It’s Baaaaaad Out There

Healthcare is in the poorest state it’s ever been, and it’s about to get worse.

ByErik Goldman

A couple of weeks ago, I attended the Medical Spa Expo & Conference to try and get a sense of what this rapidly growing “Medi-Spa” trend is really all about.

I learned a few important things. First, there’s no end to the amount of money one can make by catering to consumers’ vanity and telling them what they want to hear. Not everything in the spa world plays on false hope, but there sure are a lot of “revolutionary miracles” that promise to reverse aging, burn fat without effort, reprogram metabolism “at the cellular level,” and “reveal the true you.”

Second, the line between wellness-oriented healthcare clinics and cosmesis-oriented salons is blurring beyond distinction. Whether that’s good or bad, I don’t know, but it is clear many spas and salons want to be more “medical.” In some cases, this means having an MD on hand to dole out the botox. In others, it represents a more serious commitment to helping clients optimize their health through nutrition, stress management, biofeedback and botanical medicine.

It’s also clear that many physicians, clinics and hospital systems are building or partnering with medical spas to serve as refuges from the ravages of insurance-based, illness-oriented medicine. Beneath all the creams, serums and facelift wands, the medical spa trend is telling some scary truths about healthcare at large.

Case in point: a team of four physicians, neurologists and neurosurgeons, who’d flown in from Idaho to attend the spa show in New York. I asked one of them what such a highly skilled crew was doing at a fluff-fest like a spa show. One of them turned to me and said: “Buddy, you have no idea how bad it is out there.”

Reimbursement cuts, overhead increases, insurance hassles and ever-in­creasing loads of patients with strokes, Alzheimer’s, and other brain disorders make it increasingly difficult for these guys to make a decent living. They’re pushed to treat more patients in less time, for less money, and they’re reaching the breaking point. They went to the spa show because they were planning to bail out of neurology altogether and open up a spa or wellness center.

I was shocked. This guy was a neurosurgeon—the cream of the medical crop! Able to open up patients’ skulls and muck around in the gray matter! The sort of doctor who, in the past, was practically guaranteed a handsome living with all the amenities. Here he was utterly frustrated and looking for a way out.

I’ve heard this kind of frustration from primary care doctors, who generally make less money than subspecialists and surgeons, and view the latter as the big winners in the healthcare game.

Last year, I met a very kindly family physician, who’d practiced for decades in a solid middleclass neighborhood in Brooklyn, NY. He took care of patient care, while his wife ran the practice, old-school style. A few years ago, they got so frustrated with the paperwork, the insurance battles, the dwindling reimbursement, and the harried seven-minute patient visits that they closed the practice and moved upstate—to raise grass-fed cattle! Talk about trading one set of “BS” for another!

According to my new neurosurgeon friend, it is every bit as bad for many specialists, who might seem, from the outside, to have an advantage.

I recently got a call from a young physician friend of mine, who’d re­cently graduated from osteopathic medical school, and was into her first months of residency in New Mexico. I asked her, “How’s life as a doctor?” She replied, “Oh, it sucks. I’m doing an ICU rotation this month. It is mostly very old men, and I have to do all this stuff to keep them alive, when they probably really need to die.”

She then described a few ICU horror stories, like having to try and rouse a very elderly man enough to take the respirator tube out so they could ask him whether he would consent to be re-intubated!

On one level, these are all isolated incidents, worst-case scenarios that overlook the many lives saved and crises averted by modern medicine and its delivery systems. But these “isolated” scenarios are popping up all over, and I think they’re telling the same story from different angles: the healthcare “system” is a jumble of conflicting financial incentives and social imperatives that inadequately fund the health services we most need, while providing a seemingly endless array of interventions that often lead nowhere.

The Healthcare Reform Debate

To me, the healthcare scene is a mirror reflecting our own collective confusion, our collective schizophrenia around issues of public well-being, individual freedom, personal responsibility, distribution of wealth, how we want to live, and how we want to die.

All of which brings me ‘round to Mi­chael Moore’s film Sicko, and the return of the healthcare reform debate.

Let me start by saying that in principle I agree with Moore’s basic premise that a single-payor European or Canadian style national healthcare system would be, if not exactly a great thing, at least not a bad thing. A Single Payor National Health Care System (SPNHCS) is, in my mind, the best option for basic coverage of the millions of uninsured people (and I’m one of them).

It won’t solve all our healthcare woes, but an SPNHCS would certainly be no worse for patients, practitioners and American businesses than the bureaucratic mess we’ve got now.

