occupy
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.