Why we need to Occupy Healthcare now

The CEO of WellPoint, the second largest health insurer in the US explained why so eloquently in a quote from a 2008 quarterly earnings update. “We will not sacrifice profitability for membership.” An example of a dutiful employee fulfilling her charge to the corporation that writes her 14 million dollar yearly paycheck. Corporations are not concerned if you cannot afford health insurance. Corporations will pursue profits at all costs, sometimes breaking the law. WellPoint is currently under investigation for allegedly illegally siphoning state Medicaid funds. In recent years WellPoint stopped insuring women recently diagnosed with breast cancer to save costs. The US Dept. of Health and Human Services had warned WellPoint to stop this practice in 2010 and that it would soon be illegal. Corporations aren’t concerned with health, but about the next quarterly earnings statement, and keeping shareholders satisfied. The corporation does not have a conscience or responsibility to ensure that Mrs. Jones has a ride to her doctor’s office to get her blood pressure checked, or that Sarah’s parents can’t afford to pay for her asthma medications. Healthcare is now driven by big business and profits.

Not only is the health insurance industry involved, but pharmaceutical manufacturers are making large profits by promoting, advertising, and getting doctors to prescribe the newest, most expensive medications. How do they get doctors to do this? Dr. John Abramson explains brilliantly in his book “Overdosed America: The Broken Promise of American Medicine.” Most funding for research comes from privates companies these days. A company doesn’t want to invest in a product that will not have a big marketplace payoff. Studies can be subtly designed and data presented to show a companies’ new product is superior to an old, less expensive, generic medicine. Doctors are busy seeing lots of patients to keep their offices open, thanks in no part to declining reimbursements from the health insurance companies. They often don’t have time to read an entire study about a new medication to understand the subtleties and flaws. Sometimes, they rely on the opinion about a new medication or treatment from a local expert specialist, who is getting paid by, you guessed it, the pharmaceutical company that makes the medication. It is extremely challenging in this era to separate the wheat from the chaff in medical research. Some would argue we haven’t made any real progress in improving health since the funding sources for medical research changed from the government to private industry back in the 1980′s.

But Occupy Healthcare must go beyond diagnosing and treating illnesses for us to afford improving our  health. We have to start focusing more resources on prevention. As Nate Osit astutely pointed out in a previous post in this forum, incentives are perverse. There are more rewards in our current system to amputate a diabetic’s infected foot than to prevent the infection in the first place.  According to recent CDC statistics, 1/3 of adults in the United States are obese. This number corresponds well in my practice as approximately 30% of patient visits on a given day are to address illnesses causes by lifestyle choices. These illnesses maybe preventable with the correct incentives for education and promotion of healthy living. Our culture in this country is not that much different from 19th century China, where estimates are that 1/3 of the population was addicted to opium. Our modern-day drugs of choice are now food and inactivity. We are starting to change these incentives, in small ways. Some companies have wellness programs that reward employees for healthy behavior, walking, getting their blood pressure checked. Some insurers are doing this as well. But it’s not enough, yet.

I don’t know what the answer is. Many well-educated people will say we need a single payer system to reduce costs. That maybe is a start. Opponents of a single payer model will cry “socialism” and that they don’t want the government involved in their healthcare. The reality is most of healthcare funding already comes from the government. Healthcare delivery may work in a for-profit business model with the right incentives. Accountable Care Organizations (ACOs) that reward for quality care might work, if we could figure out what the elusive quality care is and how to measure it. Regardless of what model we decide will work best for healthcare delivery, we need to start developing a critical mass of people working towards it now. Our current model is not working for too many people. We need to Occupy Healthcare now.

About

David Walker, MD is a family physician employed by a community health center. He is passionate about serving the medically undeserved and preventative health. He tweets about the latest evidence on the benefits of exercise at twitter.com/walker_md and for Health Care For The 99% at twitter.com/DoctorsForThe99. Opinions are his own.

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Posted in Contagion, healthcare, Innovation
  • http://HealthIsSocial.com Phil Baumann

    Hi Dave

    I wonder if the problems in Healthcare (the industry versus ‘health care’ the practice) are so vast, pervasive and challenging, that it may be ‘too late’ – in the sense that the systems we have in place will just have to collapse before they’re either fixed or replaced by new models.

