Health for Profit

Imagine your doctor telling you this:

Well, Bill, you have a very serious illness. In fact, if we don’t do something about it, you’re going to die. Fortunately, we have a cure. It costs $1 million. Do you have it? No? Oh, that’s too bad. Well, it’s been nice knowing you. Please give my best to your family.

Unimaginable, right? No doctor would ever say that. Never. What the doctor would say would be more like, “Well, Bill, we better make an appointment with our team of surgeons, anesthesiologists, oncologists, anthologists, and scientologists, and get you into surgery as quickly as possible so we can save your life.” Yeah, that’s more like it. The doctor cares about you. He is working hard to save your life. Nobody is going to let you die. Then all those doctors and hospitals would just send their bills to your insurance company.

In Canada, they would send their bills to the provincial agency in charge of health care (OHIP, where I live). There would be no need to check with them before hand: other than some cosmetic surgeries and exotic experimental treatments, pretty well everything is pre-approved. OHIP would then pay the bill. Done.

In the U.S., however, they would have to negotiate with your HMO or your insurance company and arrive at an agreed upon treatment plan. The doctor gets paid for doing surgery, not for keeping you healthy. He wants to do as much surgery as possible so he can retire early. But the insurance company or HMO wants to keep their money so they can pay it to shareholders and reward their top executives with mind-boggling salaries, private jets and country club memberships, and numerous vacations. They will do everything they can to keep from having to pay for your surgery. “Well, it’s not as if Bill is really all that well-liked anyway…”

Christian doctors, who hold an incredibly high regard for human life of course, charge only a modest amount, even if they know they could get a lot more. Ha ha.

The cost of medical treatment is a reflection of a number of factors, including scarcity and necessity. The U.S. has opted for a free enterprise model. Supposedly, all those doctors and hospitals will keep their costs real, real low, because they have to compete with each other for patients. So hospitals advertise the odd special: “New stem-cell leukemia treatment– was $350,000, but marked down, this weekend only, to $285,000. Folks, these are close-out prices!”

A kidney transplant can be a regular bargain at $120,000, if there are no complications. And that doesn’t include all the drugs you need afterwards.

Treating someone who’s been in a serious accident can cost $80,000! Just for a few hours in OR! That sounds a bit pricey for me. Couldn’t I try the emergency room at St. Mary’s? I hear they give coupons.

Well, where does the $350,000 come from? What exactly do you get for $80,000? Who gets most of the $120,000?

Well, look at a hospital. It’s got offices, computers, janitors, cooks, nurses, receptionists, presidents, vice-presidents, administrators, human resources staff, training staff, support personnel, vision statements, and so on. Some of the money goes to doctors, of course, and they’re probably over-paid (compared to teachers, at least), but they don’t get anywhere near the $350,000 total. I’ve seen some medical catalogues: hospitals pay big bucks for equipment that looks like it ought to be a lot cheaper. A little plastic tube costs $14.00. It looks like you could get it free at Wendy’s with a Kid’s Meal Cheeseburger.

Well, the reason these medical tools are so expensive is volume. They don’t make enough of them. I think everybody should own their own surgery kit. If they sold enough of them, the price would really come down.

Then we could just rent a surgery room somewhere, hire a doctor for, say, $250.00 an hour, and do the operation there. That would be true free enterprise. And why should only doctors have the right to do surgery? What if you knew somebody who was really good at it? I’ll bet the competition would really reduce the costs.

I’ll bet you could do the kidney transplant for less than $3,000. Instead of nurses, you could have your aunt or grandmother come in and tidy up, change the sheets, hand the instruments to the doctor, and count sponges. Instead of filling out ten zillion forms and arguing with your HMO, you could just give the doctor your car, or a year of yardwork, or your stereo.

A big, big problem is that about half of all the medical treatment in North America goes to terminally ill elderly patients. An 86-year-old guy with bad kidneys gets some heart pain, so we zap him into surgery and perform a triple by-pass. Because he’s old and weak, he’ll take about three months of constant care to recover. A week after he starts walking again, they’ll find cancer or something, and do some more surgery. There goes the family inheritance. So this guy worked hard for fifty years, got married, had kids, contributed to his employee pension plan, bought insurance, bought a house as an investment, scrimped and saved and invested and wasted not… only to get sucked dry by doctors in the last six months of his life. It’s like some kind of horrible, dirty trick they play on all of us. You think you’re getting ahead, but THEY, whoever they are, the holders of wealth in our society, get it all back from you in the end. Your children and your children’s children have to start all over from scratch. That sucks.

Modern Medicine

We were wrong about doctors and science.

For the past 100 years, we all thought that we were all living longer and healthier lives thanks to science and modern medicine. We could eat whatever we wanted, do all kinds of daring things– like lock ourselves into two tons of jagged metal and glass and hurl ourselves down the highway at 100 miles per hour– and cover the earth with refuse and soot, and still live longer and longer and longer.

