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Cantarow writes: "Here are some statistics about the US's ruinous system of health care that you'll find appalling, though probably not surprising. Page numbers come from the book I'm reviewing here."

A health care rally. (photo: Health Care for All)
A health care rally. (photo: Health Care for All)

An American Tragedy: Healthcare for Profit

By Ellen Cantarow, Reader Supported News

22 July 17

A review of Dr. John Geyman’s Crisis in US Health Care: Corporate Power vs The Common Good (Copernicus Healthcare: Washington, 2017, 377 pp.)

ere are some statistics about the US’s ruinous system of health care that you’ll find appalling, though probably not surprising. Page numbers come from the book I’m reviewing here:

  • The combined annual cost of insurance and health care is $25,000 for a family of four, while one year’s worth of cancer drugs exceeds $200,000, forcing patients to choose between bankruptcy and treatment. [262]

  • Health care makes up a seventh of America’s national income, despite which, 50,000 Americans die every year because they lack health insurance, according to findings in 2012 by Harvard researchers and the US Census Bureau. [98]

  • Tens of millions of uninsured or underinsured Americans include “5.9 million uninsured mothers, one in five of whom are likely to have the greatest physical and mental health care needs.” The “underinsured” are 31 million people who have insurance but can’t get care when they need it. Even the insured get “surprise bills for services they thought would be covered.” [261]

  • In 2014 over a half-million Americans paid more than $50,000 each for medicine, up by 63% from 2013, having been prescribed high-cost “specialty” drugs. [81] In that year the cost for a bottle of 500 tablets of the common antibiotic Doxycycline, soared from $20 to $1849 in just six months. [80] The contrast with other countries is immense; Herceptin, a breast cancer drug, costs 30 percent less in England and 28 percent less in Norway than it does in the US. [81]

  • Costs vary from region to region and even from hospital to hospital. In California, an uncomplicated Caesarian section ranges from $8,312 to $70,908, while in the early 1960s it cost $300 and included pre- and post-natal care. [79]

These statistics are drawn from Dr. John Geyman’s Crisis in US Health Care: Corporate Power vs The Common Good. A founding member of Physicians for a National Health Plan, Geyman charts “60 years of ‘enormous changes,’ 1956-2016,” the period of his primary care practice in rural and urban regions. A former conservative who turned progressive as he learned about America’s health-care enormities, Geyman says our health care predicament is rooted in “a confrontation between profit-seeking corporate stakeholders and the common good,” and while he doesn’t use the c-word, the book is a thoroughly convincing indictment of capitalism in its effects on our nation’s health.

In the US, access and choice are restricted by one’s insurance status and ability to pay, not by medical need [258]. American health care, says Geyman, is “dysfunctional,” “broken,” and “at a crisis point.”

The book explores the corporatization of health care – its increasing privatization and lack of accountability; soaring costs; decreased access and quality of care; the criminalizing of mental health; the shift from altruism to self-interest as the dominant medical ethic; the adverse influence of specialization on continuity of care; the malign influence of religion on medicine; the eclipse of prevention and public health by a focus on disease treatment; and the decline of physicians’ professionalism and autonomy.

A great part of that decline owes to the fact that over 60 percent of American doctors work for large hospital systems that squeeze doctors to “produce.” For instance, consolidation spawns “productivity-based contracts” that reward doctors “for ordering more expensive tests and providing a higher volume of services.” [81]

A penultimate section traces Geyman’s own medical education and practice. In the closing section of the book, with suggestions for graduated tax rates on Americans, he proposes national health care, by contrast with expanding the Affordable Care Act (ACA) or adopting a Republican “reform.”

