“A business that makes nothing but money is a poor business.” – Henry Ford (1863-1947)
During the Sundance Film Festival, held in January in Park City, UT, the documentary “Escape Fire: The Fight to Rescue American Healthcare” was debuted by Matthew Heineman and Susan Froemke. I have not had the opportunity to see the 98-minute documentary, yet I was enthralled with descriptions of the project on the Internet.1 A video trailer begins with the staggering statistic that the United States spent $2.5 trillion (or 17% of the U.S. gross domestic product estimated at $14.5 trillion in 2010) on healthcare in 2010. The basic premise of the film is that approximately 75% of this expenditure goes toward treating preventable diseases.
In essence, the U.S. does not have a “healthcare” system but a “disease-management” system that is slowly bankrupting the country, as “it generates rivers of money flowing into very few pockets.” Many experts, such as Donald Berwick, MD, former director for the HHS’ Centers for Medicare & Medicaid Services, say they believe the current system is unsustainable and will not only be disastrous for our healthcare system but also impact the general health of the nation as we mortgage our children’s future with spiraling costs. A national study in the American Journal of Medicine found 62.1% of all bankruptcy filers in 2007 claimed excessive medical expenses as a primary cause. 2 Although the U.S. spends more money per person on healthcare than any other nation, the nation ranks 50th in the world on life expectancy at birth.3
Despite these sobering statistics, the U.S. healthcare system is startlingly resistant to change. Leslie Cho, MD, a Cleveland Clinic cardiologist, defines the basic problem with the current system. She notes on the documentary trailer that she can spend five minutes with a patient in order to prepare to place a cardiac stent and be compensated $8,000 or more, but, if she spends 45 minutes with a cardiac patient to find out the basis for the patient’s health problems, she estimates her compensation at $15. Physicians generally are rewarded financially for doing procedures on as many patients as possible, not necessarily for talking to patients about their health and determining what issues are contributing to their health problems. Cho concludes by expressing her dismay at the irrationality of this type of system. I absolutely agree.
Even more concerning is the reality that, despite our tremendous investment in healthcare and our leadership in medical technology, medical errors from hospitalizations and outpatient care are estimated to kill more than 40,000 Americans annually.4 Medication errors are considered a major source of fatal mistakes. Certainly the federal system of medicine has been grappling with these issues within our own patient populations.
The federal system of medicine has distinct advantages in dealing with many of these issues and already recognizes that patient outcomes, rather than numbers of procedures, should guide healthcare investment. Because financial incentives have considerably less influence on our practice, the move to a more patient-centered approach to medicine, which is more integrative and preventive-medicine based, is more palatable in our community.
In my own experience with the Army Pain Task Force, mentioned in “Escape Fire,” I have had many providers approach me personally to congratulate federal medicine for our efforts to create a new integrative, multidisciplinary approach to pain medicine. Sadly, these same providers follow up their praise by stating that such a system would never work for them. One pain physician stated, “My group would fire me the next day, if I suggested some of the integrative medicine approaches you are suggesting. While I agree it is the right thing to do, we just cannot afford it.”
My perspective on this issue echoes much of what is presented in the “Escape Fire” documentary. I congratulate the filmmakers for helping to awaken the medical community to the fact that we cannot afford to adhere to the medical business status quo. For it to survive, we must make these changes to our system. We are the best in the world at treating established diseases; we also must become the best at preventing them. Our system must learn to value healthcare provider education in healthy patient living at least as much as we value medical technology and procedures. As a profession, we need to rediscover the value of simply talking to our patients. Although the business of medicine is necessary to provide a system of care, business should never become its driving purpose.
1http://www.indiegogo.com/EscapeFire accessed 30 Jan 2012.
2Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United States, 2007: Results of a national study. Amer. J. Med. 2009:122;741-746.
3https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html accessed 30 January 2012.
4Institute of Medicine (2000). “To Err Is Human: Building a Safer Health System (2000)”. The National Academies Press. Retrieved 2012-01-30.