Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA

“It’s up to all of us, the consumers, to take charge of our health. It’s almost like voting. It’s your responsibility.” — Anne Wojcicki

Anne Wojcicki is the co-founder and chief executive officer of 23andMe, a company that provides direct-to-consumer genetics information derived from mouth mucosal cells obtained from a saliva sample. While the procurement, use and dangers of obtaining personal genetic information is fodder for an editorial itself, I am more interested this month in her quote directing consumers to take charge of their own health. It is an unsettling fact that Americans consume a tremendous amount of healthcare services. In 2016, national health expenditures surpassed $10,000 for every man, woman and child. This represents nearly 17% of the gross domestic product (GDP) of the United States. For comparison, the average for developed nations is near 11%, with the Netherlands being the next highest at 12% of its GDP (according to the Kaiser Family Foundation Health System Tracker).

Despite the tremendous financial investment in healthcare, the United States consistently ranks last in healthcare quality among 11 developed nations, according to The Commonwealth Fund1 organization, which conducts a survey every three years evaluating healthcare systems on topics of care process, access, administrative efficiency, equity and healthcare outcomes. The report specifically stated this dichotomous situation of high health investment, resulting in inferior health services is indicative of this country’s “poor access to primary care (that) has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies and coordination and safety problems.”

Like many Americans, I am dismayed by our congressional leadership’s failure to provide comprehensive healthcare legislation that result in a health services standard for all of our citizens.  Perhaps even more maddening is that this situation is not the result of lack of investment, as is the case in many developing countries’ economies where populations are often medically underserved. So why are we spending so much and, compared with similarly wealthy countries, receiving so little in return as a population?

I believe the answer lies in the word consumption. The Merriam-Webster dictionary defines consumption as “the act or process of consuming – consumption of food, consumption of resources.” Based on what we spend on medicine as a nation, it appears we consume a considerable amount of medical resources. This situation begs the question: If we are consuming so much and yet receiving so little in return, are we consuming the wrong healthcare goods and services? Furthermore, if we are not getting what we are paying for, why are we not radically changing the existing system? These questions are, of course, rhetorical, and I feel the answer is pretty obvious.

In our capitalistic society, healthcare is big business, and corporations and investors are getting rich on business as usual when it comes to healthcare practices in the United States. I imagine it is extremely difficult for our elected officials to legislate economically disruptive healthcare policy which likely will adversely affect campaign contributions from those lobbyists representing the healthcare industry on Capitol Hill. I personally believe we have more of a disease maintenance system in this country, rather than a healthcare system. Our business-oriented medical system prizes corporate and investor profits by encouraging healthcare consumption with little concern for the outcomes resulting from the public expenditure.

The idealist in me, snug in my federal medicine cocoon that insulates me somewhat from the seedy business side of medicine, is quickly disgusted by the present medical system reality that is driven by greed with seemingly little regard for the actual health of the nation. I quickly recover from this smug, self-righteous and incomplete understanding of this complex issue, since I recognize nobody is completely free of self-interest and the influence of money. Altruism toward others in life is a beautiful thing, but too much of that way of thinking will cause your family to go hungry. If one accepts that egocentricity is a fundamental motivation of human behavior, then the inability of our elected representative to overcome the overwhelming influence of the corporate healthcare machine is perhaps understandable, although not very palatable.

Certainly the American public has considerable culpability for the present healthcare dilemma in this country. We elect our representatives, often term after term, who succumb to the financial influence of the healthcare industry lobbyists. Influence of the public through the power of the ballot box is perhaps the most comprehensive collective measure the public can take to improve our health standing among the developed nations. In the meantime, healthcare consumerism by individuals is likely the surest and quickest way to begin reform. Since, as individuals, we are bombarded with daily messages from corporate healthcare on the power of pills and devices to cure our many ills (to include a few made-up ailments for good measure) it is understandable how we have been beguiled into the belief in a “pill for every ill.” We have become as cattle when it comes to healthcare consumption, grazing mindlessly on the wonder drugs and devices peddled through every media outlet for our improved health as we thoughtlessly abdicate responsibility for our own health, our most precious personal asset, to &ldsquo;the ‘system.”

If we truly want to improve our healthcare system, we must not only demand change from our elected representatives, we must demand change in ourselves. The complexity of modern medicine requires an educated and informed consumer of healthcare. It is no longer appropriate or safe to place yourself in the hands of the system and say, “Doc, do whatever you think is best.” While drugs and procedures are often the life-saving answer, proactive approaches such as diet, exercise, acupuncture, massage, physical therapy, chiropractic, behavioral health, movement therapies and the like are no less important, they just are not as lucrative for the healthcare corporations. As a society, we have to learn to value outcomes in patients over what we are doing to patients. Each of us, collectively as consumers of healthcare, has tremendous power and influence over those who provide those services. We can only exercise this power by educating ourselves to become more informed consumers. This change is truly our responsibility, along with better voting, as Wojcicki suggests.