The ACA comes in for much criticism. It “was supposed to contain health care costs and make them more affordable. It has been a complete failure in that regard, partly due to its lack of price controls and partly because it has fueled a new merger frenzy among corporate giants in the medical-industrial complex.” [15] Much of the population under the ACA “finds care unaffordable, and forgoes necessary care with poor outcomes that would be prevented under a system of universal coverage.” [305]

I was particularly interested in Geyman’s remarks about Medicare, since this past winter I learned that without my permission my health insurance had been changed from traditional Medicare to something called “Medicare Advantage.” Suddenly my coverage for all sorts of things was questioned and payments were denied. Repeated calls to Blue Cross/Blue Shield of New Jersey, which had been my husband’s employer, disclosed that the Garden State had made the change; I was told I should have gotten a form in the mail asking me if I agreed to the change – I hadn’t.

“Many patients on traditional Medicare are now surprised to find themselves automatically enrolled in private Medicare Advantage plans,” writes Geyman. Centers for Medicare and Medicaid Services “secretly allowed these plans to enroll traditional Medicare patients without requiring them to opt in.” It turns out that private Medicare plans are riddled with “poor service ... with inadequate physician networks, long waits for care, and denials of many treatments, as insurers pocket new profits.”[22]

Like Geyman, I recall I time when the relationship between doctor and patient was sacrosanct and long-lasting, so I also found his fifth chapter, with its discussion of the decline of primary care in the US, arresting. In 2008 the World Health Organization (WHO), defined primary care as the basis for a strong health care system, and enumerated essential features of such a program. They include accessibility with no out-of-pocket expenses, focus on a person (not a disease) over time, and a broad range of services. “[C]ountries with ... strong ... primary care have better outcomes at low cost,” according to the WHO. [70] Yet while the US desperately needs more primary care physicians, Title VII funds that support primary care training plummeted between 1977 and 2009.[64]

I am immensely lucky to have a primary care doctor who has dissociated himself from any hospital. He scheduled two initial interviews of forty-five minutes, and he usually spends a half-hour to forty-five minutes talking with me about medical problems that have arisen as I have aged. I find it abhorrent that he is the exception to the American rule, and I’m gratified to find both agreement and documentation for this, as for everything Geyman presents in this must-read for patients and their physicians. One editorial caveat: the book is riddled with acronyms, sometimes frustratingly lacking initial definitions.

A companion book could be Elisabeth Rosenthal’s An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. She is a New York Times reporter as well as a physician, and her style is engaging, even while her book is just as dense as Geyman’s – not your on-the-beach weekend reading, but an education in itself. your social media marketing partner


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+58 # librarian1984 2017-07-22 12:55
Democrats Had Better Get On Board for Medicare-for-al l or Go Home
+55 # Rodion Raskolnikov 2017-07-22 15:55
Yes, Ellen is right. Healthcare in Ameerica is only a cash cow for corporations. They milk about $3.4 trillion dollars out of the US economy each year. that comes down to about $10,000 for every man, woman, and child in the US. Imagine, every human in the US pays to the for-profit corporations about $10,000 each -- $40,000 for a family of four -- just for the very substandard health care they receive.

This is just robbery. But the corporations get away with it because they bribe law makers.

Someday soon, they will milk this cow dry. The cow will just die. This can't go on forever, as costs go up every year.
+55 # elizabethblock 2017-07-22 17:58
I remember when Americans arguing against medicare said it would deprive people of the right to choose their doctor.
Well, golly gee. How about the right to choose whether to have a doctor at all?
Thank God I live in Canada.
+37 # Lolanne 2017-07-22 18:59
There is a group called MDVIP that does offer something more akin to the old fashioned, "sacrosanct" relationship between doctor and patient, but it comes at a price: a steep annual fee over and above insurance co-pays/deducti bles, etc. That annual fee in the state where I live is over $1600. It sounds really good, until you remember that this kind of care used to be routinely available from your family doctor. I recently had a doctor (whom I was seeing for the first -- and last! -- time) try to sell me on this MDVIP plan, which he was about to join. But it should not be necessary to pay a large extra fee to receive adequate care! IMO, MDVIP is just another corporate-owned endeavor that puts the money before the patient's well being.
+6 # economagic 2017-07-23 09:21
The name suggests that the doctor is the VIP! If that were not enough, this item from their website: "We believe good health starts with a great doctor."

