Is Our Health-Care System “Broken”? by David C. Stolinsky, MD

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Sunday, November 1, 2015

Cancer survival rates

Source: The Telegraph

I am reproducing this table on cancer survival rates throughout the world in its original form, rather than formatting it to fit the page better. My purpose is to show clearly which nation is at the top in this crucial field. Other aspects of health are affected by many factors, only some of which are within the grasp of health care. But our chances of surviving cancer are very closely related to the care we receive.

Look at the table. Now tell me why, if the American health-care system is “broken,” we have the best cancer-survival statistics for most forms of men’s and women’s cancer. And then tell me why so many “progressives” urge us to emulate the health-care systems of European nations with lower cancer-survival figures. Does this make sense? Is this about improving our health or controlling our people?

But perhaps you prefer a graph.

Five year survival rates for common cancers

If the American health-care system is “broken,” what would you call these systems? What is worse than “broken”? Dilapidated? Decrepit? Rattletrap? Moribund? Yet the American Left has nothing but praise for these systems.

Perhaps it’s a question of emphasis. “Progressives” are not advocating a socialized health-care system, but a socialized health-care system. Their aim is not health care, but socialism. Their plan is not to improve our health, but to control us by the most effective means possible – to hold the care of ourselves and our loved ones in their hands. Who would dare to oppose bureaucrats who have the power of life and death?

We are told that despite all the money we spend on health care, America does not rank with the best in regard to infant and maternal mortality, or in regard to life expectancy. In fact, the difference is minimal. Life expectancy at birth for the European Union is 78.67 years, while that for the U.S. is 78.11 years − only six months shorter.

Patrick Henry said, “Give me liberty or give me death!” He did not say, “If I might get an extra six months of life, I’ll give up my liberty.” But what if we give up much of our liberty, and in return don’t even get the six months?

Advocates of ObamaCare loudly complain about the expense of the last six months of life – as if anyone can know this except in retrospect. So they plan to cut health care for the elderly, the disabled, and the chronically ill, even veterans. A government publication encourages veterans to go without expensive care for chronic illnesses. Under ObamaCare, “end-of-life counseling” will be given to all elderly or disabled people.

How do you cut funding for chronic care, and at the same time extend life expectancy? You don’t. You make “the last six months of life” a self-fulfilling prophesy.

And how do you give “end-of-life counseling” to people whose lives are not ending, without suggesting that their lives should end?

America is responsible for over 60% of the Nobel Prizes in Medicine and for the majority of advances in health care. Cancer and heart disease are our two biggest killers. We do well with these, so why isn’t our life expectancy even longer? Here is a clue: 12.8% of Americans never reach the age of 60. Most cancer and heart disease deaths occur after age 60.

So what is killing Americans before the age of 60? Americans are. The number-one cause of death for African American males from the ages of 15 to 34 is homicide. Faster ambulance response and more trauma centers may reduce this figure somewhat. But clearly, this is not a problem of health care.

Similarly, we can spend more money for prenatal and obstetric care. But if women come across the border eight months pregnant, never having seen a doctor, is the fetal and maternal mortality a problem of health care? If pregnant and nursing mothers drink alcohol or use illegal drugs, can doctors solve the problem?

If young people rot out their bodies, minds, and souls with heroin, cocaine, methamphetamine, and who-knows-what, can doctors clean up the mess? How many fatal overdoses and cases of hepatitis and AIDS will it take to convince us that government-run health care is not a cure-all?

If you doubt this, check out the life expectancy and the rates of infant and maternal mortality in the various states. Compare the best figures with those from the District of Columbia, which is similar to other inner cities. For example, the maternal mortality rate for D.C. is 34.9 maternal deaths per 100,000 live births, compared with 2.7 in Massachusetts. The infant mortality rate in D.C. is 14.1 per 1,000 live births, compared with 4.5 in Utah. The life expectancy in D.C. is 72.0 years, compared with 80.0 years in Hawaii.

Then check out the rates of AIDS and HIV. The rate in D.C. is 148.1 cases per 100,000 inhabitants, while that in Vermont is 1.0. Why is a resident of D.C. 148 times more likely to get AIDS? Is there an AIDS clinic on every block in Vermont? Do they have medicines not available elsewhere? Do they hand out condoms in kindergarten? Or does it have something to do with the way Vermonters live their lives?

