VENDING MACHINE

Posted in Rants on January 5th, 2010 by Ed

Perhaps you caught Rush Limbaugh, he of the $400 million radio contract, marveling at what wonderful care he received in a Honolulu hospital recently. He refused to take questions (notably about the opiates that were in his possession when he was stricken) or "talk about politics" but he did manage to give a typically logical sermon on the glories of free market health care:

"Based on what happened to me here, I don't think there is one thing wrong with the American health care system. It is working just fine, just dandy, and I got nothing special."

We'll assume that his "confidence inspiring" experience left him short a little blood in his brain, and therefore he should get some slack for failing to understand the difference between point-of-service health care and the financial underpinnings of the system. Most Americans believe that outstanding health care is available and the problem, if anything, is that a lot of people can't afford it. Find a way to insure everyone and we'll truly have the best system in the world, right?

I disagree. As long as Rush is playing the anecdotal evidence game, let me share some of my own.

Having insurance is very important to me – perhaps moreso than the average person who lives life without a financial safety net – because I have a couple of chronic health problems that require a Keith Richards-sized handful of expensive medications to keep in check. Lots of people are in similar situations – diabetics, for example, have continuous, substantially above average medical requirements that make them costly members of an insurance pool. The last time I was brave enough to calculate the total, my out-of-pocket cost would be about $1600 per month. So I'm thankful to have coverage.

Anyway, the point is that I already take a lot of pharmaceuticals. I'd prefer to take less, but people who have cancer would prefer not to have cancer. Our health really isn't about our preferences. Last week I saw a new doctor for the first time, given that I've been pretty healthy since moving to a new state. We had the standard new patient visit, just chatting about my overall health. I mentioned that I've had a lot of respiratory problems since moving here, perhaps because of a local allergen that I'm not used to. He said something offhand about this area being bad for allergy sufferers and rattled of a prescription for Symbicort and a second for an Albuterol inhaler. After a perfunctory respiratory exam (which he didn't bother with before giving me the inhalers) he told me I might have a touch of bronchitis, necessitating Zithromax and some cough suppressant I'd never heard of. He noted that my right shoulder sounds like a cement mixer when I raise my arm – an old boxing / drumming / etc. injury that probably requires surgery – and wrote me up for a nice anti-inflammatory.

It almost became a game at this point.

He asked about my sleep habits. I truthfully answered that I sleep terribly, usually a few hours per night. Before the sentence was punctuated he was halfway through the Lunesta prescription. He suggested that given my family history I might consider a beta blocker for high blood pressure – which I don't actually have, but I might get at some point in the future. I considered faking the symptoms of pregnancy to see if he'd give me an epidural, but I let it go. I walked out of the office holding – I shit you not – eleven prescriptions counting my long-term medications and the Appetizer Sampler of other medications he decided I should try based on our 10 minute consultation and a cursory physical exam. Excepting one of the inhalers – I have to admit that my asthma is horrible lately – I threw them all in the trash.

This, to me, is not good health care. This is a vending machine that dispenses pills. It is one step removed from a WebMD-style interface in which one inputs symptoms and presses a button to have pills clatter out of the computer like a slot machine. Like Mr. Limbaugh I'd make the argument that the care I received was in no way exceptional. In fact I consider this pretty standard based on my experience with a lot of doctors over the years. Our health care system, primarily due to the "get 'em in and out as fast as possible" business model of insurance companies and the exaggerated influence of the pharmaceutical industry, makes almost no effort to find out what's wrong with us. It doesn't treat conditions, it treats symptoms. Did my doctor suggest allergy tests to figure out what's causing my problem? A shoulder X-ray? A sleep specialist? Nah. Tests are expensive! Writing prescriptions is easy. Doesn't cost the provider a dime. And let's not hold the public blameless either; we are a nation of people who want quick, chemical solutions. We don't want to make lifestyle changes, we want pills that thin our blood and absorb more cholesterol and put us to sleep and wake us up and give us boners and make pain go away.

I'm certainly not going to go Tom Cruise on you and suggest that taking medicine is inherently bad. But before we crown the American Way the best of all possible worlds we need to examine more closely what those who can afford our health care are receiving. Rather than parroting the all-too-convenient line that our system is great except that some people can't afford it, I'm more interested in "reform" that addresses both cost and quality. Because the latter often falls woefully short of the "confidence inspiring" monument to patient care that makes Rush and his ilk so misty-eyed.

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