There, I said it. I feel much better already.
And trust me, I know poop. I deal with it on a daily basis. I'm an internist in a major metropolitan area and there is no shortage of poop here. And the fun doesn't end when I'm done with work - home is where the real action is. I have two small children, one of whom is still in diapers. Fortunately at work I don't have to actually handle the poop. I paid enough in tuition to absolve myself of that duty. My degree, however, doesn't command the same amount of respect at home as it does at work. In fact just last month I bare-handed a turd out of the bathtub.
I know poop when I see it, smell it, or sadly, when I touch it. And for better or worse, that is my everyday life. Fortunately I'm not a gastroenterologist - if it weren't for their incredible salaries I don't know that such a specialty would even exist.
I also know some medicine. I trained at a very good institution and did well on all my exams.
So it's no exaggeration when I say that the US healthcare system is crappy. I see it, smell it, and handle it every day, and it has all of the same consistency of poop.
I don't mean it in a disparaging, "I hate your face" kind of way, but rather in a "yes, your face IS ugly but let's see what we can do about it" kind of way.
But doctor, this is America! We have the best healthcare in the world here! How can you say such a thing! My great-grandma had a 5mm tumor removed from her pineal gland by a uber smart sub-sub-subspecialized surgeon using a Davinci robot with a state of the art harmonic scalpel!
Well, it's really a relative crappy when viewed on a macroeconomic scale. Certainly it's better than nothing. But for the amount of money we spend on healthcare, our overall outcomes suck. Yes, they suck. Take a look at the following data of life expectancy (in years) by country (1):
| Country | 2008 | 2009 | 2010 | |
| Australia | 81.5 | 81.6 | .. | |
| Austria | 80.5 | 80.4 | .. | |
| Belgium | 79.8 | 80 | .. | |
| Chile | 77.8 | 78.4 | 78.6 | |
| Czech Republic | 77.3 | 77.3 | .. | |
| Denmark | 78.8 | 79 | .. | |
| Estonia | 73.9 | 75 | .. | |
| Finland | 79.9 | 80 | .. | |
| France | 81 | 81 | 81.5 | |
| Germany | 80.2 | 80.3 | .. | |
| Greece | 80 | 80.3 | .. | |
| Hungary | 73.8 | 74 | .. | |
| Iceland | 81.3 | 81.5 | .. | |
| Ireland | 80.1 | 80 | .. | |
| Israel | 81 | 81.6 | .. | |
| Italy | 81.8 | .. | .. | |
| Japan | 82.7 | 83 | .. | |
| Korea | 79.9 | 80.3 | .. | |
| Luxembourg | 80.6 | 80.7 | .. | |
| Mexico | 75.1 | 75.3 | 75.5 | |
| Netherlands | 80.3 | 80.6 | .. | |
| New Zealand | 80.4 | 80.8 | .. | |
| Norway | 80.8 | 81 | .. | |
| Poland | 75.6 | 75.8 | .. | |
| Portugal | 79.3 | 79.5 | .. | |
| Slovak Republic | 74.8 | 75 | .. | |
| Slovenia | 78.8 | 79 | .. | |
| Spain | 81.3 | 81.8 | .. | |
| Sweden | 81.2 | 81.4 | 81.5 | |
| Switzerland | 82.2 | 82.3 | .. | |
| Turkey | 73.6 | 73.8 | .. | |
| United Kingdom | 79.8 | 80.4 | .. | |
| United States | 78 | 78.2 | .. |
And look how much money it takes us to buy this sub-standard outcome (1):
| HEALTH EXPENDITURE | |
| Total expenditure on health, % gross domestic product | |
| 2009 | |
| Australia | |
| Austria | 11.0 |
| Belgium | 10.9 |
| Canada | 11.4 |
| Chile | 8.4 |
| Czech Republic | 8.2 |
| Denmark | 11.5 |
| Estonia | 7.0 |
| Finland | 9.2 |
| France | 11.8 |
| Germany | 11.6 |
| Greece | |
| Hungary | 7.4 |
| Iceland | 9.7 |
| Ireland | 9.5 |
| Israel | 7.9 |
| Italy | 9.5 |
| Japan | |
| Korea | 6.9 |
| Luxembourg | 7.8 |
| Mexico | 6.4 |
| Netherlands | 12.0 |
| New Zealand | 10.3 |
| Norway | 9.6 |
| Poland | 7.4 |
| Portugal | |
| Slovak Republic | 9.1 |
| Slovenia | 9.3 |
| Spain | 9.5 |
| Sweden | 10.0 |
| Switzerland | 11.4 |
| Turkey | |
| United Kingdom | 9.8 |
| United States | 17.4 |
I should point out that I'm no economist. I have no formal business or finance training. I'm pretty sure I took an economics class at some point in high school. But I understand enough to know what I don't know, and so I don't make any claims in complete ignorance (partial, at most).