And if any doubt remains, look at homicide rates. Violence is not “as American as apple pie.” The homicide rate in some states is as low as in the least violent European nations. The homicide rate in the District of Columbia is 29.1 per 100,000 inhabitants, compared with 1.0 in New Hampshire. These are not minor differences − they are gross disparities. The pathologies of the inner city are many, but government-run health care cannot be the answer. We already have it in the District of Columbia, and the figures are dismal.

But note that I did not say “results.” The terrible health figures from the inner city are not the result of the health-care system. They are the result of unhealthful lifestyles and living conditions. They are the result of pervasive violent crime, rampant drug abuse, and promiscuous sex. They are the result of rotten schools run by the government, which leave young people unprepared for gainful employment.

They are the result of ignoring the proverb, “He who does not teach his son a trade teaches him to be a thief.” Of course, this assumes that there is a father present to teach anything at all. But look at the data for births to single women. Compared with Utah, where 19.6% of births are to unwed mothers, the rate in D.C. is 58.5%. Well over half of all births in the inner city are to single women. This fact is related to the number of children living in poverty. And that fact is in turn related to the poor health of many of the children, which may have lifelong consequences. These are moral and social problems, and they cannot be solved by health care.

One more factor to consider is immigration. Milton Friedman, recipient of the Nobel Prize in Economics, taught us that we can have either open borders or a welfare state, or we can have neither, but we can’t have both. And that is precisely where we are headed. Advocates of ObamaCare claim that it does not cover illegal immigrants. But in fact, undocumented immigrants are already being covered by Medicaid in many areas.

What will follow is predictable. A flood of immigrants, legal and illegal, will cross our borders to enjoy “free” health care. If you are worried about rationing of care now, think what will happen to the elderly, the disabled, and those with expensive diseases when millions of newcomers overflow waiting rooms.

In short, “reform” of health care may very well cause a deterioration of our health.

Our object should be to improve our health, not merely to rearrange our health care. Our object should be to help Americans become healthier, not to control every aspect of their lives. And the longer the debate goes on, the clearer it becomes that the object of government-run health care is control, not health.

Our health-care system is not “broken.” It has problems, but in important respects it is the best in the world. That is why many of the richest and most powerful people in the world come to America when they are seriously ill. The system needs a tune-up, not a major overhaul. The same is true for America itself.

Written by David C. Stolinsky, MD

Dr. Stolinsky is a retired medical oncologist and co-author of Firearms: A Handbook for Health Professionals, published by The Claremont Institute. For other articles written by Dr. Stolinsky, check out our search feature on this website.

The photos used to illustrate this article appeared in the original article posted on www.Stolinsky.com. Copyright ©2015 Stolinsky.com.

This Article may be cited as: Stolinsky, David C. Is our health-care system "broken"? HaciendaPublishing.com, November 1, 2015. Available from: http://www.haciendapublishing.com/articles/our-health-care-system-%E2%80%9Cbroken%E2%80%9D-david-c-stolinsky-md

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helping each other!

In my opinion, it's not really broken. It has problems but if we all help each other we can get through it.

Is the U.S. health care system broken?

This is an expanded commentary based on a specific comment I recently wrote for Surgical Neurology International in response to an article by Dr. Clinton Frederick Miller, which was highly critical of American medicine and making a pitch for the further socialization of the American health care system.[11]

This interesting article by Dr. Miller argues several points that are misleading or factually incorrect. My friend and colleague Dr. Russell L. Blaylock has already written an excellent rebuttal as far as the moral and political implications in this paper that cuts into the heart of the matter: While some of the observations in the article may be correct, the type of “liberal/left proposals to solve the problems are harmful.”[11] I agree with Dr. Blaylock’s assessment. Moreover, when Dr. Clinton F. Miller blames the free market for the problems in the U.S medical care system, I would argue that the reality is quite the opposite.[1] A two level cervical fusion may cost $11,000, but if the free market was fully allowed to work, the price would be far less because of unfettered competition, as occurs with other professions and trades. The same would happen with the stereotactic biopsies at $4000-$8000. Price would come down if the free market was allowed to work, and patients and their families would be educated to shop around for quality and most affordable medical care. As Dr. Miller himself has pointed out 96% of illnesses are not serious, and patients could act as prudent consumers and with freedom of choice, if we truly had an unfettered free-market in medical care. One only has to compare the price of dental care where the market is less restricted to medical care (where third party payers and the government are involved) to immediately recognize the distortion of the fee-for-service U.S. medical care system. Despite the misconception of a free market in medical care in the U.S., the reality is that already more than half the system is socialized, and the rest is under managed care, a highly regulated system in which cost-containment is the raison d’être and the managed care entities and insurance companies work hand in glove with the government, a collectivist and corporativist partnership.[2,3]