Life expectancy at the turn of the century was, oh, about 22. Now, men can expect to live to 75 and women to 75 and four days. And it’s all thanks to modern medicine.

Or is it?

Turns out, maybe it isn’t. Turns out maybe we don’t even believe it ourselves: everyone is flocking to alternative remedies. Got some strange rash on your bum? Go to a chiropractor. Stomach upset? Get a massage. Broken arm? Take some natural herbs and stick some needles into your arms.

Why are so many people doing this? There are a gazillion television programs telling us that doctors are smart and compassionate and nurses are beautiful and sexy. Why do we suddenly prefer tea enemas?

Maybe it’s because we discovered some kind of secret truth about doctors and hospitals. For one thing, an awful lot of people seem to die after seeing a doctor. For another thing, hospital food is pretty well uniformly bad.

We all have been raised to believe that science– doctors– saved us from the awful polio virus. That fact is like a totem of modern science, a cathedral: it hovers over us constantly, hammering into us the idea that science saves, that modern medicine can cure everything. But I was shocked a few years ago to discover that the incidence of polio had waned to practically nothing before Jonas Salk invented a vaccine for it. (Check it out for yourself if you don’t believe me.) All these years, we thought that science had saved us from polio, but it didn’t. It was something else. What was it? If the real doctors know, they sure won’t tell us. “Go home, eat a variety of foods, and stay out of wars.” Not good tv. The pharmaceutical companies sure won’t tell us. “This drug, which cost you 100 times more than it cost a vet to give to a hamster, will cure you if you take it tonight since we have figured out that most people go to the doctor just after a particular virus has peaked in strength and, therefore, will feel better the next day no matter what, so you might as well think it was the drug that did it so we can make zillions of dollars to invest in research so that some day we might be able to copyright your DNA and sell parts of it to other people.”

But we’re all living longer, aren’t we? So if it wasn’t science and medicine that saved us, what did?

Probably, the simple abundance of relatively nutritious food. You may think about McDonald’s and laugh, but it might surprise you to know that even a Big Mac has some nutritional value. You can walk into a McDonald’s and pick up a Big Mac and some fries and a milk shake pretty well any time you want to. That’s affluence. It wasn’t like that for thousands of years. Does a Big Mac sound nutritious? Not very. But consider a world in which many people didn’t even know if they were going to have enough food to last them through the winter.

So yes, we are fat and unfit, but we are living longer than ever, even though, if you believe the TV preachers, we are the most drug addled, promiscuous, violent, and pernicious generation that ever lived. Think about that! If even one tenth of what the TV preachers– and more than a few pulpit pundits–say about the human race was true, wouldn’t life expectancy be declining?

A few years ago, the doctors in Israel went on strike. A well-known study (so well-known I can’t remember the name of it) was done on mortality rates during the strike. It turns out they went down. Some people rationalized that this was because patients were forced to postpone surgeries, stop eating hospital food, and pay smaller health insurance premiums, but it’s not true, according to the researchers. The death rate actually went down. It went down and it stayed down. Eventually, the pr got so bad that the doctors went back to work without getting anything that they wanted. Maybe that’s the real reason there hasn’t been a doctor’s strike yet in Ontario.

Do you suppose that if church ministers unionized and went on strike, that the church might actually grow? Well, think about that a bit too. In our church, the Christian Reformed Church of North America, ministers generally spend a lot of time at big meetings hollering at each other about purity and orthodoxy and scriptural authority and the like. What if they just went out into the cities and cleaned up a few vacant lots and distributed sandwiches to the homeless instead?

Here’s another juicy piece of information: what professional group do you think declines surgical procedures more often than any other? You guessed it: surgeons. That’s worth thinking about a lot the next time your doctor recommends surgery to you.

I have one last little gripe: most of us are gradually coming to the realization that animals deserve a little more respect than we have been giving them in the past. We used to see animals as steak-fodder, beasts of burden, and incipient fur coats. Now, thanks to the extremists, we moderates are beginning to realize that animals are not all that much different from us. I mean, sure, lions and tigers kill indiscriminately, while we only kill when we really, really have to, like when our oil reserves are low so we can’t hurtle ourselves across the highways in our metal and glass behemoths anymore, but, basically, we’re not all that different. Then why does a vet get, like, 50 cents for doing surgery on a dog, while a doctor gets mega-bucks for doing surgery on a human being, like, say, Preston Manning? Does this make sense? Do you really believe that a doctor is that much smarter than a vet?

What I think we should do is de-regulate surgery. Let anyone do it. After all, the free markets have given us this wonderfully rich and meaningful lifestyle we all now share (unless you are lazy). Why not let it work its magic on medicine? If you get a few really, really bad surgeons setting up shop, hey, people won’t go to them after a while and they will go out of business, like Microsoft, so we will only be left with the best surgeons. And they will have to price themselves competitively or else people won’t go to them anymore, unless you are very rich, in which case you probably also pretty smart, in which case you wouldn’t go to a surgeon anyway. I mean, would you rather have some crackpot cutting into you with a knife or giving you a tea enema?