The Brave New World of Health Care, by Richard D. Lamm, Fulcrum Publishing, Golden, Colo., 2004, 144 pp., $12.95
Richard Lamm, former governor of Colorado and Cushing orator at the 1986 Annual Meeting of the American Association of Neurological Surgeons (AANS) in Denver, looks at healthcare in the United States and concludes that it is “unsustainable, unaffordable, and inequitable, and needs to be substantially amended and revised.”
Facing Economic Realities
He begins by describing our system of healthcare financing as the crime of the century and the greatest embezzlement in all of history. He calls the funding of Social Security and Medicare a giant Ponzi scheme in which the federal government collects taxes for Medicare and Social Security and spends the money on current social benefits and other government services. In his view, the Medicare and Social Security trust funds consist entirely of IOUs and do not reduce the fiscal obligations of future generations by one penny.
Then Lamm examines our present healthcare system, which he acknowledges has many wonderful services but is incredibly expensive. He sees the system too often substituting technology for other healthier strategies; consequently, healthcare is out of reach for many Americans. He shows that we cannot do politically what needs to be done economically by pointing out that even though we spend $5,500 per year per capita, we cannot pay for everything that modern medicine can deliver. He believes that training physicians to be patients’ advocates produces healthcare, but not necessarily health. He suggests that health may be measured more accurately by such socioeconomic factors as education, income, nutrition, housing, sanitation, and working conditions.
Weaknesses in the System
In Lamm’s view, public policy negligence has led to funding excesses and system inadequacies. His six-count indictment of the U.S. healthcare system cites:
- more than 40 million uninsured
Americans;
- Insurance coverage for all seniors regardless of wealth;
- overfunding of medicine and underfunding of public health;
- a medical education system that overproduces specialists;
- overcapacity of hospital beds; and
- the misperception that healthcare is a right.
To illustrate his points, Lamm relates two contrasting stories involving state governors. In 1995, the governor of Virginia, James Gilmore, intervened in the care of a patient in a permanently vegetative state to prevent the wife from removing her husband’s feeding tube. He contrasts that with the story of John Kitzhaber, both a physician and former governor of Oregon, who championed his state’s Medicare prioritization system. Dr. Kitzhaber could not ration medicine, but Gov. Kitzhaber was forced to do so because cost must be a consideration in virtually every public policy decision.
Attending to the Health of the Group
The author continues by explaining the dilemma that no matter how we organize and fund healthcare today, our medical miracles outpace our ability to pay. Therefore, he believes, death remains the ultimate economy, since everyone saved by a medical miracle will die one day. The author himself has been involved in the well-publicized “duty to die” controversy, and he relates the interesting story in this book.
Lamm urges us to rebuild the house of healthcare by focusing on the health of the group rather than the health of the individual. He points to the World Health Organization’s emphasis on universal coverage meaning coverage of all, not coverage of everything.
A New Moral Vision
Anyone familiar with Dick Lamm expects that he will not conclude this book without giving us his solutions. He begins by suggesting fixes for Social Security, Medicare and retirement, but he then hones in on controlling healthcare costs. Some of the suggestions will appeal to physicians—such as limiting malpractice and administration overhead; others will not—such as limiting the supply side of healthcare. He ends with a very thoughtful summary of his conclusions, providing a new moral vision for healthcare and laying out the essential elements for that vision.
Former Rep. Patricia Schroeder is quoted on the dust jacket as saying that this book should be mandatory reading for every citizen. I won’t go that far, but I agree that all neurosurgeons ought to read it.
Gary Vander Ark, MD, is the director of the Neurosurgery Residency Program at the University of Colorado and president of the Colorado Medical Society. He is the 2001 recipient of the AANS Humanitarian Award.