Third party payers (insurance companies as well as the government) are a problem because the system is perceived, and in fact mishandled, as if somebody else other than the patient is paying the medical bills; thus, the invisible hand of the free market is hampered. It is abused on all sides and these abuses escalate. Insurance companies are stuck with huge medical and hospital bills, and they are able pass the costs to the enrollees, ultimately the patients. This is a problem that like the other shortcomings mentioned above needs addressing, but with a major overhaul as with Obamacare, the U.S. health care medical care market would be further distorted. With fully socialized medicine, it would be destroyed! Dr Miller warns us about the healthcare-industrial complex and likens it unfavorably to General Eisenhower’s military-Industrial complex, but the fact is we should be much more concerned when government enters the equation in these unholy corporativist partnerships, as in Obamacare, which is a more advanced level of corporate socialized medicine with more regimentation, more socialization, and less freedom.

Dr. Miller mentions Hippocrates and the Oath and I’m happy that he does. But it is not socialized medicine, not even managed care, that upholds the tenets of the Hippocratic Oath, but the individual-based (not government-based), patient-oriented free market medical care.[4] It is of interest that Dr. Miller is concerned with the trend that physicians are “not fulfilling a physician’s sacred first duty to engage in responsible and humanistic collaboration with the patients we are privileged to serve.” Here I tend to agree to some extent but wonder if the word “humanistic” was chosen with a purpose in mind or whether he meant “humanitarian” or “compassionate.” The term “humanistic” has today, even as Wikipedia has noted, so many meanings from “man-centered” to “humanitarian” that it is difficult to discern which is meant within the context of that sentence. I suppose Dr. Miller meant “humanitarian.” If he meant humanistic with alternative meanings, the term is incorrect at best or disingenuous at worse.[12]

Over treatment and alleged unnecessary medical care, too much surgery, heroic care, all of this happens — but they do not all mean greed and the implied (immoral) profit motive, as ascribed by Dr. Miller, but also the penchant of Americans to live longer sometimes without considering quality of life — after all, somebody else (government or insurance companies) is paying the medical bills! It is not all the doctors’ fault, but the imprecision of the art and science of medicine and our way of life and our way of thinking. And the American way is not always wrong.[5,6,7,10] We need education and information, and how to take care of ourselves, but we in the U.S. do not need further regimentation and collectivization.[8,9,10] Some of the problems enumerated by Dr. Miller do exist as noted, but some of the proposed solutions, such as full implementation of socialized medicine, are far worse. I have provided supportive references after some of the statements that I hope are helpful to the uninitiated and those who may want to learn a bit more about the U.S. medical care system, the good, the bad and the ugly.[1-12]

References

1. Faria MA. ObamaCare — Toward Free Market or Socialized medicine? HaciendaPublishing, September 26, 2011. Available from http://haciendapub.com/articles/faria-obamacare-%E2%80%94-toward-free-ma...

2. Faria MA. Rationing irrationality in Anticipation of ObamaCare. HaciendaPublishing, October 4, 2013. Available from: http://haciendapub.com/articles/faria-rationing-irrationally-anticipatio...

3. Faria MA. ObamaCare — Another step toward corporate socialized medicine in the U.S. Surgical Neurology International 2012 3(1):71-71. Available from: http://surgicalneurologyint.com/surgicalint_articles/obamacare-another-s...

4. Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics? Surg Neurol Int 2014;5(1):146. Available from: http://surgicalneurologyint.com/surgicalint_articles/the-road-being-pave...

5. Stolinsky, David C. Is our health-care system "broken"? HaciendaPublishing.com, November 1, 2015. Available from: http://www.haciendapublishing.com/articles/our-health-care-system-%E2%80...

