Not A Collaborative Articulation of Shared Purposes

As I sat through the second day of a continuing medical education course, I was confronted by a hypothetical in which a 59 year old Mexican-American man presented with high blood pressure, obesity, diabetes, and abnormal blood fats. The instructor emphasized that this man was at very high risk of a heart attack or stroke. The instructor and audience carefuly considered the diagnostic and treatment program needed to reduce this man's very high risks of death and disability related to diabetes, arteriosclerosis, heart and blood vessel disease and high blood pressure.

As I listened to the expert instructor's exquisite analysis, it struck me that the wrong questions were being asked. This man was approaching the end of his disease shortened lifespan because when he was 19 years old, no one was interested in intervening and preventing or ameliorating the diseases he was genetically programmed to develop. Why not?

Our health care system's insurers, PPOs and HMOs, had no incentive to spend a significant amount of money on a man who would likely be the customer of a competitor when he finally developed expensive serious sickness. In previous blogs, I have described the practice of employers to frequently shift insurers, PPOs and HMOs to save money. Perhaps Kaiser, which works hard to retain members, might have a long-term interest in its members' health. But most of the country's health care is not provided through Kaiser. For the working population it is provided through relatively few insurers, PPOs and HMOs which focus on short term profits and yearly executive bonuses rather than long term health of clients. And it is left to Medicare to pick up the costs of caring for the disabled and elderly who may have been victims of systemic neglect early in their lives, when intervention might have made a big difference.

We have a dysfunctional expensive and wasteful health care system in which the principal players have disparate goals and in which the intention is not to further the health of our nation but to game the system, maximize profits and leave it to others to pick up the shattered lives of unhealthy Americans when they are - for example - 59. Let's all agree that we must take care of our young people, when that intervention can make a major difference in their lives, their health, their contribution to our nation and its economy, and our common good.