunately, the answer is a resounding, "No." The U.S. ranked near the very bottom of the top 40 nations -- below Columbia, Chile, Costa Rica and Dominica -- in a rating of health systems by the World Health Organization in 2000. In short, we pay about twice as much per capita for our health care as does the rest of the developed world, and we have almost nothing to show for it. I'm not against high-tech medicine. It has a secure place in the diagnosis and treatment of serious disease. But our health care professionals are currently using it for everything, and the cost is going to break us. In the future, this kind of medicine must be limited to those cases in which it is clearly indicated: trauma, acute and critical conditions, disease involving vital organs, etc. It should be viewed as a specialized form of medicine, perhaps offered only in major centers serving large populations. Most cases of disease should be managed in other, more affordable ways. Functional, cost-effective health care must be based on a new kind of medicine that relies on the human organism's innate capacity for self-regulation and healing. It would use inexpensive, low-tech interventions for the management of the commonest forms of disease. It would be a system that puts the health back into health care. And it would also happen to be far less expensive than what we have now. If we can make the correct diagnosis, the healing can begin. If we can't, both our personal health and our economy are doomed. Politicians aren't going to resolve this issue overnight. Any health care reform bill that gets jammed through Congress in the next month or two will be dangerously flawed. Washington needs to take a step back and re-examine the entire task with an eye toward achieving the most effective solution, not the cheapest and most expeditious.

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