The Pain Profiteers

[TygrBright]

The system that deals with Americans' health has morphed, during the course of my own lifetime, from a flawed but focused system with limited resources but admirable motivations, to a twisted, crazy, free-for-all steel cage match between greedy sociopaths scrabbling for dollars.

Context first:

In post-WWII America, the health care system was enjoying a convergence of fortuitous circumstances:

• Decades of research based in Universities, hospitals, and government-funded laboratories was in the process of paying off, yielding serious, widespread benefits that improved both longevity and quality of life. Vaccines reduced childhood mortality by a major percentage, antibiotics, techniques and equipment developed for battlefield medicine were being adapted to improve all kinds of surgical outcomes and keep septicemia and bacterial killers at bay.
  
  
• Expanded (government) funding of public health, among other factors, had facilitated the growth of a primary health care services network, improving the quality and availability of emergency rooms, hospital care, childhood immunization, professional training and education for health care workers, and other benefits. It wasn't enough, but it was better than America had EVER had.
  
  
• Additional hospital and primary care capacity was largely based on nonprofit and government infrastructure- in most communities all hospitals were either "county" or "city" hospitals, or charitable hospitals run by a religious or fraternal order. They suffered chronically from underfunding and limited capacity, but they were there to heal and to improve community health. That was their purpose.
  
  
• Health Insurance --a relatively new concept-- was largely structured either as a nonprofit (Blue Cross) or as a mutual benefit (non-shareholder, non-publicly traded) corporation. IOW, its primary goal was to balance premiums and payments across the largest possible pool of participants, to benefit those participants.
  
  
• Maybe most important of all-- with the exception of over-the-counter nostrums and yellow pages displays for specialists? There was virtually NO advertising of health care products and services. There were public health ad campaigns about getting kids immunized, not spreading disease, good hygeine practices, etc. But no million-dollar Madison Avenue campaigns to convince everyone that they had SYMPTOMS!! That must be TREATED!! EXPENSIVELY!! NOW!!

Who was getting rich off sick people when I was a kid? Well, sure, there were some.

• A lot of docs who got into medicine because they wanted to become wealthy and respected members of their community, with premium country-club memberships and plenty of clout.
  
  
• Manufacturers of popular over-the-counter remedies such as aspirin, topical disinfectants, etc. were doing pretty well though by the standards of today's Pharma it was mere chicken feed.
  
  
• Manufacturers of major durable medical equipment were doing pretty well, too, selling x-ray machines, EKGs, autoclaves, surgical suite furniture, lab analysis equipment, etc. But because most of their customers were either government or charitable hospitals, or groups of independent physicians in private practice, there wasn't a gigantic profit margin. The market, while growing, wasn't subject to the kind of hype-fueled explosion we now see whenever some expensive new technology rolls out of the R&D labs.

But our attitudes about health and health care were different, too. "Preventive care" was largely limited to an annual once-over from your doctor, plus immunizations for kids. There was less expectation that every physical discomfort was a symptom of a problem you could identify if you just kept doing tests, and solve if you just kept trying pills and surgeries.

The bad side of that was the number of people who died because they didn't get early care for treatable conditions-- gee, that happens today, too. The good side of it was less vulnerability to "over-diagnosing" and "over-treating." There was less of today's tendency to expensively pathologize normal human ills that people mostly recover from on their own anyway.

Another down side: Plenty of mediocre and careless medical professionals got away with mediocre and careless practices that we'd label malpractice today. The upside of that? A good doctor then wasn't afraid to say, "There's not much we can do except try to make the symptoms less painful while it runs its course." That saved a lot of people a lot of money, stress, and painful side effects, even while it resulted in some unnecessary deaths.

I think we had better immune systems back then. Current science is starting to agree, recommending that people lighten up on the anti-bacterial soap, allow their kids to be exposed to minor ailments, etc.

It wasn't utopia. Rural accessibility was limited to (if you were lucky) a town doctor in the town nearby, and a hospital at the county seat. There were plenty of scary diseases we had no tools for and no idea how to treat. Plenty of things were virtual death sentences, then, that (if you're lucky enough to have money and access now) are no big deal now.

But between 1900 and 1955, average US life expectancy increased from 47.3 years to 69.8 years, a gain of 22.5 years.

Between 1955 and 2010 it increased to 81 years, a gain of 11.2 years.

Currently, in comparison to other wealthy nations, we rank near the bottom in longevity as well as other significant health indicators.

So what happened?

It started in the sectors where there was already profit: Pharmaceuticals and medical equipment. A few big breakthroughs (much of the R&D for which was publicly supported or subsidized in various ways) resulted in exploding profit margins. The money attracted the bottom-feeders and remoras of capitalism: The demand producers.

