Trainwreck Nation

TrainwreckFact #1: Most Americans’ healthcare is paid for by a third party, either private insurance/pharmacy benefit managers or governmental entities like Medicaid and Medicare, or by both.

Fact #2: This type of third party payor arrangement only works when most people who are a part of it don’t need it.  For example, most people have car insurance but it is only a tiny subset of car insurance policy holders who find their cars damaged or destroyed at any given time.  Likewise, homeowners insurance works because the ratio of homes that are damaged or destroyed to those that are intact and therefore without any claims filed against them is very small.

Fact #3: The third party payor arrangement for healthcare doesn’t work very well because, not to put too fine a point on it, there don’t seem to be too many well Americans left.  Injury and illness — and increasingly chronic illness in particular — are very common.

In my own office, I see high blood pressure, high cholesterol, back pain, bipolar disorder, obesity, chest pain, anxiety, seizure disorder, and headaches…before we open the doors to see patients.  The above description covers some but not all of the complaints and diagnoses of my staff.  And my staff ranges in age from 24 to 45 years old, a fairly young office.  The military is having trouble finding young people who are physically and mentally fit for serviceAs of 2006, a paltry 8% of Americans were adhering to a healthy lifestyleThe obesity rate for children is at or above 30% in 30 American states.  Even with the current administration’s obsession over healthcare, we have a President who smokes and a surgeon-general nominee who is overweight.

Physicians are often taken to task for not practicing preventative medicine and for treating disease in its advanced stages rather than detecting it early or preventing it outright.  But exactly what arcane medical secrets are doctors supposedly holding back from the American patient?  That high fat, high carbohydrate, high calorie diets are bad?  That regular exercise is good?  That smoking is detrimental to one’s health?  While there is always room for improvement in medical practice with regard to prevention, the lion’s share of America’s medical malaise rests with the lifestyle choices made by patients.

There are plans being made to provide universal healthcare for all Americans.  These plans are predicated on the idea, which may not be entirely correct, that there are large numbers of Americans who are in desperate need of medical care but who cannot afford it.  If this is true, we can predict that a new influx of sick people into the third party payor system will create even more of a burden on a system that is already dysfunctioning badly.  In fact, after the state of Massachusetts implemented universal healthcare, that is exactly what happened.

I’ve written on Dr. Bobbs that I don’t think the third party payor model is the best or even a very good way of paying for healthcare.  But if we are going to persist with this model for the foreseeable future, we desperately need large numbers of healthy, vibrant people who can contribute funding to the healthcare system while utilizing little or no healthcare resources themselves.  But from where will these trim and vigorous people come?  Even the young, a term once almost synonymous with health, are smoking, getting fat, and not exercising very much.

Americans need to simply change their lifestyles and change them radically.  They also need to have a primary care physician who sees them periodically.  How can this be achieved?  One former presidential candidate went so far as to say, “[Y]ou can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK. ” While we are not quite to the point of compulsory visits to the family doc, the fact that a serious candidate for the presidency could seriously say such a thing is a sign of the times.

While the debate on healthcare rages on, it’s important to remember that what American healthcare really needs is not simply more coverage and more medicine and more doctors.  It would really help if we had fewer patients.

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