6. Faria MA. Bioethics and why I hope to live beyond age 75 attaining wisdom! — A rebuttal to Dr. Ezekiel Emanuel's 75 Age limit. HaciendaPublishing.com, November 5, 2014. Available from: http://surgicalneurologyint.com/surgicalint_articles/bioethics-and-why-i-hope-to-live-beyond-age-75-attaining-wisdom-a-rebuttal-to-dr-ezekiel-emanuels-75-age-limit/ 

7. Faria MA. Longevity and compression of morbidity from a neuroscience perspective: Do we have a duty to die by a certain age? Surg Neurol Int 2015;6:49. Available from: http://surgicalneurologyint.com/surgicalint_articles/longevity-and-compr...

8. Blaylock RL. Regimentation in medicine and its human price (Part 2). HaciendaPublishing.com, March 20, 2015. Available at: http://www.haciendapub.com/articles/regimentation-medicine-and-its-human...

9. Blaylock RL. Regimentation in medicine and the death of creativity (Part 1). HaciendaPublishing.com, March 14, 2015. Available at: http://www.haciendapub.com/articles/regimentation-medicine-and-death-cre...

10. Ausman JI. Perinatal Mortality, Free Care, and other Misconceptions — Socialized medicine vis-à-vis American Medicine. Hacienda Publishing. November 27, 2012. Available from: http://www.haciendapublishing.com/articles/perinatal-mortality-free-care...

11. Miller CF. Why I am concerned about the future of medicine. Surgical Neurol Int 2014. Available from: http://surgicalneurologyint.com/surgicalint_articles/why-i-am-concerned-...

12. Faria MA. Religious morality (and secular humanism) in Western civilization as precursors to medical ethics: A historic perspective. Surg Neurol Int 16-Jun-2015;6:105. Available from: http://surgicalneurologyint.com/surgicalint_articles/religious-morality-...

Further thoughts and criticisms (with same references as above)

Liberals (aka progressives) have also a predilection to compare the U.S. with other industrialized nations, whether it is health care or gun violence statistics. First, selection bias (of countries for comparison) should have no place in scientific methodology, and the usage of statistics that usually accompany these discussions brings in a method of science that should abhor biases. Second, why should the rest of the world be ignored sociologically, as if they were no part of the community of nations made up of human beings with the same yearnings and natural rights as anybody else?

Be that as it may, I have had similar previous discussions on this subject and have had to reiterate that despite the shortcomings, drawbacks, and alleged abuses of the American medical care system, that fee-for-service American medicine is still the best in the world. This is particularly true given our unique cultural situation, the growing and heterogenous population that it serves, rampant immigration, popular expectations, and other political and cultural considerations.

As to specifics, Dr. Miller alludes to over-diagnosis and over treatment of breast and prostate cancer, and goes to mention that 85% of men over the age of 60 at autopsy harbor microscopic evidence of in situ prostate cancer, suggesting that this is a benign condition requiring no treatment.[11] Let me just state that a dead senior citizen at autopsy is one thing; it is another for a symptomatic but very active elder person not to be treated because his prostate or her breast cancer may not be invasive or deemed not serious, or ignored simply because of the age of the patient.[2,6,7]

Dr. Miller then goes on to criticize over treatment in neurosurgery and opines, based on a 2007 New England Journal of Medicine study, that conservative treatment of lumbar radiculopathy is as good as surgical treatment with microdiscectomy.[11] That may be in the long run but he glosses over the fact patients experience less pain sooner and recover faster with microdiscectomy. He then impugns venal motives to his colleagues for advising surgery when medical treatment is supposedly just as good, claiming, “experienced spine surgeons have known this all along” but because of “selfish motives” fail to disclose this to the patients. Not necessarily so, because the art and science of medicine and neurosurgery is imprecise and different surgeons have better or worse results with one method or the other. Patients (and surgeons) are unique individuals, not statistics. One size does not fit all. Then he accuses others of more mercenary motives for criticizing the study; he writes, “certain vocal elements within the spine surgery community” contended the results of the study because “obvious selfish intent to protect a ‘bread and butter’ source of income.” That may be so for some, but not for other critics, and as he himself noted, there were shortcomings in the study, as well as differences in the results. So much for Dr. Miller and specific rebuttals, let’s return to general concerns.

