By Philip Caper, M.D.
Bangor (Maine) Daily News, Dec. 18, 2014
When I was a kid, I liked to play a game called “connect the dots” where I connected a series of numbered and apparently unrelated dots to reveal a picture of a person, animal or object. I still enjoy connecting dots, but now I do it with apparently unrelated observations and try and understand the picture they reveal. Here are several dots I have observed lately.
The Commonwealth Fund recently released a study of the adequacy of health care for people over age 65 in wealthy countries. Even after 50 years of Medicare, seniors in the U.S. had nearly twice the rate of cost-related problems accessing care than those of any other wealthy country. Our seniors also have more chronic illness, take more medications and struggle more to pay for health care than those in the 10 other countries studied.
The difference is that in all of the other countries, everybody, not just seniors, have health care coverage. The study’s authors speculate that by the time we reach 65, we have a lot of catching up to do because of the inadequate care we received when we were younger, when preventive care could have made a real difference.
The Consumer Protection Financial Bureau recently published a report stating that about 75 million consumers in the U.S. have had bill collection problems reported on their credit reports. They found that “roughly half of all collection problems that appear on credit reports are reported by debt collectors seeking to collect on medical bills claimed to be owed to hospitals and other medical providers.” NBC News concludes that medical debt is hurting the creditworthiness of 43 million Americans, and the systems in place to collect and report this debt can be challenging.
An article appeared last week in the New York Times, headlined “ The Punishing Cost of Cancer Care.” The author, oncologist Mikkael Sekeres, puts the problem faced by cancer patients starkly.
“As the price of chemotherapy now routinely reaches $100,000 for a full treatment course, my patients are forced more and more into making the equivalent of Sophie’s Choice when it comes to treating their cancer: Spend down their savings for an improvement in survival that might amount to a few weeks, secretly hoping that they will be one of the lucky few at the ‘tail’ of the survival curve — the handful of people who live years more; or decline the therapy and in so doing ensure that their families will be provided for after they have died.”
Yet another New York Times column pointed out there appears to be a direct relationship between social status and health: the higher your social status, the better your health. Low social status engenders a chronic “fight or flight” response, a state of chronic insecurity, helplessness, fear, anger and stress. These emotions cause the secretion of adrenal hormones that, if excessive, cause high blood pressure, diabetes, heart and kidney disease, and strokes. We seem to be reaching a tipping point, where our American health care system soon may be producing more illness than it cures.
As I have written before, social factors, not medical care, are the most important determinants of illness in Americans. Early detection and timely medical care are the most important determinants of how effectively diseases can be treated and how far they progress.
So what thread connects these seemingly unrelated dots, and what picture emerges? I see a health care system that is evolving to serve primarily the financial needs of the large corporations that comprise our medical-industrial complex, not the real needs of patients and other ordinary people.
As the share of medical costs borne directly by patients continues to rise, the market for supplemental insurance policies and other gimmicks marketed to deal with those out-of-pocket costs will grow as entrepreneurs in the financial services industry scramble to exploit loopholes in the law. More and more debt will be financed with high interest rate credit cards and other consumer credit.
The winners, once again, will be the insurance companies, credit card companies and banks. The losers will be the patients and the rest of the U.S. economy.
I think we can do better than this. We need to overhaul the way we finance and pay for health care and return its focus to serving patients, not the needs of corporate America. The experiences of other wealthy nations show we can do this by expanding and improving Medicare to everyone. That is strong evidence upon which to base our own public policy.
By excising the profit motive from the heart of health care, we can reshape the emerging picture to one that works for all of us.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org or through his website at philcaper.net.