For one, even after 40 years of Garrison Keillor's "All the children are above average," etc., we still don't understand that we can't all have "great" doctors. To say otherwise is either a failure to think or a lie, neither of which I want in my (PC) doctor.

For another, good health starts with a thoughtful, engaged, and well informed person. The etymologic root of the word word "doctor" means "teacher"--not god, not commander. These guys (OK, one of the three doctors pictured on the main page is a woman) do claim that their model is based on educating the patient. But their program appears to be aimed toward older people with some means, many if not most of whom already have the basic knowledge of how to live healthy and also of how to increase their knowledge as needed.

"IMO, MDVIP is just another corporate-owned endeavor that puts the money before the patient's well being."

Yes, thanks for the warning!
+25 # economagic 2017-07-22 19:10
Wow. All accurate and no surprise to those of us who have been following this issue for three decades and more. The comments on ACA are also accurate, and many of us said the same at the time. I'm not even a health care economist, much less an MD or an industry analyst, so hooray for Geyman for pegging that (including the bogus alternatives) and to Cantarow for bringing it to us.

I thought "Medicare Advantage" sounded like a scam when it was announced, but I was a decade from retirement and way to busy to research it. Our local SHIP Program representative recommended UHC MA over Double Cross 70/30, and I haven't had any serious trouble with them. But I read recently that they are under investigation if not indictment for defrauding Medicare.

And that's the one nit I would pick with the book or the review: The "dominant medical ethic" is whatever is profit for stockholders, especially executives and Board members, not mere "self-interest" except in a sense that even Adam Smith would not recognize.

In the past two years I have lost two primary care doctors: a very good one from a corporate-owned clinic to the VA, the other from a clinic attached to a monster teaching hospital who needed work closer to his home. I just made the acquaintance of a nice young doctor at the latter clinic, but I think I need to get a little farther out of The System, if that's possible without paying everything out of pocket.
+2 # Lolanne 2017-08-11 16:46
Quoting economagic:
I thought "Medicare Advantage" sounded like a scam when it was announced, but I was a decade from retirement and way to busy to research it. Our local SHIP Program representative recommended UHC MA over Double Cross 70/30, and I haven't had any serious trouble with them. But I read recently that they are under investigation if not indictment for defrauding Medicare. ...

I have used M'care Advantage plans since first learning about them in 2005 or 6. Haven't found them to be any more of a scam than healthcare in general in the U.S., but in choosing one of those plans one does have to be very, very careful to research them thoroughly. I've found the M'care site to be very helpful in that. It's a gamble, of course. For reasonably healthy people who don't have serious medical needs, they work out OK. Despite the co-pays, I have come out with less annual costs for health care each year than if I had paid a monthly premium for a M'care Supplement plan in addition to regular M'care. That all may change this year, though, as I've just had surgery and will need to be taking a medication for the rest of my life (have not yet started that so don't know what my expense may be...). Any way you look at it, the available health care in America for us older folks (and everyone, really) is a toss-up, a real gamble on whether one will develop any serious health issues -- which, of course, none of us can really predict.
+23 # maindrains 2017-07-22 19:36
There is another book published in Canada about the Canadian healthcare system called "better Now; 6 big ideas to improve healthcare" which is universally applicable and demonstrates how perverse and anti people the US system is.
+5 # Dudu101 2017-07-23 09:38
From about Danielle Martin's "Better Now: Six Big Ideas to Improve Health Care for All Canadians":

