The paradign cris of U.S. medical care

In all the heated debate about medical care - should the public sector pay, should it be totally privatized, etc. - some facts essential to the discussion never surface. Medical technology is so advanced and costly that the old method of paying for it is no longer viable. The simple truth is that the economic paradigm for U.S. medical practice today is basically the same as a century ago: you go to the doctor and pay him for his service; he sends you to a specialist, whom you also pay; you're sent to a hospital and face additional bills - on top of which you pay for all the medications you need and prescriptions the health providers write. And so it was in grandpa's day - with the one possible exception that today expensive insurance may pick up some of the costs.

However, today's technological advances make the medical practice of only 50 years ago seem virtually primitive. There were no hip, knee or organ replacements that cost tens of thousands of dollars, while prolonging the life and healthy activity of those undergoing these procedures; there were no dental implants that are not only the optimal method for tooth replacement but can cost up to $2,000 for a single tooth; there was not the vast array of expensive diagnostic equipment that detects maladies that never surfaced a few decades ago; and there were not the extensive and costly cancer and other disease treatments that prolong millions of lives today. Add to that the proliferation of drugs that didn't exist before, but today preserve quality of life, if not life itself, and we see there is no comparison between medical practice today and that of only a half century ago. Yet it functions from the same economic paradigm. The result is a frightening gap between what modern medical technology can provide and its affordability to the average citizen - a gap that did not exist before the technological leap.

How, then, do we bring the two together? We can put huge amounts of money in the people's hands so they can afford medical care, and at the same time convince the private sector that controls most of the industry to greatly lower its costs at the sacrifice of profit. Since these are highly unlikely solutions, we must then either change the economic paradigm, or continue denying to the majority of people access to the available technology, with dire results for not only the deprived people (tens of thousands of Americans die annually for want of affordable medical care) but for society in general. U. S. medical care lags far behind that of other industrialized nations, and by 2010 the U. S. ranked last among the advanced nations in infant mortality.

The only remaining alternative, then, in keeping with a humane society is a new economic paradigm consistent with today's medical advances - one that would make the most advanced medical technology affordable to the least affluent people. This change would involve not only those who pay for the care, but also those who give the care and receive the payment.

Any new paradigm is limited by two realities: the average citizen cannot afford what contemporary medical care can provide; and the private sector - corporations and their owners - having no social obligation, resists paying for medical care, while the unqualified, complete-coverage medical insurance it offers is beyond the reach of most people. The only remaining alternative is payment by the people's government. And that process has already begun, first through Medicare for the elderly, Medicaid for the indigent, and now The Affordable Care Act (Obamacare), despite all its initial glitches. Ultimately, the single-payer (i. e., government-sponsored) model of the advanced nations will be the unavoidable solution - a step that the progressive state of Vermont is already taking.

The medical care delivery system based on the outmoded paradigm of non-integrated, individual entrepreneurs must also change. Young doctors graduating with many thousands of dollars of school debt must find lucrative practices in order to pay that debt - a demand that further skews medical care toward the wealthy and away from the majority's needs. Those who qualify to become doctors should be sent to medical school at government expense and then - as salaried professionals - assigned to where they are needed, regardless of economic class. They would work in fully-equipped clinics staffed with specialists and attached to hospitals freed from the old for-profit paradigm. This model is also beginning to take root as more as more doctors band together in clinics equipped with the latest technology that no individual practitioner could afford.

The only ones who vie against this model as "socialized medicine" are those racking up enormous profits on the obsolete American "health-for-profit" system. And nowhere else in the industrialized world are those profits so great and public affordability so wanting. In The New York Times (10/13/13) we read, "Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for $20 and dispense it free of charge to asthma patients. [and] a prescription drug that was selling for more than $250 a month in Oakland pharmacies costs under $7 in Europe."

It is only through the negotiating power of governments sponsoring health care that the cost of drugs remains reasonable - to the extent that American users are importing them. The imports of the exact same drugs available in the U. S. were so much cheaper that "The Obama administration initially proposed allowing some importation of drugs, [but] the idea was dropped from the Affordable Care Act after intense opposition by the pharmaceutical industry." In addition to importing drugs, Americans are actually "exporting" themselves for surgeries overseas that cost a tenth of what they do here. Because most Americans can't afford U. S. medical and dental costs, a vicious and profitable new ploy has come on the scene: medical credit cards underwritten by the same banks responsible for the subprime debacle.

"A growing number of health professionals are urging patients to pay for treatment not covered by their insurance plans with credit cards and lines of credit that can be arranged quickly in the provider's office" (The New York Times, 10/14/13). Medical practitioners are turned into shills to assure they'll be paid, while interest rates on this credit run to 23 percent annually and can rise to a 33 percent "penalty" rate if a payment is missed.

Medical care is so unaffordable to Americans, that the same Times article reports that, "In 2010, people in the United States charged about $45 billion in health care costs on credit cards" - another example of people forced to accrue huge debt just to get basic things they need in life.

The bombardment of self-serving propaganda from the private sector has irrationally turned the majority who would benefit from socialized medicine against it. Let those who want to keep the old economic paradigm limit themselves to the primitive medical care compatible with that paradigm.

Andrew Torre lives in Landgrove.


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