Returning to the U.S and European comparison, Western Europe has a largely stagnant and, in some countries, an aging population that has difficulty sustaining itself. Europeans are able to ration health care very efficiently with socialized medicine because of the much more homogenous population and culture it serves. This situation would be very difficult to accomplish in America without establishing an authoritarian government, curtailing freedom, and changing the American way of life, very likely for the worse. Scandinavia has had a long tradition of tribal Nordic welfare (socialistic) that is time-honored and thus frequently not abused, serving its temporary purposes (e.g., socioeconomic and moral support until the afflicted persons get back on their feet). In the U.S. welfare services are abused as they are largely politically motivated, rather than a time-honored social and traditional more.

And in Spain, Greece, France, and the rest the economies are sinking because of their uncontrolled spending in social (including medical) services they can not afford. In this tenor, I recommend the papers by Drs. Ausman and Stolinsky.[5,10]

Collectivism has been a failure wherever it has been established, and socialized medicine, in particular, has been the key arch of that socialization, an essential component of collectivism used by politicians to seduce the people making it easier for them to accept dependence and tyranny. Europe has been free to pursue their pacifism and social safety net, including socialized medicine in large part from the goodwill of the U.S. during World War II, the post-war Marshall Plan, and the protection that America (and her gun culture) provided during the cold war. but what worked for her may not work for us.

Collectivism in any of its incarnations, socialism, fascism [National Socialism], communism, and even corporativism [the unholy partnership of big business and government as in corporate socialized medicine] is supported by a faulty, if not an unnatural and evil ideology. Humanity has paid the price in lives (i.e., 100 million lives in the 20th century alone) for the evils of collectivism! For all the criticism, capitalism, even “crony capitalism,” at its worst, may deal with greed and profits, but not with lives and the support of tyranny.[13,14]

The pharmaceutical industry has also been attacked elsewhere and not always unjustifiably so. The abusive high-price of U.S. drugs has also been cited as a shortcoming of the American “free-market” medical care. But pharmaceutical companies will gradually be paying the price in loss market, as the many Americans who pay for their own medications will buy them from abroad via the internet at a fraction of the cost. People paying for medical care (fee-for-service) and medications from their own pockets will shop for the best prices, which is the free market at work, but education and freedom of choice are essential for the free-market to function![15,16]

Third party payers as mentioned are a major problem and my concerns are worth repeating: the system is perceived as if somebody else other than the patient is paying the medical bills; thus the free market is hampered. It is abused on all sides and these abuses escalate. Even insurance companies are getting ripped off, but they easily pass the costs to the enrollees, ultimately the patients. This is a problem that like the other shortcomings mentioned above need addressing, and with Obamacare, the U.S. health care medical care will be further distorted. Socialized medicine in other countries is frequently lauded even by citizens of Canada and Great Britain. Why? Because it is not only a national symbol for them but also a great false measure of security. Only 4% of people are sick enough to need the system at any one time, and when they do they find queues to see specialists, waiting lists for radiographic studies and surgery, restrictions of services, and various forms of rationing. In some cases pets can obtain tests faster than human patients because veterinary care is fee-for-service, while medical care is socialized! Obamacare in the U.S. is a more advanced level of medical corporativism, another step towards fully socialized medicine with further regimentation and less freedom.

Additional References

13. Faria MA: America, guns and freedom: Part I — A recapitulation of liberty. Surg Neurol Int 2012;3:133. Available from: http://www.haciendapub.com/articles/america-guns-and-freedom-part-i-reca...

14. Faria MA: America, guns and freedom: Part II — An international perspective. Surg Neurol Int 2012;3:135. Available fro: http://www.haciendapub.com/articles/america-guns-and-freedom-part-ii-%E2...

15. Faria MA. Enhancing Access Via Medical Freedom --- Call It MSA Empowerment. Medical Sentinel 2000;5(4):123-127. Available from:  http://haciendapub.com/medicalsentinel/enhancing-access-medical-freedom-call-it-msa-empowerment

16. Faria MA. Enhancing medical care in the U.S. via health savings accounts (HSAs). Surgical Neurol, 2005 Sep;64(3):276-7. Available from:
 http://haciendapub.com/articles/enhancing-medical-care-us-health-savings-accounts-hsas

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