This is the second guest article in my series on health care (previous articles here, here, and here).
Today's article is by Ryan Peterson, currently a Radiology Preliminary Year Intern at Emory Hospital in Atlanta, Georgia.
I understand that I’ve been only working in medicine for the last 5 years of my life, but that has been MY life. I write only from my perspective. I do not claim to have the definitive answers to the complex problems in health care. I only share what I see.
So, why has health care become so expensive? There are many reasons for this, but as I see it, the major problems are:
1) People are no longer responsible for their health
2) Expensive technology, medicines and treatments have become expected
3) Doctors are trying to cover their own ass (CYA).
4) We are afraid to allow natural death.
For today let’s just take #1. We are actively trying to kill ourselves. Our diets rely principally on fast food and “take out.” Coke has replaced water as our sole source of fluid intake. Our children sit in front of the TV or computer, playing video games, for hours. We drive everywhere we can. Smoking starts well before high school (at least down here in the South). Kids start having sex at earlier and earlier ages without proper education on protections from deadly preventable disease. Drinking alcohol and jumping in the car is not given a second thought. Americans don’t take responsibility for their own health.
The most common diseases that cause a person to come into the hospital are preventable diseases. Physicians in America do a horrible job at management of chronic diseases. Why? This is because physicians are only a small player in the health of an individual person.
Here are some examples:
- Heart disease is the number one killer in America (yes more than cancer). Heart disease is most commonly caused by plaque that builds up in the arteries supplying the heart. These plaques are mostly produced by our high fat diet, genetics and smoking. Doctors give people expensive surgeries (place stents in their heart), place them on 2-3 blood pressure medications, an aspirin a day and give them cholesterol lowering drugs. None of these things will ever replace proper diet, exercise and smoking cessation. ALL FREE. Instead of getting up off our butt, Americans wait for someone to give them a daily pill (which they take 50% of the time). We in America don’t want to put the work in to maintaining a healthy lifestyle. I would say that 65% of reasons people come into the hospital/ER are for chest pain related symptoms. Multiply that by millions of people = EXPENSIVE.
- Cancer is #2 on the list of causes of disease and death. Of cancers, the big front runner is lung cancer (30%). Think of all the cancers that could be possible, and then think that smoking leads to a cancer that accounts for1/3 of all known cancers. Only about 10% of smokers get cancer but that accounts for a huge chunk of medical resources. Emphysema (#3 or #4 on the mortality list) is caused only by smoking. While only 10% of smokers get cancer, 100% will get emphysema if they live long enough (most get it well before they die). Colon cancer is up there as well but we will leave that for people who do not like fiber in their diet or cameras placed up their rectum.
- Type 2 diabetes leads to multiple, repeated hospital admissions. It leads to sequential amputations, heart disease, and significantly increases the risk for stroke. No “pimped out” insurance plan will ever improve diabetes the way free diet and exercise would. I could give my patient the most expensive drug out there (helamonster saliva), weekly checkups with the doctor and nutritionalist counseling every week and not have any improvement in that person’s blood sugar. This “acquired” diabetes is 100% preventable but Americans cannot seem to give up their 44 ounce bottles of coke.
- Stroke is another expensive cause of significant morbidity and mortality. However, it is not always caused by our behavior. But just so you know, smoking, cholesterol, and high blood pressure all lead to strokes. Strokes lead to long term care and extremely high costs to the health care system.
My point is we are not taking responsibility for our own health. OUR CULTURE IS KILLING US. Everybody knows that a life of hamburgers, cigarettes, and TV are not healthy for us. Yet we still do it. We have cut physical education from our schools. Sexual education is now taught in schools and not in the home. Parents do not cook anymore or get their kids to “go play outside.” We do not eat our vegetables. As a physician, I cannot force you to go to a fat camp. I cannot even force you to take your medications or even go see your doctor when I discharge you from the hospital/ER. I do not want you to be a granola-eating, vegan, yoga master. I just want you to take responsibility for your life.
So, if you are unhealthy, that leads to disease. You go to a doctor. That doctor tries to treat you with the best evidence-based medicine and treatments (always starting out with improved diet and exercise=FREE). Then you are not compliant with your medications or follow-up appointments, and you continue living your unhealthy lifestyle. That leads to worsening of the disease and more complications, leading to exponential drugs, money, and resources needed. Your insurance company sees you as a risk (as well you are) and raises your premiums. Multiply that by millions and we get the astronomical numbers for health care cost (16% of GDP). This is why I think health care costs are increasing year by year.
There is no company giving large sums of money away to executives to equal that amount of increase. Physicians are not all buying an island out in the Caribbean. Americans are getting more preventable chronic disease and are not willing to make the changes needed to stop that disease. Premiums will continue to increase until the disease burden decreases. The system will continue to be ineffective until patients take responsibility for their own health. And by the way, if you think that the government will be more effective at regulating costs, look at the statistics for Medicare and Medicaid (socialized government run systems of which I am currently employed) - effectiveness is not much better.
In conclusion:
• Americans are actively trying to kill ourselves.
• Society has become addicted to fast food, cigarettes and computers.
• Twenty medications does not equal good health but does equal a lot of money.
• Diet and exercise are free and are the most effective things for a disease-less life.
• No government run health insurance plan (or any plan for that matter) will lead to improved health of the Nation.
• It is the RESPONSIBILITY OF THE PEOPLE to improve their own health.
• The system will continue to be ineffective until patients take responsibility for their own health.
• Government is missing the mark in their current health care revision plans- not enough focus on prevention, education, incentives for health. (I’ve read most of the bills out there.)
These are my thoughts and feel free to disagree.