Addressing the Medical Industrial Complex

There's a word. There's a word that describes our current healthcare system, dominated by private insurance, regional groups of private hospitals, and other powerful interests that look more like a numbers racket. We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care. The above-referenced word is amoral.

Can a system be amoral? One tries to find a better word to describe a system which: has become the number one cause of personal bankruptcy; is now the third leading cause of death; is characterized by conflicts of interest and perverse incentives; disempowers the patient; denies the capacity for innate healing; operates with little regard to risk/benefit and cost/benefit ratios; lacks any real transparency; imposes erratic patient privacy laws; is overly beholden to special interests; and has even driven some doctors and other "healers" to the point of such despair that they have abandoned the profession altogether.

Yes, the word amoral seems to fit. There's a term from social philosophy -- objectification -- that refers to the act of treating a person as an object or thing. How apt that term is applied to the current insurance-based model. It's not health care but rather sick care. Incentives are measured in terms of procedures, not health outcomes. The line becomes blurred between prescribing and selling. Bureaucrats and accountants oversee the care of the patient who might just as well be regarded as a piece-part. Sayeth the model: maximize revenue, whether the underlying life is short or long.      

We all have a stake. The Medicare program itself cost the nation last year $644 billion, about 14% of total government spending. But that number is mere abstraction in the context of today's world of infinite budgets. Rather it's to those living outside the Medicare womb where the effect of a seemingly arbitrary, capricious, and whimsical system is most directly evident.

There's a saying among poker players that after a half hour in a game you don't know who the patsy is then that patsy is you. Such is the state of the medical industrial complex. Insurance is an extraction machine, starting with skyrocketing premiums not always evident when paid by one's employer. A just-released survey from the Kaiser Family Foundation shows annual premiums for a family have now topped $21,000 while deductibles have more than doubled since 2010.

Then there's the black magic of hidden costs when it comes to those deductibles i.e. massively inflated assessments for a drug, blood test or a scan can translate to more being paid out-of-pocket by the patient under an insurance plan than what would otherwise be owed for a straight cash payment reflecting the actual cost. Yet, the real crime comes with the uninsured patient who has absolutely no protection from the tyranny of jacked-up pricing. Compounding the tragedy is that the so-called patsy didn't even choose to play the game in the first place.

Rather than to simply bemoan the tragedy of the current medical industrial complex, however, our Member Monday discussion will center around some very positive initiatives aimed at taming the beast. One such movement emanates right here in Highland's bosom with a model called Direct Primary Care (DPC), initiated by our own Dr. David Tusek. Central to the DPC model is the notion that when it comes to health care the only functional relationship that really counts is the one between the doctor and the patient. This doctor advocacy extends not only to treatment but to cost containment (focus article, click Direct Primary Care Model)

The DPC features -- open, honest, ethical, fair, transparent -- could be summed up as the antithesis of the amorality characterizing the current system. The tenets of DPC reflect the sacredness of the doctor/patient relationship: "speed-dial" doctor availability 24/7; same-day appointment for urgent matters; minimal monthly membership (typically $80); no co-pays or deductibles. Cloud Medical, the operating entity, has further invoked its market power and its knowledge of actual costs to negotiate rates for matters in support of its direct care coverage. While catastrophic coverage insurance applies to matters outside the purview of primary care, one study has it that 76% of ER visits were for healthcare conditions that actually fell within the scope of primary care medicine.

This discussion could lead to other areas where fundamental changes might be better effected from the bottom-up. One of our best earlier sessions was on the topic of "Kludgeocracy" (click, Kludgeocracy In America), a neologism referring to the perverse incentives that drive complexity and incoherence in many systems and which can lead to system compromise or even breakdown, from government to public education to taxation to welfare programs.

And, yes, to our first stop, healthcare. 

(To access previous Member Monday introductions, click: TOC)