But look at the freaking data! We (America) spend a bazillion dollars each year on healthcare and have a life expectancy similar to that of Slovenia and the Czech Republic! (Don't take offense at that my Eastern European friends - the joke is really on us!) In essence we're spending $100,000 to buy an average Chevy truck! Don't get me wrong - I enjoy Chevy trucks as much as any American male. But at that price? No thanks. That's a horrible deal. And for that much, it's a relatively crappy piece of machinery.
Furthermore, the money that we spend is money that we soon won't have. Medicare spends much more than it brings in. In 2010 47.5 million people were provided some sort of care at a staggering cost of $516 billion (2). At the current pace, the Medicare fund is expected to run out in 2024.
And it gets worse! Not only do we grossly overpay for healthcare, but we're under the impression that we're getting something great for it. We're buying the perception of good healthcare. We're spending so much, we tell ourselves, that we must be getting our money's worth. But we're not. We're taking it in the shorts is what we're doing. Those of you who purchase your own insurance know this already. Premiums are rising at an incredible rate. And for what? So we can live a shorter life than most of the industrialized nations of the world?
Look at the following data on perception of healthcare. This is the percentage of population (all ages) who considers his/her health to be "greater than or equal to good" (1).
| Country | 2008 | 2009 | 2010 | |
| Belgium | 76.7 | .. | .. | |
| Canada | 88.1 | 88.5 | .. | |
| Czech Republic | 68.2 | .. | .. | |
| Denmark | .. | .. | 85 | |
| Estonia | 56.3 | 54.6 | 55 | |
| Finland | 67.7 | 68 | .. | |
| France | 72.4 | .. | .. | |
| Germany | 64.7 | .. | .. | |
| Greece | 76.4 | 75.3 | .. | |
| Hungary | .. | 54.2 | .. | |
| Iceland | 80.6 | 80.3 | .. | |
| Ireland | 84.4 | 83.4 | .. | |
| Israel | 79.7 | 79.8 | .. | |
| Italy | 63.4 | 63.6 | .. | |
| Korea | 43.7 | 44.8 | .. | |
| Luxembourg | 74.1 | 73.9 | .. | |
| Netherlands | 77.5 | 78.5 | .. | |
| Norway | 80 | .. | .. | |
| Poland | 57.7 | 56.3 | .. | |
| Slovak Republic | 31.1 | .. | .. | |
| Spain | .. | 74 | .. | |
| Sweden | 79.1 | 79.9 | .. | |
| Turkey | 68 | .. | .. | |
| United Kingdom | 76 | 76 | .. | |
| United States | 88 | 90 | .. |
But doctor, there got to be some logical explanation for this!
Translation: but doctor, my shit don't stink!
Yes, as a matter of fact it does. It looks, smells, and even tastes like poop! OK, I can't prove that last part because I have not, to my knowledge, ever ingested enough fecal material at one time to actually know what it tastes like. (If you're disgusted at that thought, recall that most gastrointestinal illnesses are transmitted person-to-person via the fecal-oral route. Yep, you've all tasted that yummy goodness!)
