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Monday, February 26, 2007

Universal Healthcare: Necessary but not Sufficient

Family Man wrote a brief post about the state of what could laughably be called “healthcare” in this country, after he found that his insurance wouldn’t cover a stop-smoking medication (WTF??). My response got a bit long for a comments page, so I decided to put it here.

This actually started with a trip to the chiro-cracker today. A little money shook loose and we were all feeling somewhat kinked (in the neck & back, not the other way), so Mrs. Fetched called them up and got us back on the monthly plan. There’s a big whiteboard behind the counter, where they usually flag their evening seminars and the like; today it had a bunch of negative statistics about the medical profession. I have a feeling there was a lot of FUD involved, but the things that stood out for me were the huge number of unnecessary surgeries (for whatever definition of “unnecessary”) and the number of emergency cases due to drug interactions or allergic reactions to drugs. Both of those could be attributed to the profit motive — in other words, a system devoted to healthcare rather than profitcare would naturally attempt to minimize both.

In the system we have today, everything in the medical system is geared toward maximizing profit. Providing some level of healthcare is necessary to keep people from demanding change (although that has begun, and may be too late to stop), but that hasn’t been the primary concern for quite some time. We’ve all heard of — or perhaps experienced — the assembly line-like visits of “managed health care,” and read the articles about people with cancer or other major illnesses whose doctors have their hands tied by HMO bean counters. The Boy’s diabetes medication, now that he is not covered by our insurance (not at home and not in school), is pretty much unaffordable for him. Drug companies have to recoup their “research costs,” although much of that research is funded by taxpayers (that is, you and me) and their marketing budgets are often higher than their research budgets. Then, of course, you get episodes like Merck trying to downplay (or even hide) serious side effects with Vioxx — because, after all, there’s money to be made.

FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market.

(The numbers were on Wikipedia, take with an appropriate amount of no-salt.)

The other side of the coin, of course, is how the profit motive promotes unhealthy activity — smoking this cigarette makes you cool, drinking that soda improves your life, open a beer and you’ll immediately be surrounded by Hot Babes™. This processed-to-hell-and-back "food product" is soooo easy to fix and tastes great! (just don’t look at how much sodium & cholesterol is in it) Oh, and by the way, watch this TV show and that TV show — it’s much more relaxing than exercise.

Now you have a McMansion you can barely afford and can’t get rid of, and you spend two (or more) hours a day commuting to/from a job that stresses you out. Your spouse works a similar job, so neither one of you have the time or energy to fix healthy meals. Breakfast is a sausage and egg biscuit in the car, lunch is a dash to the burger stand, and supper is a pre-packaged whatever.

So one day you wake up: you’re 45 and your weight, blood pressure, and cholesterol are in the “sucks” range. The doc diagnoses your spouse as “pre-diabetic” (you don’t exactly know that that means, but it sounds scary) and tells you both to get some exercise and start eating better. Oh, and by the way, here’s your prescriptions.

But we don’t have time to take care of ourselves! We have a lifestyle to maintain!

And you, one might say, are the “lucky” ones. You make your weekly pilgrimage to Wal-Mart, buy a bunch of stuff you don’t need and gripe about how shoddy it is, without a single thought about the people wearing the blue vests. They have many of the same problems as those of us “comfortably” in the middle class, but when the time comes to make that trip to the doc, the price tag attached to those prescriptions is simply beyond their means.

More and more people are standing up and demanding universal healthcare. President Clinton tried taking the initiative, but it was shot down by the usual suspects and their shills in Congress and talk radio. But these days, even Bush-league must at least pay lip service to the grass-roots demand that something be done. Katiebird has a series of articles on Eat4Today that are simply titled, “Cover Everyone” — great stuff.

Universal healthcare will help those folks in retail jobs, not to mention people who can't find a job that can put food on the table, but it isn’t enough. For many of us, from the middle class on down, our very lifestyles have become toxic. We’ve bought into the mantra of “more” (try chanting it, drawing out the ‘O’), not realizing that it has given us less: less time because it’s wasted in a long commute, less money because we buy too much house and fill it with too much stuff, less health because we don’t take the time to exercise or eat right. We’re on a treadmill, all right, but it’s not the kind we should be on.

There’s no pill that can cure lifestyle problems (unless the drug companies are hiding a formula that will make people resistant to marketing… not likely), but it’s our lifestyle that is making many of us sick. We could create a perfect health care system that covers everyone, but the Constitution won’t let us ban marketing or even destructive lifestyles. I’m not sure we could even legally ban unhealthy food (especially since a certain amount of things like carbs, fat, sodium, and cholesterol are necessary nutrients). No, if we want health for ourselves and our neighbors, it has to start with us. We should work to Cover Everyone — that’s only right — but we also need to invent a better way of life, one that will keep us out of the doctor’s office in the first place.


  1. Hi FARfetched.

    You've said a lot of what I wanted to say yesterday, but just couldn't come up with the words.

    I agree with you in taking personal responsibility, but as you pointed out, it's very difficult to do in this modern world.

  2. Good post.

    Overall, if insurance would cover preventative measures, such as subsidizing part of a gym membership (or, in my case, exercise equipment, since we don't have a gym in town), covering nutrition counseling (only if you're diabetic), and generally encouraging good behaviors, a lot of issues could be avoided.

    It is far more lucrative to treat diseases than to prevent them - or to cure them.

  3. Hey guys.

    FM, I've thought for a long time that the first step is to unplug the TV, permanently. Nothing I've observed since has changed my mind there.

    J, I think it's more a matter of penny-wise and pound-foolish, or perhaps a matter of "discounting delayed reward" (the insurance companies would rather keep their money now and spend it later). Like any other corporation, insurance companies are all about maximizing profits — eventually, they would get around to the notion that healthier policy holders cost them less money. I think they'll get the rug yanked out from under their business model sooner than that, though.


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