You know who they are. Their job is to convince vast numbers of consumers that they NEEEEEEED something.

Never did they have an easier job. What's simpler to sell than pain relief?

Not just the pain of illness itself... but the pain of worrying about illness. The pain of not knowing whether that shortness of breath is just overweight and overexertion, or the Big One that's gonna kill ya tomorrow.

Not to mention the very real pain associated with the fully justified fear that when we do need care, when something threatens our lives, we won't be able to get the help we need.

From there it was all downhill.

As soon as the profiteers realized the magnitude of the fat pickings to be made from human pain, they started transforming the system. Insurance companies went for profit. Corporations bought out hospitals and transformed them into profit centers. Big Pharma and the Medtech industries ramped up their R&D and hired more remoras to fuel more demand.

Naturally, this escalated to a food fight as the profit pie couldn't possibly expand quickly enough to fill all of the greedy gullets. "Healthcare Misers" were invented, ostensibly to rein in the madness, but in reality to ensure that the profit shares were channeled into this sector's coffers or that. Scratch a "cost control" mechanism, and you'll find a bottom line needing black ink, mostly in the private sector.

Then the Pain Profiteers and their tame remoras and their Healthcare Miser puppets went after the dollars controlled by the public sector. Spend here, cost-control there, and buy some legislators to push your agenda.

I know of only one way to end this madness:

Put most of the Pain Profiteers out of business, and put strict limits and controls on the rest.

Until we do that, we're stuck viewing the disgusting spectacle of their grotesque banquet at our expense.

polemically,
Bright

[longship]

2. Then, in 1994 Congress passed DSHEA, and was signed into law.

And quack medicine came out of the woodwork.

DSHEA:A Travesty of a Mockery of a Sham (Science Based Medicine Blog).

To paraphrase: “sell whatever you want, just don’t let us catch you.”

What’s more frightening than this inexcusable lack of oversight is that many of the products marketed under DSHEA aren’t just vitamins and such, but products that claim to do the same things as real medicines. How do they get away with that?

By using the Quack Miranda Warning, that’s how. Anyone who lives in the States knows this one almost as well as the “real” Miranda warning:

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

I put in the asterisk because there’s always an asterisk. The warning always appears at the bottom of a back page in very fine print. This statement is required when making any clinical claims regarding a product, and it is up to the manufacturer to make sure all claims are true.

Here’s the thing: many products covered by DSHEA are, by their advertising, clearly “intended to diagnose, treat, cure or prevent…disease.”

(Much more at link)

And no where does quack cure marketing work more effectively than for pain, which is often non-specific, self-limiting, and subject to placebo (i.e. null) effects. So the supplement industry grew up overnight, marketing all mostly worthless placebo medicine. For colds, by definition self-limiting. For any number of symptoms which can be charitably categorized as symptoms of life. Toxins!!!! OMFG! Gotta get those out! (In spite of the fact that evolution has given us all an exquisite biological system to do just that without any help.) And vitamins, in spite of the fact that Americans don't have nutrition problems, and we generally piss out all the extra, or we may get toxic overdoses of those which aren't water soluable.

And guess who makes the big bucks selling these supplements? That's right. Big Pharma!

It's a fraud.

Add that to your list.

Best regards.

[okaawhatever]

4. It's not just big pharma. Look at how many of the supplement companies are founded or run by right

wing activists. Think the McDonnell scandal in Virginia as an example.

[longship]

6. Indeed. That, too.

But so-called BigPharma also has gotten into the game.

An unregulated market where one can just make shit up!

[Agony]

3. Kick

thx for taking the time to write and share this

Cheers,
Agony

[TBF]

5. I had to look up "polemically" -

and that my dear Bright is why I love your OPs. A very apt description of how capitalism has run amok in this area.

[TygrBright]

7. Thank you, kind words gratefully received.

I have very little interest in quacking myself, so I tend to avoid much contact with "the system."

What set this one off was going in for my annual checkup and being told I needed to make a co-pay.

"Wait!" sez I. "Doesn't O-care render co-pays for preventive maintenance moot?" (Or something like that.)

So the desk gal gets all apologetic and sez "Yes, but the thing is, if you and the doctor discuss ANYTHING ELSE during the course of the visit, or if she recommends any tests or diagnostic workups or anything else, we have to bill that separately, and collect a co-pay for it."

And, sure enough, my doc found something she wanted to follow up on! AMAZING!!

She's not a bad doc, in fact she's pretty good. But between the insurance companies and the state Medicaid rodeo, she's getting so squeezed that even she has to resort to crap like this.

So, steaming gently, I drove home thinking... "It really is fucked up now, isn't it? There's simply nothing left of a real, functional, workable *Health* *Care* System.

And this came out.

appreciatively,
Bright