The Cost of Success

For those of you who didn\’t know, I entered the National Novel Writing Month \”contest\” (which has no winners).  I got to the goal of 50,000 words yesterday.
One of the main questions that is asked in my novel (which may or may not ever see the light of day) is this: What would happen if a wonderful cure came along that would take away most, if not all sickness? Remember, it is fiction.

The answer is, of course: utter chaos and collapse of our system.

Our system is designed to deal with sickness.  It is designed to fix problems.  If a wonder-drug came along, here\’s what I think would happen:

  • Pharmaceutical companies and hospitals would have to oppose it, as they would suffer financial ruin if people became healthy.
  • Doctors, especially those focused on chronic illness or treatment of serious problems, would take a huge cut in pay.
  • A huge number of healthy people would enter the workforce, disrupting an already fragile economy.

Human stupidity, of course, would remain.  There would be some work for those in the medical profession, but only a fraction of what is there now.

I don\’t think anyone expects this \”wonder drug\” to appear any time soon, so what\’s the point of entertaining this scenario?  Looking at the extremes can often give us insight to our current problems.  One of our biggest problems is this: our system thrives on its own failure.  If we fail to keep people well, the healthcare economy improves.  There are more jobs to be had to treat and take care of these sick people.  There is more need for new drugs to treat the increased number of sick people.  Hospital beds are full, and doctors are busy.

Life is good for those of us in medicine when we fail.

I think this truth is not lost on some of those people who are cynical about traditional medicine.  They see the motivation to keep people sick, and assume that there is a conspiracy afoot to accomplish this goal.  Now, if there is a conspiracy, it doesn\’t include me.  I do see success in keeping people healthier than if they didn\’t see me, and nobody has tried to bump me off yet.  I\’ll let you know if they do.

But despite the fact that I don\’t see a conspiracy to make people sick, I do see a lack of a conspiracy to make people well.  It\’s not an organized conspiracy; it\’s just a sin of omission.  Success of our system, defined as people being kept healthy, comes at a huge cost.  Why would people strive for success when the prize would be a pink slip?

Again, I am not saying that this is a conscious decision.  I don\’t think there is a back-room deal between pharma, hospitals, and the government to prevent wellness.  No, I just see a total lack of an organized effort to fix things.  We are giving absolutely no motivation for success.  There is nobody in the healthcare industry who truly benefits from health.  If this is our goal (and I think it should be), shouldn\’t we somehow make it worth someone\’s while to keep people healthy?

Why aren\’t we setting goals to shut down hospitals, not keep them profitable?  Why aren\’t we trying to motivate well care and prevention so that sick care and intervention will stop being so profitable?  This can\’t be lost on those whose livelihood depends on the failure of the system.  There will be great inertia to the sacred idea of treating the sick, and a reluctance to abandon it for the idea of eliminating the sick (through prevention, not euthanasia).

Would your kids clean their rooms if you docked their allowance for doing it?  That\’s what we are doing.  That\’s how our system is designed.  We should not be surprised at failure when success comes at such a high cost.

Until things are changed at the most basic level, success in healthcare will be a purely fictional idea.

11 thoughts on “The Cost of Success”

  1. As usual, very insightful. I won’t see this change very much in my lifetime. But, I think it is really great to get the problem stated so clearly.

  2. I disagree with one of your three assumptions. A perfectly healthy work-force would mean an increase in available workers. It would also eliminate the cost of employer-provided health insurance, allowing the employer the opportunity to hire more people. An expanded employed work-force would result in greater buying power, resulting in an improved economy. Yes, there would be reductions in the health-care work-force, but this is no different from the changes in work-force profile created by the automobile (fewer buggy makers), the airplane (fewer train conductors) and the refrigerator (fewer icemen). None of these things caused chaos in the economy by themselves.
    Additionally, I don’t see Big Pharma (whoever that is) conspiring to keep this magic pill off of the market. Whoever held the patent to this (until it went generic) would make a pile of money higher than Mount Rushmore.

  3. I think you underestimate the size of the effect. Medicine accounts for a huge part of our economy. Read into that, it employs more than nearly any other industry. If a large % of hospitals, physicians’ offices, and drug companies were put out of business, the shift in the workforce would be enormous. The examples you gave were of very small fields not resembling the magnitude of healthcare catering to sickness. I do think that healthy people would be of benefit in the long run, but the short term disruption of the status quo would be enormous. It would cause chaos, then settle down. Still, I believe it would be an enormous disruption.
    Regarding pharma, think of the business model: get rich on one drug that makes others unnecessary. Make an obesity pill, and see the need for cholesterol, diabetes, and blood pressure pills plummet. Yes, the one company grabbing the brass ring would be rich, but they would cut their own throat in the long-run. Perhaps they would find it hard to resist, but every other drug company would put obstacles in their way. All influence that they have on the FDA would be brought to bear. Don’t think they wouldn’t try. It would be bad business to do otherwise.

  4. Do you think that the public is an unindicted co-conspirator in keeping illness alive and well?

  5. Dr. Rob: I once consulted a Naturopath, who happened to give me some nutritional advice. She must have billed it as such, because the Insurance company threw it out for reimbursement. No payment for wellness information.
    Presently am reading a great book by Bruce Lipton, The Wisdom of Your Cells – I know you would like it – if you haven’t read it already! (It comes on CD, too, if you would want to listen in the car….) He was called a heretic by his peers for advancing different ideas about cell function, based on his research, which are different than what he was supposed to teach medical students. So he quit. He, too, had comments about the Allopathic community’s approach to wellness. Guess it’s every patient on their own, to make their best choices. Too bad, with so much ignorance abiding and the medical community knowing so much! ….Although sometimes patients don’t want to hear about their own responsibility for themselves, so methinks there is a lot of investment on both sides in the present system…. Your patients are so lucky to have you! Thanks, as usual, for the gift of your words and ideas…. 🙂

  6. I don’t think the problem is with allopathy (I say as an allopath), but with the payment system. I know how to do prevention, and do it as much as I can. To me, the problem is the high number of people who make tons of money off of people staying sick. We are asking for a system that increases the number of sick, not well people.

  7. A promising drug called RESVERATROL proven to cure or treat diabetes mellitus was bought by GLAXO for $750,000.00 two years back…never heard since. Perhaps Glaxo will shelf this as it also known to treat aging etc. Think about how much damage this will do to other drugs that will become less profitable or obsolete. Stem Cell research is another one….not much funding on this. why?

  8. It seems to me that those who benefit directly from activities that result in our poor health would include the makers of processed foods, fast food restaurants, video game makers and industries that pollute our air and water. Not only are there economic incentive for not preventing illness, but there are incentives for (indirectly) causing illness. To extend your analogy, people are being paid to mess up our kids’ rooms.
    Incentive structures to prevent sickness would have to be applied more broadly than just to the medical community.

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