Thursday, March 25, 2021

The Profit Motive in Healthcare

Profit-based healthcare doesn't favor personal health.

Boris Johnson (or as Trump calls him, "Mini-Me!") recently stepped in the dog-doo by saying that profits and greed are what brought the CoronaVirus vaccine to market.  Speaking of markets - like the old "Common Market" - those snooty Europeans are apparently boycotting the UK when it comes to vaccine shipments.  The UK is "Mini-Me!" to the USA in terms of Corona infections and death rates, but at least in the USA, one-third of the population has already been inoculated.  In many States, including Georgia, shots are available to anyone at any age. For free, too - at least at our local "gubment-run" health department (and they say Republicans can't do Socialism!).

But the comment struck me as odd.   Yes, the profit-motive drives healthcare in the USA.  It brought us the opioid epidemic, for example, that crippled and killed hundreds of thousands, nay millions, of people, to profit one family's business. But beyond drug-pushing - which is a huge consequence of capitalism in health care (if I never see another ad for prescription drugs, that's fine with me) - I think the entire system favors sickness, particularly chronic illness, that can only be managed, for a profit, or if cured, only by staggeringly expensive techniques.

This is why the medical industry can sell you a sex change, gender corrective surgery, gender affirmation surgery, for a million dollars, but can't cure the common cold.  It is why doctors will perform expensive surgeries to correct your heart condition, but let you accumulate plaque for 30 years without trying to alter your behavior in the interim.  Patient heal thyself.

And if you can find a disease that can't be cured, but can be treated with a lifetime of staggeringly expensive medications, then, buddy, you've won the lottery. HIV is a godsend for the medical industry - you can't cure it, but you can hook someone on a lifetime of treatments to manage it.  

Chronic conditions are ideal also because if the patient dies, well, no one can accuse you of malpractice - hey, he was like that when I found him!

Diabetes is another good one, too - and thanks to High Fructose Corn Syrup and a crappy diet, anyone can get it - you no longer need to have some inherited condition.  Buy stock in DiVita Dialysis! A growth industry!

Just kidding - there is one of these DaVita franchises on every street, across from the McDonald's. But there is another chain competing with them for those medicare dollars - like the Burger King across from the McDonald's as well.  So it doesn't pay to try to pick winners.  Besides, with CoVid, all these boomers on dialysis might be shuffling off the mortal coil and where does that leave you?  No fun if the chronic condition actually kills the patient.

And in that regard, I am sure more than one pharmaceutical CEO is secretly hoping this CoronaVirus thing mutates so they can sell a new vaccine every year from now on. Hey, we can't let all those mask manufacturers suffer, either, right? Or else your investments in PPP stocks are worthless.

What got me started on this is that our healthcare provider in Gerogia - the aptly named Ambetter Peach State - has this website that exhorts you to exercise and eat right, and gives you points for going to the doctor or filling our surveys or promising to exercise.  You can buy a toaster or some small gift with these points, or just use the points to charge a debit card which can be used for your co-pay.

They also do odd things like send you a herb planting kit.   It is interesting, but I think it is part of some Obamacare mandate to encourage preventative medicine - that is to say, keeping people healthy so they won't need that hundred-thousand-dollar procedure down the road.  Maybe they should consider encouraging people to stick to their present gender or not surf Qanonsense sites, as gender operations and mental health treatments are two of the big money-pits in medical care and one reason why Obamacare is so bloated.

Yes, sometimes life-saving medical procedures are necessary - and they can be expensive.  But on the other hand, it is harder and harder to find a good GP and quite easy to find a specialist - the latter makes far more money, in case you didn't get it.  I love those old-time doctors with their practical medical advice.  For example, I had back pain, and an old Navy doctor gave me some back exercises to do and recommended massage. Mark went to a pill doctor (since disbarred and arrested for running an oxycontin operation) and he suggested invasive back surgery, a spinal tap (that went horribly wrong) and of course, oxycontin.  Mark ended up doing the back exercises, yoga, and getting massages and I am happy to report, he's doing fine.  Occasionally there is a flare-up, but that's part of 50-something growing pains.

Our last GP died unexpectedly of an undiganosed genetic heart condition.  Since then, finding a GP has been hard.  We relied on "doc-in-a-box" for a while (those urgent care centers, next door to McDonald's and DaVita) and now have a Cardiologist as a GP - with predictable results.

So is socialized medicine the answer?  Well, it depends on who you talk to.  In Canada and the UK, you will find proponents and opponents of their National Care system.  My experience with the very well-run local Health Department seems to indicate that government-run health clinics, at least, can operate efficiently (I shouldn't say that, or they will appoint someone like DeJoy to run the place - into the ground - to "prove" that government-run anything is a bad idea).

Medicare seems to be a hybrid of both worlds. The government sets prices for procedures, and doctors and hospitals seem to be able to make a buck at it.  In Florida, for example, eye surgery places are located in strip malls.  If you have elder health issues, don't go to a local doctor who has never seen such a problem but once or twice in his life - go to Florida where the storefront Doc did fifteen procedures this morning.

This present system, with "retail" prices for procedures - that no one pays, unless they are indigent, in which case they never pay - is just stupid.  It is a patchwork system that favors the very wealthy, who can pay to cut to the head of the line, or fly off to China to have a Falon Gong heart installed (according to the paranoid Trump supporter I talked to yesterday). But that is the problem with "socialized" medicine - they just let any ordinary Joe have medical care, even before important people!  Why waste a perfectly good liver on some working stiff, when your kid needs one after she OD'ed on designer drugs?

Well, of course, I can't solve the problem and have no idea how to solve it.   We live and die, and if, by chance, some medicine or medical procedure makes you a little more comfortable or extends your life a little bit, great. Other than that, the outcome is preordained.  But one can hope that the current system can be improved somewhat - the glaring errors of Obamacare fixed, or at least reduced to a chronic condition.  And who knows?  Maybe medicare-for-all might be an answer of sorts - the medical industry doesn't seem to have an issue with a system that cuts regular paychecks for them.

Just wait until you are 65 - your doctor will suddenly find there are a lot of things wrong with you, expensive things, that for some weird reason didn't exist when you were 64 and your cheap-ass insurance wouldn't pay.  Maybe Boris Johnson was right - this "profit motive" or "greed" does a good job of delivering health care, to those who can afford it, or have good insurance, anyway.