Tuesday, July 28, 2009

The medical-industrial complex

Writing in The New York Times one doctor says that the rise in health care costs can be explained by the so-called "medical-industrial complex":
In the past, people sought health care because they were sick. Now the medical-industrial complex seeks patients. It encourages those with minor symptoms to be evaluated and urges those who feel well to get “checked” — just to make sure nothing is wrong.

So, if health is the absence of abnormality, the only way to know you are healthy is to become a customer.

But healthy people aren’t great customers; they’re like the people who pay off their entire credit card balance each month. The money is in those in whom an abnormality can be found.

The medical-industrial complex has made that relatively easy to do.

It develops diagnostic technologies able to find smaller and smaller abnormalities. So more and more of us are found to have damaged cartilage in our knees, bulging discs in our backs, and narrowed blood vessels throughout our bodies. And far too many are also found to have “spots” or “shadows” that are seldom significant but are said to be “worrisome.” So more and more of us have knee surgery, back surgery, angioplasty and more diagnostic investigation.

And the medical-industrial complex has another way to find more abnormalities: it simply narrows the definition of normal. Take blood pressure. In the past, relatively few were said to have abnormal blood pressure. Now a normal blood pressure is said to be below 120/80. This means that well over half the adult population of the United States is abnormal. The same is true for cholesterol. And although it involves a smaller portion of the population, narrower definitions of normal are expanding the number of people said to have diabetes and osteoporosis. So more and more of us are treated for these conditions.

Finding more abnormalities has been a great strategy for our industry. But it has been a disaster for health-care costs.
While sounding sinister this is really no different than any other industry or product. Turn on the TV or open a magazine and you will see numerous advertisements for products that the producers assure you will improve your life immeasurably and are indispensable to a happy and complete life. But that doesn't mean we are forced to buy them. Rather we weigh their pros and cons, decide if they are worth the money and move along.

The real problem here is simply that too many consumers don't pay for the product. If they think that something might be wrong with them they demand treatment and expect their health insurance company to pay for it. Disconnected from the direct costs their decision-making is skewed.

Don't believe me? There is enormous pressure on people to not only feel good, but look good as well. Cosmetic surgery is a booming business, yet there is no cost explosion.

The real problem, yet again, is our over-reliance on health insurance.

1 comment:

Amber said...

You must be standing from a privileged position in order to say that the real problem is that too many people are too disconnected from their health insurance, and health costs. Thousands of Americans don't have health insurance at all or are under-insured. Sure, there are countless plastic surgeries and other drug enhancements that insurance companies could more ethically deem "optional" and decide not to pay for.

I would like to question your neo-liberal logic/discourse of choice. It's as big of a problem as the question of whether or the medical profession has been corrupted by market values.

If you have time, check out Annemarie Mol's book The Logic of Care: Health and The Problem of Patient Choice (2008). It's only 97 pages long. I would be interested to hear what you think.