Healthcare’s Contract With America: Routine Maintenance

by Admin on August 4, 2010 · 4 comments

in Patients, Providers

Until the 1970s, most medical care was primary care. Certain primary care doctors were known to be better at diagnosing things than others, and if you thought something was really wrong and your own doctor couldn’t figure it out, you went to a diagnostician. While these talented people may have charged a bit more, I don’t remember it being 5x or more, as a visit to a specialist costs today.

As medicine became more and more influenced by technology, however, it quickly became more specialized.  That’s why HMOs were founded: to keep people out of the offices of specialists. HMOs used primary care providers as gatekeepers to specialists,and unless you were referred to. a specialist by your PCP (Primary Care Provider), you couldn’t go.

Sick people stared over the gate at the coveted “specialists,”  feelIng denied and rejected by an uncaring system. Eventually, enough of them sued or voted with their wallets and the HMO system collapsed. Without the gatekeeper, people descended In hordes upon the specialists, who were only too happy to receive them, having been nearly bankrupted by the HMOs.

And that is how we got here–to the place where an under exercised and overfed population has lost the will and the ability to care for itself and goes trotting off to the specialist to treat the problems caused by–themselves: their obesity, lack of conditioning, sleep deprivation and prescription drug dependence. The specialist radiates, operates, and medicates, turning what should have killed us evolutionarily into “chronic conditions” that cost 19% of the GDP to control.

Not only have we lost the will to correct our behavior, we have also become unwilling to be penalized for those costly conditions. How dare they raise my insurance premium or tell me I am too old for a liver transplant or a hip replacement?

And now comes the backlash. Here come the studies that finally prove the new cancer drugs don’t really work better than the older ones and the cardiac surgery doesn’t prolong life, followed by the indications that too much salt, or too much fast food, is the cause of it all.

And here we come back to the concept of the family doctor, now perhaps renamed the ” medical home,” whose job it will be to give you the same advice your mother used to give: get enough rest, go out and play, eat your vegetables.

Good luck finding a primary care doctor as the culture shifts back to the pre-eminence of prevention and the control of costs. The past two decades have driven them almost to extinction, abandoned to the “specialist” with his bag of pills and black box of scans. All the technology finally leads us back to the same conclusion: it’s cheaper and easier to prevent illness than to cure it. We change the oil in the car and run the virus scan and the spyware filter. Now we have to set up maintenance contracts with ourselves. As a culture, we can’t afford to trade in these bodies, like “cash for clunkers.”

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