Sicko 1 - Why Michael Moore is wrong about healthcare

Hi, this is Dr. Mark Hyman, welcome back. I, like many of you this week, saw Michael Moore's new movie Sicko. Now this is not my usual blog that's oriented around solutions on a health problem, but I want you to stay with me because I want to help you understand what has to happen for meaningful change to occur for our sick healthcare system. And it's not what Michael Moore suggests. Now back to the movie. I must say I was disappointed. I was hoping for a novel look at the problem of not only access to healthcare, but to the type of healthcare that's practiced. Now I'm all for more people getting access to healthcare and for providing better care and at lower cost, but I am not for getting more people access to a broken health care system that creates more problems than it solves. Now if our health care system is responsible for over 700,000 deaths a year, which it is, from medical errors, hospital infections, bed sores, surgical errors, drug reactions and lots more, which actually makes our health care system the leading cause of death overall, followed by heart disease and cancer, and which costs us an extra $250 billion a year in costs, Do we want more people to be exposed to this type of care? I don't think so. Now his answer to all our healthcare woes is to have a single payer system like Canada. Now I went to medical school in Canada and I went to internship there and I can tell you the picture is not as rosy as it seems. I worked with a poor family doctor who had to see over 50 patients a day just to earn a basic living. And when the doctors went on strike, because they were unhappy with the system, the death rate actually went down. So if the system is so great, maybe you can tell me why so many of my medical school classmates migrated south of the border. Universal coverage may be part of the solution, or maybe not, but he really missed the whole point in my view. If we improve a broken system by reorganizing how it's paid for, we still have a broken system, and he didn't address that in any way. In fact, his movie is a distraction from the real problem, which is the type of medicine that we're practicing is antiquated, it's often dangerous, and it's based on the wrong premises and outdated approaches. It must be founded on the laws of biology that help us address the true causes of disease, not just find better drugs or procedures to deal with them once they occur. Getting more people access to the wrong treatments doesn't benefit us in the long term to create a sustainable model of health for society. The thing he misses, the thing he really misses, is a direct discussion and analysis of the lack of quality in our healthcare system. And quality is defined as the health of our population, which is clearly less than almost every developed nation, and worse than many third world countries. In fact, we're 45th in life expectancy coming just after Bosnia and just ahead of Albania. Now, I don't dispute the inherent problems where the whole system profits from reducing access to care or denying care or avoiding preventive care or shifting costs to employers. You know, when Starbucks pays more for the health care of its employees than for coffee beans, we know we're in trouble, right? So what Michael Moore ignores is that the entire ecosystem of businesses and products and services that are related to the health of our population has its whole orientation backwards. The healthcare industry and the food industry profits from us being sick and fat. All the incentives are absolutely backwards. Until it is actually profitable for everyone to help create health rather than disease, we will not thrive as a society. We need to find a way to line up all the incentives for everyone involved in healthcare. For the insurers or actually our government who actually pays 60% of all the health care bills through Medicaid, Medicare, the VA tax deduction and other incentives for the pharmaceutical industry, the hospital industry, the food industry where sales of products that support health would bring in more profits than foods that destroy health, and doctors who would be paid more for creating health rather than doing procedures. That's what's got to happen. You know, Marian Nestle, who's the professor of nutrition and food sciences at NYU, she says, It's difficult to think of any major industry that might benefit if people ate less food, certainly not agriculture, the food product, grocery, restaurant, diet, or drug industries. All flourish when people eat more and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating. In fact, the best part of the movie for me was the part when the British doctor described how he was paid more for helping people lose weight and stop smoking and improve their sugar, their blood sugar or lower cholesterol. If an American doctor does that, They lose money. The British docs actually get a bonus for keeping people healthy. The American doctor gets paid thousands of dollars for doing angioplasties and stents and maybe 30 bucks for talking to someone about their cholesterol. Though doctors are generally well-meaning, well-intentioned people, the system actually appeals to their dark side. Do more procedures, provide more invasive care and get paid more even if it ultimately does not benefit the patient. What is absolutely frightening is that the system of payment for care and the system as a whole almost never addresses the issue of value of the care we get. Now value is really the benefit which is the improved outcome of our health, the outcome of the care, divided by the actual cost of the care. So let's say you paid for a fancy new car but it had no engine or no tires or didn't run when you put the key in the ignition. the car company would go out of business. But in medicine in America today, we have a shiny new system that just doesn't run very well, despite paying 40% more for the care than any other nation in the world, or almost $7,000 per person, or close to $2 trillion, by the way, which one-third of which is for administrative costs. Now, in American healthcare, the outcome of that care is mostly ignored. namely the health of the patient. So in a landmark report from the Institute of Medicine, which was published in March of 2001, it was called Crossing the Quality Chasm: A New Health Care System for the 21st Century. The author said, between the health care we have and the health care that we could have lies not just a gap, but a chasm. So what's the real answer? Now, even though I know where we need to end up. I don't have all the answers, but I do know this. We have to change the competing needs in the healthcare industry and related industries. Promoting and treating sickness should not generate more profit, creating health should. So how can we as a society line up all the needs and interests of all the stakeholders in our sick healthcare system? Now let's just take the trail through our healthcare system of one thing. If we follow the trail through our healthcare forest, it'll be clear that in alignment of values, needs, and interests must occur if there's going to be meaningful change. It'll be also clear that no one component can be separated from any other. And then if we create change in one area of the system, often negative forces fill in the blank space. So let's for example follow the trail of a simple soda and french fries. Now the government subsidizes farmers to grow corn and soy crops with $30 billion a year. And that fuels the fast food and junk food industry with high fructose corn syrup and trans fatty acids, which are then used to produce energy dense, poor quality, disease creating foods such as soda and french fries. Now at the same time, funds for local schools are limited, right? So they can't provide students with quality food choices and physical education. The food industry, of course, then steps in, encouraging children to subsist on nutrient poor, energy dense foods from vending machines for their breakfast and lunch. and then the marketing for those products exceeds $30 billion a year, more than $13 billion of which is aimed at children, increasing demand. Now in many countries, marketing junk food to kids is actually illegal. These are tax-deductible expenses to the corporations, which in effect further subsidizes the promotion of disease by our government. These children then become obese and diabetic in their 20s and require care for heart disease and amputations before they're 30. which obviously the government much pay for. So, what's the answer, right? I know that with the creative intelligence and the ingenuity of this country, we can find a solution. I don't know exactly what it is, but I do know this: as long as any one party has to lose for another to win, we're doomed to failure. In order for things to work, everyone has to win. We have to make it profitable to improve the quality of our food supply, to encourage physical activity, and to reduce stress in our lives. When a hospital diabetes program is so successful in helping patients and improve their health and reduces amputations and the complications of diabetes, then it actually has to be shut down because the hospital loses money by charging only $60 for a nutrition consult instead of getting $6,000 for a toe amputation. That's when we know something is seriously wrong with our incentives. We have to make it profitable to help patients get healthy and have businesses make money by providing preventive care and lifestyle programs that create health. The politics of food, agriculture, environment, and education cannot be divorced from the traditional healthcare stakeholders, from patients, providers, insurance, employers, and payers and government. We have to address the roots of the problem. We have to create a system where everyone thrives. Now sometimes there are new industries that must replace old. Okay, no one complains that typewriters are obsolete or that no one needs film anymore for their cameras or that soon no one will be able to buy music on CDs. Life moves on and newer and better solutions to our problems make our lives better. The same thing must happen in healthcare. And despite Michael Moore's laser focus on a single payer system, as the answer to all of our health care problems, we need a much broader and bigger change in health care. Stay tuned. I'm going to talk more about this next week.