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Avoiding Entitlement Bankruptcy


There is a lot more money to be made in treating sick people than in creating healthy ones.

It’s our patriotic duty to become healthy. The question is whether we can do that through conventional, high-tech medicine.

How’s that for an irritating opener? But first let me address the issue of patriotism. One aspect of the definition is “zealous support of one’s country.” I personally don’t think this is limited to being willing to go to war for it. I think it also has to do with embracing a healthy lifestyle for the benefit of the collective.

In my last post, I reviewed the findings by the Institute of Medicine and the National Research Council revealing that U.S. health overall is inferior to that in the 16 other wealthiest countries. This is true in spite of the fact that we invest more in healthcare than they do. Both of these facts are bad enough, but the high and rising cost of healthcare, through Medicare and Medicaid, is a huge factor in our unaffordable entitlement spending.

On January 1, conservative columnist David Brooks wrote that unless we do something soon, entitlement spending and debt payments are projected to suck up all Federal revenue by 2025.

I thought I would isolate that sentence, because it takes a moment to digest it. He also wrote that “The average Medicare couple pays $109,000 into the program and gets $343,000 in benefits according to the Urban Institute. This is $234,000 in free money.”

Of course, the problem is that a lot of people who rail against entitlements are on them, and neither Republicans nor Democrats have been able to mobilize support for a solution. Medicare spending is only going to rise. We have some dazzling and horrifically costly solutions to many medical problems, and the not-very-well Baby Boomers moving into the Medicare zone have shown every sign of wanting to have unconstrained access.

I remember an anecdote from years ago. (My former husband was a healthcare executive.) A couple stormed into a hospital administrator’s office, furious about the care that a dying elder was receiving. “If you don’t do everything possible to save her life, we will sue you!”

Well, maybe they were trying to expiate guilt about not having done enough for granny before this, but they weren’t throwing their money around; they were demanding that Medicare money be basically poured down the drain.

The hospital insurance pioneered by Blue Cross in the 1930s was a wonderful idea, and it was advertised as costing no more in premiums than one pack of cigarettes a week or one pair of silk stockings a month. (I wrote a book, The Hospital, that touched on this history.) The industry grew, however, and coverage was extended to more than the healthy population that Blue Cross had originally sought as beneficiaries. As the number of less healthy beneficiaries rose so did expenses, and patients became steadily more insensitive to the true cost of care. Now the cost of insurance for an individual is equal to what one might pay for rent.

At the same time, and as I wrote in my last post, individual decision-making about lifestyle began decades ago to put citizens in serious harm’s way. Smoking, overeating, alcoholism, and inactivity increasingly lead to life-threatening disorders. The medical establishment addresses them through expensive advances in diagnostic technology, surgical techniques, pharmaceuticals, and the ability even to transplant damaged organs. Dying has not been eliminated, but it can be greatly prolonged in ways often harrowing to patients and families as well as enormously costly.

Of course disorders and injuries, some of them life-threatening, can occur suddenly and inexplicably. This is when the interventions conventional medicine can perform are miraculous. And with regard to emergency room and trauma care, American physicians are probably the best in the world.

America’s unique brand of high-tech medicine is driving the rising cost of healthcare entitlements. However, what we need to do to create a healthier country, to have a stronger and more productive society, is not exciting to our premier medical scientists.

Andrew Weil, M.D., founder and director of the Arizona Center for Integrative Medicine at the University of Arizona, states the imperative as follows: “The primary role of physicians should be to teach people how to not get sick, how to live in ways that promote health, how to maintain health throughout life, and how to care for themselves as much as possible (emphasis added).” What a yawn for a brilliant young physician who also hopes to become wealthy in an elite practice.

And the fact is, there is a lot more money to be made in treating sick people than in creating healthy ones, and making money is what America is largely about. Once you realize that, the world looks a bit different. It looks like one should do everything possible to avoid getting sick and especially to avoid hospitalization. Among a large enough number of people, that commitment could help us forestall entitlement bankruptcy.


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