· Ensure every Canadian has regular access to a family doctor or other primary care provider
· Bring prescription drugs under medicare
· Reduce unnecessary tests and interventions
· Reorganize health care delivery to reduce wait times and improve quality
· Implement a basic income guarantee to alleviate poverty, which is a major threat to health
· Scale up successful local innovations to a national level
+6 # chemtex2611 2017-07-22 23:00
United Health Care does a good job if AARP is on their case, but they are not OK on their own. The Medicare Advantage programs look like a great deal, because they, supposedly, come with extra services like eyeglasses and dental care, but you'll be lucky to get the basics and the insurer keeps the extra money.
+14 # Wise woman 2017-07-23 02:09
Since I have suffered major medical injury at the hands of American so-called health care, I'm beginning to wonder if some of it was NOT accidental. 100,000 people die every year in this country at the hands of incompetent doctors. That is the equivalent of a fully loaded jetliner crashing every single day. That I have survived is a miracle although I do know of others more injured who are also alive. But it comes at a big price. Big money attracts bad docs, bad outcomes and ruined lives. Patient care organizations have worked for years trying to improve our rotten system but will take a grassroots uproar to get rid of it. It's about time one of their own is finally calling American medicine for what it is - a national disgrace!
+3 # economagic 2017-07-23 09:30
You might want to read "Medical Nemesis" (1975), by Ivan Illich, about "iatrogenic" illness, from the Greek meaning "brought on by the healer." There is also a book on "pharmacologica l psychiatry" by Robert Whitaker titled "Anatomy of an Epidemic" (2010) that uses that same term and claims that the research seems to show that at least a large cohort of the people currently in long-term drug treatment or hospitalization for personality or psychiatric disorders are in that condition because of inappropriate use of medication.
+4 # _INVALID_UNAME 2017-07-25 22:38
Quoting Wise woman:

A LOT of people die every year from medical mistakes. But "medical mistakes" encompass a huge range of problems, from wrong drugs or doses given by nurses, to drug interactions in patients drinking alcohol, to patients not taking their meds as they're supposed to (30% don't), to a physician misdiagnosing an uncommon disease.

To say that "100,000 people die every year" because of incompetent doctors is absurd. Yes, incompetent docs kill people every year, but your number is silly.

I married a physician 10 years ago, and I've gotten to see things from the other side. Most docs are smart, competent, and really are doing the best they can in bad circumstances. MBAs running the industry now see patient care in terms of productivity, so docs who don't "meet the numbers" can get fired. Docs hate this -- truly they do -- but going off to practice alone nowdays the way they would LIKE to practice medicine is nearly impossible. This is because insurance companies control who gets paid what, and so they own the medical industry. Small practices can't bargain and so can't compete.

Pointing at doctors plays into the industry's propaganda about 'who is to blame'.

Honestly, patients share a lot of the blame, too, for failing to question the food industry's marketing, and allowing themselves to get in such poor health to begin with.
+1 # randrjwr 2017-09-21 18:01

I also am married to a physician, have worked and observed in her office (one-doc office for as long as she could stand it, for the reasons you mention) and I agree with your assessment, but would add another reason for poor outcomes--non-c ompliance to their physician's treatment plan by some patients.
+5 # Adoregon 2017-07-24 13:35
Single payer.

Get the [for profit] corporations out of healthcare.

Start teaching healthy living and diet in grade school based on best available science, not on food "industry" propaganda.
+4 # AlexG 2017-07-25 17:54
USA health care corporations, big pharma, and related insurance industries have long since become predatory, interlocking Monopolies in Restraint of Trade (via any honest Constitutional definition).
If genuine progressives ever again manage to regain control of the Congress, then either "trust-busting" these monopolies (in the manner of Teddy Roosevelt), or declaring these illegally-abusi ve entities to be [thenceforth] democratically- regulated Public Utilities, ought to be at the top of the legislative agenda.
A Big Dream, yes; and one that would also require realization of many other fundamental, preceding changes in US society,
Breath-holding meanwhile not recommended.
+4 # _INVALID_UNAME 2017-07-25 22:13
GOP pushes "the free market" as a solution, and believes that to be the reason to "get government out of healthcare".

But they fail to consider the obvious:

WHERE, exactly, is the free market's incentive for profit to be found? In creating a healthy population that needs little care, or in creating an ever-sicker population dependent on endless drugs and procedures?

To take it further: Massive low-quality-FOO D industry profits lead to all those MEDICAL industry profits, from resulting obesity, cancer, diabetes, heart disease, psychological problems, etc.

A win-win, for the mega-corporatio ns' earnings, stock prices, dividends, and executive compensation.

A lose-lose for people's health, finances, and happiness.

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