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Diagnosis: A “sick” system of health care

Posted on July 12, 2007 by Staff

By Anthony Fleg 

As Sicko, Michael Moore’s new “comedy about 45 million people with no health care in the richest country on Earth” prepares to open in a few days, I am more and more convinced that our current health care system is truly sick, overrun with profit motives that are like aggressive cancers, waiting to eat us alive.

As a medical student here at UNC, I appreciate the focus on health care reform by the presidential candidates as a good sign that there is willpower for change. However, the content and framing of this conversation, focusing on the “problem” of the uninsured, fails to address the root problem: A health care system driven by unchecked profit motives will not produce equity in health. 

Like any sickness, especially one of this magnitude, we cannot expect band-aid treatments to heal gushing, frothing wounds, much less to cure the disease. We cannot treat the symptoms – such as proposing to “politely” and gradually extend coverage to more Americans, thereby addressing the symptom of the uninsured – and seriously think that by doing so we are curing the health care system of the disease that created the uninsured. This is akin to treating a life-threatening blood infection with Tylenol, focusing on the symptoms of the fever instead of the microbes causing the infection.

But it is not at all surprising. Lobbyists for drug companies and health insurance companies far outnumber the elected officials on Capitol Hill, to the point that they begin to write our laws (e.g., see Medicare Part D, HPV vaccine mandates). Medical and health organizations are largely invisible on the issues of health versus profits, with others colluding with industry for personal benefits (e.g., the AMA’s sale of physician-prescribing information). Even at the level of the clinic, for-profit interests abound: promotional cabinets of the highest-cost medicines, with few physicians questioning the conflict of interest that arises when their “educators” and lunchtime companions are for-profit pharmaceutical companies.

No, the problem is not the uninsured. And universal coverage, in the absence of larger reforms that promote health, not profit margins, will only stop the bleeding temporarily.

Put another way, if we focus on the “problem” of the uninsured, the logical inference is that the problem is the uninsured folks themselves, since they are the target of the intervention. Instead we need to ask, “What is the bigger problem that creates this symptom?”

“Why, in the richest country in the world, do 50 million or so people go without proper health coverage?”

“Why, in the country that spends far more than any other nation per-capita on health, do we have embarrassingly poor health outcomes, especially for the marginalized of our society?”

The answers to “Why?” – and, therefore, the solutions – do not rest with the victims of this system.

I urge all of us to adopt a justice-oriented approach to the debate on reforming the health care system. Using this lens, our goal is to create a health care system that works for equity in health, not merely creating insurance for the uninsured. To do this, we must be willing to advocate for the removal of the for-profit machine that runs our health care system, including not only the industries (pharmaceutical, insurance, biotech, device manufacturers) but also the workforce (physicians, administrators).

In the same way that you wouldn’t waste time popping Tylenol for that blood infection, this justice-oriented approach is the only medicine worth taking if we are serious about meaningful change and the curing of this sickness. Other solutions, watered down to attack symptoms, to appeal to potential voters and to appease the corporate interests funding the politicians and feeding the doctors, simply will not do.

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