Articles by JCS

Doctor No

Doctor No

By

JC Smith, DC, MA

An enraged Congress took Wall Street and Detroit executives to the woodshed to explain why their industries collapsed as they made millions.  Now I’m waiting for the next shoe to drop for Congress to hold the reclusive AMA’s feet to the fire too.

President Obama said during his March 24, 2009 press conference that solving the healthcare crisis is imperative to solving the financial crisis; “in fact, the biggest driver of long-term deficits are the huge health care costs that we've got out here that we're going to have to tackle …”[1]

If Obama and Americans are to “tackle” this healthcare dilemma, first we must realize the present healthcare crisis is not by accident but the design by a powerful medical cartel consisting of the AMA and its allies, the HMOs, Big Pharma and Big Hospitals, all stakeholders in the present capitalistic healthcare system making billions in profits at the expense of patients.

The problems are obvious: today medical bills consume $2.4 trillion annually—approximately $7,000 per person, which is nearly 20% of the GDP, and as much as half of this money does nothing to improve health.[2] According to the World Health Organization, in 2000 the USA ranked #1 in cost, #72nd in population health, #37th in healthcare delivery and the fact that 48 million Americans have no coverage. [3]

In contrast, France ranked #4, #4, and #1, with only 1% uninsured. [4] Obviously the French are getting more bang for their francs than we’re getting for our dollars despite the fear-mongering in the media about socialized medicine.

The looming question Congress must ask the “guardians of health”: why is American health so poor considering we spend more money per capita than any other country and have supposedly the best doctors, the best medical schools, and the best teaching hospitals in the world? It would seem logical if Americans spend the most on healthcare that we would have the healthiest citizens and best healthcare system in the world, but we don’t. Why?

Congress should demand answers to this paradox, just as it grilled the automakers from Detroit why they made gas hogs during an oil crisis or why Wall Street tycoons were giving themselves bonuses with bailout money since it simply doesn’t make sense. Indeed, the American Medical Association has been strangely quiet in this healthcare debate by avoiding the media and offering no explanations or solutions publicly, but we can be certain the AMA is twisting arms on Capitol Hill behind the scenes to keep the present system in tack.

It’s not that we don’t have enough doctors, in fact, we may have too many aggressive MDs who over-prescribe drugs, shots, and surgeries in America, evident by the fact that the US does 5 times more back surgeries per capita than the UK and Scotland combined.[5] Without question, America is the most over-medicated society in the history of the world yet among the sickest.[6]

Congress also needs to ask the insurance industry why its premiums are rising at double-digit inflation annually. Like pouring salt in a wound, the HMOs take 25-55% profit off the top[7], the top six HMO health plans paid 37 executives an average salary of $7.5 million [8], then implement a policy of “squeeze care to expand profits” to deny patient care and overwhelm practitioners with paperwork as they cut fees.

Congress might ask about the extravagant spending on compensation packages for top pharmaceutical executives. The executive with the highest compensation package in the year 2000, exclusive of unexercised stock options, was William C. Steere, Jr., Pfizer's Chairman, who made $40.2 million. The executive with the highest amount of unexercised stock options was C.A. Heimbold, Jr., Bristol-Myers Squibb's Chairman and CEO, who held $227.9 million in unexercised stock options.[9] The 7 top drug kingpins had an average salary of $20. 2 million. [10]

Congress should ask why medications are so expensive, such as 2,898% markup for Paxil 20 mg and a 224,973% markup for Prozac 20 mg.[11]

Congress needs to ask the hospital executives why almost no other business in America has such abusive pricing power as hospitals, including the power to keep charges secret from customers until they get their bills. The Wall Street Journal described how "non-profit" hospitals have accumulated billions of dollars of untaxed profits on the theory that they are providing a public service while providing very little actual care to the uninsured. These hospitals also have little incentive or competitive pressure to be competent or cost effective as they live high on the hog of a captive audience.[12] The top 3 hospital kingpins averaged $15,937,849.[13]

Congress must ultimately decide if capitalism and health care even mix, which explains why many nationalized systems in Europe and Canada do better and cost less according to the WHO report. Instead of a commodity to buy, these countries have decided health care, like public education, is a right and not solely a privilege for the wealthy.

It appears just as the deflated Republican Party has become the Party of No to anything President Obama suggests, the same can be said of the AMA—the Profession of Know has become the Profession of No—“No to reform, no to universal healthcare, no to alternatives, and no comment to Congress.”

To be certain, the American healthcare system has been sick for a long time so it won’t change easily as the Profession of No fights to maintain control even as Americans are suffering in a broken, expensive, and ineffective system.  Indeed, the medical cartel has failed terribly as leaders in the war on disease, but like the CEOs on Wall Street, they’ve profited dearly.

It’s time for Congress to hold the Profession of No’s feet to the fire. It’s time for the AMA to stop hiding and take the bitter medicine of Congressional investigation too.

Think Outside the Little Black Bag

It’s past time for the American people to think outside the box or, in this case, to think outside the doctor’s little black bag since the solutions cannot be solved with what’s in the bag. In other words, the present American healthcare system emphasizes the “pound of cure” rather than the “ounce of prevention” that complementary and alternative medicine (CAM) healthcare professions have long practiced. The medical cartel has also shunned the “ounces of cure”—the emerging low-tech alternatives like chiropractic instead of spine surgery.