The movie Sicko boils the healthcare crisis down to a few core themes:
1. Insurance companies are fundamentally evil in that they pretend to care about people but only really care about money.
2. Big Pharma is evil because it wants to make tons of money off products that sick people “need.”
3. The U.S. spends vastly more on healthcare than any other industrialized nation, but there’s no evidence we’re healthier. In fact, it’s quite the opposite.
4. SPNHCSs, like in England, France, Canada and Cuba (the countries visited in the film), represent a much nicer and better way to do healthcare.

Again, I agree with much of this, but I can’t say that I love Moore’s methods. His explanations are overly simplistic; he avoids anything that doesn’t fit his premises; and he’s shameless about pushing emotional buttons, playing for laughs or tears, rather than reasoning out a meaningful case.

But my real problem with Moore’s film is what it ignores. There’s no mention of the connection between chronic illnesses and the chemical-laden, nutritionally-void food people are eating. There’s no mention of personal responsibility for cultivating and maintaining health. There’s no talk at all of holistic/natural medicine as a key to a better healthcare future.

Moore presents people as hapless victims of circumstance, who then fall prey to ruthless corporations. Drugs/ surgeries/hi-tech interventions are an absolute necessity, and an unquestioned good. The only question is, why those big bad corporations are so heartless and unwilling to just give everybody what they need—like they do in other countries.

Moore never really questions the need, and how the “need” is in large part manufactured. His logic goes like this: “SchmidtKloneBeckham just came out with Wonderol and it can cure cancer? Well, dammit, every man, woman and child in this Great Nation deserves Wonderol! It shouldn’t be just for the rich, right? So we’ve gotta get Wonderal into every insurance plan so everyone can have it, right?”

And so it goes…Sales of Wonderal skyrocket, making Wall Street happy. Politicians think they’ve done their job caring for “the people.” Patients and families have a new ray of hope. Down the road, we might find that Wonderal doesn’t really work, or has bad side effects. But that’s okay because by then, those Big Pharma R&D wizards will come out with Betterol.

Meanwhile, Corporate America remains free to dump cancer-causing toxins into the environment. The food industry continues producing cheap, tasty and poisonous “branded foods.” And doctors opt to build spas, because practicing medicine, especially meaningful preventive medicine, has become impossible.

To its credit, Sicko does open up the very legitimate and very large question of whether we can reconcile the social and moral imperatives of healthcare—to prevent illness and provide for the sick and ailing to the best degree possible—with the fiduciary imperatives of for-profit corporations: to make money and earn returns for shareholders.

But it also fails to look at the drivers of the crisis, which are not the “shit-happens” accidents and unpredictable illnesses, but rather the easily predictable lifestyle and environmentally-related chronic conditions, the poverty-related illnesses, the luxury drugs, and the hopeless and expensive end-of-life intensive care.

When talking about healthcare reform, Moore also fails to make the absolutely essential distinction between “Universal Access” (i.e., SPNHCS) and “Universal Coverage.” This will be a very important issue in the coming years. Whoever ends up in the White House in 2009, they are very likely to propose some sort of “healthcare reform,” and it will probably involve a universal coverage plan, meaning that “everybody must have health insurance.” (Think Mitt Romney’s Massachusetts plan writ large.)

Sen. Ron Wyden (D-OR) has already put a bill into Congress to that effect. His, and other such plans are all variants of HillaryCare, i.e. Healthcare “reform,” that keeps the for-profit insurance companies in the catbird seat.

The point is, Universal Coverage is not the same as guaranteed Universal Access, as in a Euro/Canadian SPNHCS. Universal coverage plans mandate that everyone must buy insurance, thus putting even more money into Big Insurance. Can’t afford it? Well, the government will buy it for you. Great! Even more public dollars going into the Managed Coffers!!

Universal coverage has traction with both Democrats and Republicans, the former believing that they’re fulfilling their social obligations to the poor, the latter feeling like they’d be lifting the huge healthcare burden off big employers, with the added be­nefit of dumping more dollars into Big Insurance, which means more money going into the institutional investor sector. Republicans love that!

The flaw in universal coverage plans is that essentially they try to reform the system while keeping the problem well-ensconced in the center. Instead of getting the wolves out of the henhouse, universal coverage simply puts more chickens inside.

You’d think a corporate critic like Michael Moore would see that, and call it for what it is. But Moore’s also a highly partisan Hillary fan. So he turns a blind eye to what is likely going to be a really bad blunder that will only give us more and more of the same insanity we’ve had for decades. Only now we’ll be forced to buy it.

I’m not implying that I have any answers. But if we’re really serious as a nation about addressing the healthcare problem, we need to look at the situation as it really is, and study the hidden imperatives that drive the systems and all the players to behave as they do. It’s not about pointing fingers, laying blame or hanging villains. It’s about figuring out what would really work to bring the greatest good to the greatest number of people, and then setting about to build systems that achieve these goals.NW