More Thoughts on Health-Care Reform

Whatever your political thinking happens to be, you can’t deny that the American health-care system is dysfunctional and in serious need of improvement. The late Emanuel Cheraskin, MD, DMD, once said it best: Medicine is America’s fastest growing failing business. His thinking applies to the entire health-care system, not just medicine.

Why does health care keep getting more expensive? One reason is that the current hodge-podge system is based on earning money through interventions – e.g., physician visits, tests, hospitalizations, surgeries, and prescriptions. I’m not against making money, but the incentive is for every part of the system to encourage more and more interventions, and the costlier the better. Money is made off illness; no illness means no profit.

As a consequence, there is little desire by anyone in health care to reduce the number of interventions or their cost. Nor is there much interest in saving money, because saving a few billion dollars translates to a company losing a few billion dollars in profits, and no company wants to lose money.

I do believe there is a need for some type of universal coverage. Indeed, my European associates are aghast at the thought that one of every six Americans does not have any insurance coverage to defray the cost of needed medical care. And those who do have insurance often have to haggle with their insurers about what procedures are covered and what are not. Quite simply, universal coverage is the ethical and moral way to treat our brethren.

But providing some type of universal insurance of medical coverage is not a solution in itself. Costs will eventually increase, and there will eventually be more pressures to cut services or ration care to rein in costs.

Real improvement in health care must come from a concerted effort to prevent disease and to reduce the need for medical care. I believe this would be best done through improved eating habits, greater physical activity, and other positive lifestyle changes. Without a genuine program geared toward prevention -- perhaps something along the lines of government efforts to curb smoking -- the costs of a health-care system (regardless of who pays) will eventually lead to its collapse.

Maybe someone will figure out that the health-care system could profit big time from prevention-oriented interventions. At least that's my hope.