A good example of the medical cartel sabotaging emerging green technology in healthcare was the huge, $100 million federally-funded study known as ALLHAT that showed simple diuretics were the best blood pressure medicine to start with.[14] Unfortunately, the drug companies “ganged up and attacked, discredited the findings,” according to Curt Furberg, the early leader of the trial.[15]

Dr. Benjamin Rush, Founding Father, Signer of the Declaration of Independence, and the Father of American Psychiatry, supposedly warned of the rise of a medical monopoly:

 “Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship. . . . All such laws are un-American and despotic and have no place in a republic. . . . The Constitution of this republic should make special privilege for medical freedom as well as religious freedom.”

The real solution is a complete overhaul of philosophy of healthcare as well as the incorporation of CAM treatments the AMA has fought long to destroy.

While the allopathic medical model has its successes, it also has it limitations in that not all health problems can be solved with drugs, shots or surgery. If that were the case, no one in American should ever be sick considering America is the most over-medicated society in the history of the world yet we lead the world in every category of chronic illnesses like heart disease, diabetes, cancer and chronic back pain.

 

Medical McCarthyism

Compounding this cartel’s power is the fact that MDs are seen as cultural authorities who often go unchallenged despite these obvious shortcomings and few feel qualified to question their diagnosis and treatments. After all, Marcus Welby, MD, was never wrong.

In fact, it hasn’t been that long ago when the AMA held stock in tobacco and promoted smoking in mass media advertisements. In other words, the AMA has been wrong on many things but the public had little idea at the time.

After decades claiming to be the “guardian of American health,” it turns out that the AMA is mainly the “guardian of a monopoly.” In effect, the healthcare crisis today is a function of this medical McCarthyism and demagoguery that has opposed and attack competition with unsubstantiated accusations, condemned CAM methods as quackery, and monopolized our healthcare system and public hospitals for its exclusive profit.

This lack of transparency must tell us the AMA  sees no reason for reform or the need to explain the high costs, poor outcomes, and virtually no competition—the trademarks of any monopoly.

One recommendation about insurance made during the Clinton Healthcare Reform Act of 1993 was to have “one policy per person” rather than the multiple coverage and premiums now. For example, the average American pays for private group health insurance, Worker’s Comp coverage, auto insurance health coverage, Medicare coverage, homeowner’s coverage, and personal liability insurance to cover the same person!

Americans could save billions of dollars on healthcare premiums if we were only required to have one policy per person and no matter where you were injured—at home, at work, driving a car, or personally injured elsewhere, you are covered. Instead of this global coverage, we Americans are forced to pay multiple premiums for the same person, driving up the cost of health care to consumers.

Now recent medical research trials tell us that most back surgeries[16], heart procedures[17], and knee surgeries[18] are no better in the long run than non-invasive conservative care, but the AMA and its cohorts in the media have been slow to inform patients of these revelations that could drive down costs and improve outcomes. In fact, for treatments later proven to be ineffective, there was a median time lag of 44 years from initial discovery to being disproved. [19]

 



[1] President Obama’s News Conference, NY Times, March 25, 2009.

[2] Victoria E. Knight, Half of U.S. Spending on Health Care May Be Wasted, Washington Post, December 2, 2008.

[3] World Health Organization, The World Health Report 2000: Health Systems—Improving Performance, 2000.

[4] Victor G. Rodwin, PhD, MPH The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States, Am J Public Health. 2003 January; 93(1): 31–37.

[5] Cherkin, DC et al., “International comparison of back surgery rates, Spine 19 (11): 1201-1206 (1994).

[6] Richard J. DeGrandpre, The cult of pharmacology: how America became the world's most troubled drug culture, Published by Duke University Press, 2006.

[7]Kuttner, R., Market-Based Failure — A Second Opinion on U.S. Health Care Costs, NEJM, Vol 358:549-551 Feb. 7, 2008, Number 6.

[8] http://www.harp.org/hmoexecs.htm

[10]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation

[11] http://urbanlegends.about.com/library/bl_prescription_drugs.htm

[12] Jon Basil Utley How Hospital Costs Ran Amok, August 4, 2008

[13]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation

[14] The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) December 18, 2002, JAMA.

[15] Goldestein, J. “Study found cheap blood pressure meds are best. No one cared.” Nov. 28, 2008, New York Times.

[16] Weinstein JN et al., Surgical vs. non-operative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT) observational cohort, JAMA, 2006; 296:2451–9.

[17] William E. Boden, M.D., et al., Optimal Medical Therapy with or without PCI for Stable Coronary Disease, NEJM, No. 15, vol. 356:1503-1516, April 12, 2007.

[18] Alexandra Kirkley, MD, et al.,  A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee, NEJM, Volume 359:1097-1107, Number 11, Sept. 11, 2008.

[19] Refuting Ineffective Treatments Takes Years The BackLetter® 101 Volume 23, Number 9, 2008.

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