The Business of American Health Care

The Hippocratic Oath is one of the oldest binding documents in history. This oath, still held sacred by physicians today, emphasizes the mission of physicians and all medical personnel alike.

“I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” -Hippocrates

Roughly 98% of American medical students say those words written by Hippocrates ages ago, and still hold true as a guiding framework for all medical professionals today (Sitharan et al, 2001). While this oath is held sacred those words are seldom used as a standard for modern day American healthcare. Through the numerous examples in the Times article, “Bitter Pill: Why Medical Bills are Killing Us,” author Steven Brill illustrates several problems with our current healthcare system, that could easily be addressed if medical professionals took this time to put into practice the Hippocratic Oath (Brill, 2013). Healthcare in the United States has turned into a business emphasizing profit and expansion over insuring all have access to quality, reliable services aimed at healing and preventing disease. If we use the principles established by Hippocrates long ago, Americans would be able to put more trust in their healthcare system as well as their government.

Living in a free market, consumer driven society, we are used to seeing constant price increases for products with every passing year, but don’t realize that healthcare has become a product for purchase. In 2010, the United States spent $2.6 trillion dollars on health care costs (Facts, 2014). This amount is only estimated to continue to increase to $2.8 trillion this year and remain rising to $4.8 trillion in 2021 (Facts, 2014). With costs reaching in the trillions, it is easy to wonder where all this money is going and what it is truly buying us. It would be easy to justify this immense spending if our healthcare was the best in the world and lengthened the life span of Americans, however this isn’t the case. American healthcare costs $750 billion or 27% more than other developed nations, while our lifespan in the lowest amongst them (Brill, 2013). So why are medical costs so high? As Brill demonstrated in his article, healthcare is a business focused on profits. In our current systems services, supplies, overhead, medications, everything down to the pen a physician uses has a price. A price that is then passed along to the individual patients, however in our current, free market systems, where individuals rarely have a choice in what diseases or conditions they get, which hospital services their area, or the prices at that particular hospital, many don’t realize what they are paying for or if it appropriate. Additionally, what an individual pays all comes down to if they have insurance, what that insurance covers, and if it is competitive enough to negotiate prices of services to a reasonable rate.  In this system, the providers and hospitals benefit from these margins, while the consumer suffers. Not once in the Hippocratic Oath does it mention not to treat those who can’t afford it. Instead it reminds physicians that they treat a human being ‘whose illness may greatly affect a persons’ family and economic status.’

In 2010, 16.3% (49.9 million) of Americans were without health insurance (Health 2014). Of the Americans’ with health insurance, in 2010, the majority was covered through office of employment (55%), or Medicare, Medicaid, and Military (31%), while only a little under 10% was from direct-purchase (Health 2014). On March 23, 2010, President Obama signed the, Affordable Care Act, a new law that establishes a comprehensive healthcare reform for the United States. While healthcare reform is much needed and the Affordable Healthcare Act is a start to fixing the healthcare crisis, there are still some issues with this solution. With the Affordable Care Act all Americans have a choice and ability to buy health insurance, however whether this act is truly affordable is yet to be determined. Currently, my health insurance is still covered by my parents, however if I had to apply for one of the exchanges provided by the Affordable Care Act is would cost me $3,091 a year with the minimum coverage silver plan, or $2,372 a year with lower out-of-pocket cost with the medium coverage bronze plan (Reform, 2014). With these prices, 33.89% of my annual household income would go to health insurance. Additionally, I would be required to pay almost half of my annual income before my insurance would kick-in (Reform, 2014). For me, and millions of other Americans this plan isn’t affordable or benefiting us when we still are saddled with the burden of high out-of-pocket cost before insurance. While the Affordable Care Act is helping millions of American get health insurance it does nothing to address the root of the issue, the astronomical price of healthcare. To truly establish healthcare reform, as a nation we first need to change the for-profit mentally of hospitals.

I believe that the Affordable Care Act is movement towards a positive direction; however this change is not enough. To create a better healthcare system we need transparent costs of services, stop the monopoly on pharmaceuticals and hospitals as corporations in business to make money, and insure that all have medical coverage of some sort.

Transparent costs must be present with any healthcare system. If individuals actually knew the price of heart disease, diabetes, or liver disease it might make them more proactive in taking preventative healthcare measures. While I understand that prices of operations can vary by individual, and difficultly of procedure, I believe it is the right of the patient to know these costs and be able to justify the price and decipher all medical bills.

Long ago Hippocrates stated that physicians should treat all to the best of their abilities. That means all should have access to the top drugs and that they shouldn’t be on reserve for the 1% who can afford them or are willing to go into debt to try. Hospitals should be in the business of saving lives and preventing disease, not capitalizing and buying out all surrounding competition.

The Affordable Care Act is a start to insuring all have access to health insurance; however it falls short in some areas. First, I believe that for a segment of the population such as young adults (not supported by parents), and the working poor that this act still doesn’t effectively reach and will continue to be without coverage. Second, as previously mentioned these policies aren’t as affordable as they may seem. Young adults, who are not supported through their parents insurance and the working poor, will still be saddled with immense bills they cannot afford, even if they do by the coverage.

Brill pointed out several areas that our current healthcare system has failed Americans. With the enactment of the Affordable Care Act, effective change can begin in creating a nation in which all have access to quality care and prevention. Every other developed nation in the world has a universal healthcare system in place. Annually, these nations are spending roughly $750 billion less than the United States on healthcare, while still achieving longer lifespans (Brill, 2013).  These countries have a working, effective system in place and can be a valuable tool for our nation to follow. In the end, the overall goal of a healthcare system is to heal the sick, prevent future illness and disease, and maintain the overall health of a nation, by following the guiding principles set forth by Hippocrates long ago, I believe we can make this change a reality.

References

Brill, S. (2013, January 1). Bitter Pill: Why Medical Bills Are Killing Us. Times.

The Facts About Rising Healthcare Costs. (2014, January 1). . Retrieved from http://www.aetna.com/health-reform-connection/aetnas-vision/facts-about-costs.html

Health Care Statistics in the United States. (2014, January 1). . Retrieved from http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

Health Reform. (2014, January 1). . Retrieved from http://kff.org/health-reform/

Sitharan, K., & Russell, G, & et al. Medical Oaths and Declarations. British Medical Journal , 323, 1440-1441. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121898/

Key Features of the Affordable Health Care Act. (2014, January 1). . Retrieved from http://www.hhs.gov/healthcare/facts/timeline/index.html