The Collapse of American Healthcare and How Pain Patients Can Survive It

July 6, 2009 | Filed Under: General Information | Comments(0)

Dr. Henry Adams, Diplomate in Pain Management, AAPM

“When the world is destroyed, it will be destroyed not by its madmen but by the sanity of its experts and the superior ignorance of its bureaucrats” John Le Carré


In 2005, when I was directing the outpatient chronic non-cancer pain program on the campus of Scripps Memorial Hospital in La Jolla, CA, I wrote a  draft of a book that was going to be distributed to pain patients in my pain program. Although I had to postpone publication of the book, writing the manuscript forced me to research a lot of government data that, already in 2005, showed that the collapse of American  healthcare was already taking place. The inescapable negative data included the following:

In 2008, healthcare expenditures exceeded $2.4 trillion, were projected to rise to $3.1 trillion by 2012 and, by 2016, to $4.3 trillion. The absolute numbers and the rate of growth were to become even greater as 77 million Baby Boomers would begin entering Medicare between 2011-2030. What those numbers say to anyone with a little  understanding of numbers, is that the healthcare strategy used since Richard Nixon and intended to provide “cost containment” could NOT possibly work because whenever costs continue to climb  regardless of what you do, it means that your basic strategy needs to be thrown out. What incentive does anyone have to pursue a strategy whose numbers tell is absolutely wrong?

– In 2006, America spent 4 times more on healthcare than it did on national defense.

– In 2008, the US spent 17% of every cent it made  – its Gross Domestic Product – on healthcare. That percentage, the estimates are, will climb to 20% by 2017.  Today, the US spends more total and per capita on healthcare than any other country in the world. Not because it wants to, but because there is no will to control the major costs which are “eminently” controllable.

– That fails to take into account the numbers that make it absurd to say that the solution is  that Americans  “buy” health insurance so they can access to health care when needed:  1)  12 -14 million Americans are currently unemployed and have no regular source of income with which to “buy” that insurance;  2) 77 million Baby Boomers are coming into Medicare between 2011 and 2030, will be 65, will be living on a fixed income, and won’t have the money to “buy” the health coverage that will cover the chronic diseases that naturally occur with aging; 3)  70 million Americans who live at or below the poverty level, are disabled, or 75 or older, and all of them can’t work and can’t “buy” health insurance. That adds up to the fact that 1/3 of all Americans cannot “buy” insurance, such that everybody has access to the same quality and quantity of care when and how they need it.

– Most recently, the numbers gathered on primary care physicians charged with caring for the rapidly growing needs of an America burdened with chronic diseases that require more, and more varied care reveal that: 1) the supply of primary care physicians is dropping rapidly as the demand for services for chronic diseases also rises rapidly; 2) the government in its wisdom has cut primary care physicians’ Medicare reimbursement by 21%, which has driven even more to stop providing care to Medicare patients who will need to get more, and more varied care, with the shortage of primary care physicians,  from far more expensive specialists.

Conclusion: 1) we have more people now needing more, and more varied health care due to the economic, demographic, and lifestyle patterns molded by this nation than ever before; 2) we also have less people than ever before,  proportionately, who are able to competently care for those who need it; 3) one third of all Americans do not have the consistent income that will reliably accompany cost of living changes and give them the ability to “buy” healthcare in any ongoing manner such that they will have access to the continuing  standard of care they will need to maintain wellness and optimal functionality, including the return to work; and, 4) the “healthcare-as-market” hypothesis is invalid, unusable and bankrupting individual Americans and the nation, as evidenced by over half a century of total lack of control of healthcare costs.