What we have done is manage to fool ourselves into thinking we have the greatest healthcare system in the world. We have all the greatest medical gadgets (thank you, capitalism), the most MRI and CT scanners per capita (thank you, whoever makes these things) (1), and the best of the best of the best drugs that money can buy (thank you, big pharma). It makes us feel healthier, and the data prove this.
Chew on this - given our staggering rates of obesity (more on this is a future post), it is anticipated that life expectancy may, in our lifetime, actually decrease for the first time in the recorded history of mankind (excluding the influenza pandemic of 1918). We'll be spending more and more money and getting less and less for it. What a great freaking deal. But I digress.
Until I recently discovered this data, I too was of the myopic American view that we have the best healthcare system in the world. Damn the internet for moving my cheese! And now I have just returned the favor and moved your cheese. You cannot live in pleasant ignorance any longer.
Spending a number of hours on the OECD website has caused me to change my mind. It has influenced my perception of healthcare in a very real and powerful way. It has changed the way that I practice medicine.
It was because of this that I decided to give birth this blog (without opioids or an epidural - omg those are toxic!). Economics can provide a top-down view complete with data analysis sliced in an infinite permutation of ways, and there are plenty of economists out there doing that for a living. Not to mention the politicians (I mean lobbyists) that pretend to understand what is going on here. My intent, however, is to supply a view of healthcare from the bottom up - from a physician's perspective, that is. It can be dirty down here, and damn does it smell at times, but sometimes you have to spend time in unpleasant places to get an answer. It's a unique vantage point that neither economists nor politicians seem particularly interested in seeing first hand, which really is a shame considering all that you can learn from poop.
As a whole, us doctors don't do a very good job of communication - both with our patients as well as with the public. We are masters of critique and criticism, yet we can't seem to offer any tangible solutions. Our heads are teeming with good ideas, but heaven forbid we share them with anyone! This is, after all, the House of God, and people should come to us for answers! And so I am making a bold move to reach out to anyone interested in reading a doctor's opinion on random topics related to healthcare.
I don't have any real purpose other than to write my thoughts, experiences, and impressions on the state of healthcare in the US. I am not using this as a platform to spew any ideological political nonsense. For the record I am a fiscally conservative independent that tries to avoid politics at all costs.
I am a minimalist. I try to use common sense. I want a better America and a better world. And I certainly don't want the United States of Amercia to mortgage itself to China as a result of our egregious healthcare spending (a real possibility). Then again, I enjoy spicy Chinese food and so maybe that wouldn't be as oppressive as I am imagining it.
And so I will ramble on this blog in a very stream-of-consciousness type manner and hope someone finds some worth in my partially evidence-based opinions. And if you don't, then I don't particularly care.
Stay tuned.
1. http://stats.oecd.org/
2. http://www.medicare.gov/Publications/Pubs/pdf/11396.pdf
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ReplyDeleteHaha consider yourself broken in...your optimism is only surpassed by your impartial appreciation of GI docs, Chevys, and of course, a BMI>30. Socialized medicine is the likely inevitable solution, although being owned by China may actually benefit some of us in the long run :p
Deletelike the post. excited to read more of your sarcastic, funny, and interesting thoughts. :)
ReplyDeleteVery interesting! Keep it up! I'll pass on your blog to others.
ReplyDeleteYes, Slovenia might have a similar life expectancy, but if 10 million poor people from a third world country moved in, they would see in drop in theirs as well. This reminds me of the bi-annual hand wringing that comes along with America's abysmal performance in the international math and reading tests. Middle class people do superbly, but the numbers are brought down by the massive influx of "anchor babies" whose parents do not speak English or often even good Spanish. "Socialized medicine" is just going to further wreak havoc on the health system, forcing taxpayers to further subsidize these families who operate in the humongous shadow economy here in Southern California. The only winners are the farm and chicken factory owners, who get to shove all the costs of bringing uneducated workers willing to work for next to nothing onto the rest of society. Don't know what caused me to go off on this tangent... I like your blog. Two of my uncles are doctors in Cuba-- contrary to what so many people think, it is not good to be sick in that country whether you are poor or rich.
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