Tikkun Magazine, September/October 2010
Healing Is Not a Business
by Margaret Flowers
I've heard our health situation (not a system) described in a lot of ways: irrational, unethical, a failure, cruel, unjust. I've heard it said that the way our current health situation is set up, the incentives are to worsen our health by putting up obstacles to care, forcing people to wait, doing more procedures. Patients and caregivers have to jump through so many hoops—checking networks, getting authorizations, hours on the phone—to get or provide care that it is creating anger and harming our healing relationships.
The United States spends the most of all advanced nations on health care, yet we are ranked thirty-seventh for health outcomes and fifty-fourth for fairness of financing. Roughly 50 million people are excluded, and tens of millions are underinsured and at risk of bankruptcy and foreclosure if they have a serious health problem. Of the advanced nations, the United States has the highest number of preventable deaths.
Why is this? It's because we are the only advanced nation that thinks of patients as consumers and health as a commodity to be bought on the market. It's because we have tried to fit medicine into a business model.
Medicine is not a business; it is about healing, about caring and about practicing an art—a careful balance of science and humanity that is advanced by having access to accurate, unbiased information and having adequate time to develop the intimate and trusting healing relationship. Patients are not widgets. Every patient is unique.
We have been living a dangerous experiment of market-based and profit-driven health care. The evidence is clear: the market fails when it comes to health care. We cannot continue this experiment any longer. There are too many people suffering and dying.
This past year we desperately needed an open and honest debate about what our country requires to address this health crisis effectively. That is not what we had.
The health reform process was tightly scripted and tightly controlled by the leadership in Congress and the White House. It was dominated by capitulation to the private insurance, pharmaceutical, and hospital industries. In the end, it was more about creating the appearance of success than about solving our problems.The reform that passed is designed to fail. It further enriches the worst parts of our health situation—the private health industries—without addressing the fundamental problems. Too many people will continue to be left out and the number of underinsured and financially vulnerable will grow. The result will be financially unsustainable. Already, the Centers for Medicare and Medicaid Services predict that health care costs will rise faster under the new legislation than if we had done nothing. It is designed to fail, because it maintains a market-based model of health care and because the market is a failure. This legislation cannot be tweaked into effective reform.
The smallest increment of change that will be effective is to create a single-payer health system. Single-payer is the only way to provide universal care that is financially sustainable. And having a health system that is accountable is the only way to have a framework in which to make the many other changes we must make in a rational and coordinated manner.
The health reform process made manifest what we already know. Our political system is broken. Our government and media are dominated by corporations. Those who may have been questioning whether this is true now see this corporate control, and it is the problem not just with health care but also with all issues of economic, environmental, and social justice.
I do not despair, because to despair is to give up and we cannot give up. It is too important that we end these injustices. I am hopeful for many reasons and I will share two of them with you: I am hopeful because I am seeing tremendous energy and enthusiasm among single-payer advocates. We have not given up. We say "health reform—we are still for it!" And I am hopeful because we have learned some very important lessons and so now we will be more effective. You can remember these lessons because the acronym is ICU (intensive care unit).
I—We must be independent as a movement and hold politicians accountable.
C—We must be clear in our demand that we will no longer accept a market model of health care. Health care is a public good and so must be financed through a single transparent and accountable public fund.
U—We must be uncompromising. We will no longer accept ineffective reform because we are told that it is all we can have. We will no longer accept crumbs. We need real solutions. We know what those solutions are.
For health care, the solution is a universal "Everybody In and Nobody Out" national health insurance. We call this improved "Medicare for All."
How are we going to confront corporate power when it controls the media and our Congress? We must educate others and ourselves and organize a broad grassroots movement by building coalitions of people united for social and economic justice. As Rabbi Lerner has said, we must have a higher vision, the highest ethical vision, and so we are called upon to end injustice.
When it comes to health, only 10 percent has anything to do with medical care. The other 90 percent has to do with what we call social determinants—education, housing, a safe environment free of violence and free of toxins, clean water, healthy food, adequate income, and a life of dignity, being treated equally and with respect. To create a healthy and productive society, we must join together and work for all of these things.
The time is now to build a unified movement for social and economic justice so that any president, any Congress will be accountable to the needs of the people. We must shift the base of power back to the people. Join us in our work to create health justice! Go to pnhp.org and healthcare-now.org.
Dr. Margaret Flowers is a pediatrician who serves as the congressional fellow for Physicians for a National Health Program and is on the board of Healthcare-Now. She is one of the "Baucus 8."
Flowers, Margaret. 2010. Healing Is Not a Business. Tikkun 25(5): 56