    Just a thought for consideration.

    Perhaps it’s time for us to better understand the nature of Healthcare Economics, and how best to utilize Capital – perhaps neither free market nor ‘single’ payor are the optimal solutions.

    It’s a complex issue – fraught with unintended consequences.

    • Dave Walker

      Hi Phil,
      thanks for your thoughts. I agree the industry is exceedingly complex and increasingly so. We’d likely need computer modeling to even think about trying to optimize what we have now (where’s IBM’s Watson when you need it?). As you know, most of the decisions we all make are based on emotion and I’m not sure there’s a computer right now that could model human behavior.
      I think going back to look at the economics/capital also makes a lot of sense, similar to looking at the social determinants of health as these are closely related. The affordable care act was written with good intentions, and may have some beneficial effects, but I think it is just adding further regulation to an already unwieldy system. Patience and Fortitude.

  • http://www.cyber-cise.com Joanne Frederick

    Dr. Walker:
    Thank you for your thoughtful article. I agree – we need to focus on prevention. Unfortunately our “disease care” system is predisposed to define prevention as tests and screenings which is a clever way for the status quo to protect, or increase, their revenue.

    Prevention used to mean actually prevent the problem from happening versus finding it through a test and then prescribing a drug to make it better. I, for one, vote for starting at the very start by helping people recognize that taking care of themselves is job #1 and then teaching them doing so doesn’t have to be expensive.

    Hope springs eternal.
    Joanne

  • Dave Walker

    Yes! One of the reasons I try to exercise daily, not just for myself but to set an example for family, friends, colleagues, patients. I can envision having a group for each community that is responsible for providing education on healthy behaviors, ensuring people have the resources for appropriate foods, housing, etc. Many folks seem to do ok without this help, but some of us could use a “healthy” life coach/support once in while. Thanks for reading. Patience and fortitude.

  • Pingback: Should we occupy medical schools to effectively occupy healthcare?

  • http://ducknetweb.blogspot.com/ Medical Quack

    I wrote a series about this and most of the article content is about healthcare. It was funny as I got a couple emails asking for more information, one from a protester in NY and the other an editor for Forbes, both ends if you will here I think.

    It’s all about the math, the algorithms you can’t touch, see, feel or talk to but they run 24/7 on servers making automated decisions based on parameters entered and that’s the issue with a bit of dirty match and “Killer Algorithms”. A while back one of the medical record companies I know was telling me about a former risk assessment manager they hired form Blue Cross and the new employee insurers just absolutely live by the algorithms. That came from a former insider. Hopefully the employee is much happier at the electronic medical records company:) I just did a copy and paste of the tweets below.

    Also worth looking up is my Twitter bud NYU professor Siefe who wrote the book Proofiness the Dark Side of Mathematical Deception. It took a lot of bad math and formulas to re-distribute the money and it will take a new “clean” set to fix it. I used to write code so not an issue to tell you what those who are in gutter are capable of. When the dollars are gone that back up the mega queries as we saw before the bottom falls out and eventually bad math is seen, but sometimes too late after too much damage has been done.

    Attack of the Killer Algorithms Part One -what #OWS is all about bit.ly/ralTIq

    Attack of the Killer Algorithms Part Two -what #OWS is all about bit.ly/poz682

    Attack of the Killer Algorithms Part Three -what #OWS is all about bit.ly/vlvxa5

    Attack of the Killer Algorithms Part Four-what #OWS is all about bit.ly/vjfiqj

  • http://artassocialinquiry.org Art As Social Inquiry

    Dr. Walker,
    Thank you for this wonderful blog. I come at the issue from a different angle. I paint very large portraits — larger than life heads – of real people trying to access healthcare in the US. And I also tell their stories. The idea is to connect the ramifications of our current system to the real lives that have to function within this system. So much talk talk talk….with a portrait, a real person, the debate is reframed. The question becomes “What if this happened to me?” If we all asked that question, our healthcare system would look a lot different.
    Thank you.
    Theresa BrownGold
    http://artassocialinquiry.org/