Medicine and money
08/09/15 05:23
I have several friends who are medical doctors. Most are specialists who have done well with the business of medicine as well as serving people with illness. They are all very intelligent people who have gifts in math and science and possess incisive minds. They are also compassionate individuals who really care about other people. I’m fairly certain that none of them went into the practice of medicine because of a desire to get rich. They may have considered their need to earn a living at the time they were choosing a career path, and it is also possible that they had a desire for the prestige that comes with having an education and being a professional. At the center of the decision to practice medicine, however, each of this doctors was motivated by a desire to help sick people get better. They are motivated by a call to serve other people.
They do, however, operate in an arena where there is a lot of money. All practice medicine in offices that are newer than the span of their careers. The offices of the previous generation, even those built at the end of the 20th century, are simply not large enough and not well-equipped enough to meet the standards of contemporary medical practice. My doctor friends go to work in buildings that have hotel-like lobbies with rows of receptionists and rooms full of clerks who process insurance claims. Their offices are filled with original artwork and undergo regular renovations with the addition of very expensive equipment. State-of-the-art computers are assumed. Sound systems are standard. Access to the latest diagnostic equipment is required. Systems need to always work which means that they tend to replace equipment before it fails and there is a constant pressure to have everything new and shiny all of the time.
Even though their homes are modest in comparison with their offices, my physician friends tend to live in homes that are palatial by neighborhood standards. They are invested in their work and don’t do much home repair. For the most part they hire others to do the painting and remodeling and home repair. And, like the office, they tend to replace appliances before they begin to give trouble.
It isn’t my place to be judgmental of other people, but it does seem to me that the practice of medicine in our country is associated with a huge amount of money.
In stark contrast, there are places where medical care is difficult to obtain and when it is obtained it is definitely less than state-of-the-art. Those places are impoverished communities without access to much money. Half a world away, in Sub-Saharan Africa, there are shortages of all kinds of medical equipment and supplies. According to Doctors Without Borders, an important medicine - an anti-venom for ten different kinds of snake bites - is in critically short supply. They expect to run out all together by the end of next year. There is no company that currently makes the medicine. It has been proven safe and effective and has saved countless lives. The medicine is called Fav-Afrique and the last batch will expire in June, 2016. The manufacturer, Sanofi Pasteur says that it can’t make enough money on the product and has turned its attention and drug producing facilities to making other medicines - ones with higher profit margins.
On the one hand, it is simple capitalism. Supply and demand are not measured in terms of actual need, but rather in terms of the amount of revenue that can be generated. Shortages drive up prices and when the price gets high enough then supplies will increase. Simply stopping production of a needed medicine guarantees higher prices - and higher profits for companies.
In the gap, people will die of snake bites that doctors know how to treat. These are unnecessary deaths, unless you consider the profits of the companies making the medicine to be “necessary.”
The quality of health care available is directly related to the amount of money available. And that brings me back to the beginning of this blog post. In my experience money simply isn’t the primary motivational factor for doctors. They didn’t go into medicine because of the lure of money. The system in which they have to practice medicine, however, is driven by profit. A non-profit hospital generates millions of dollars in profits for all kinds of companies. The hospital may not be making a profit, but their equipment and drug supplies are. Their consultants are. Their contractors are. The insurance companies are. There’s plenty of profit in the health care business in the United States.
The result is that the quality of care obtained by people is directly related to their economic status.
I do not have a solution for this problem. I don’t have a better system to offer. But I do believe that we, as a society, have got to get serious about looking at ways to decrease the amount of profit associated with contemporary medical practice. We probably also will need to be willing to accept a slightly lower level of luxury in the care we receive.
I, for one, don’t have a need for leather armchairs and original artwork int he waiting room. I can live without stunning architecture and multiple-story glassed in entryways at my doctor’s office. Although I haven’t spent much time as a patient in hospitals, I visit them a lot and I’m pretty sure that all private luxury suites aren’t required. In fact, I think healing might be promoted by keeping the motivation to go home a bit higher.
Much harder are decisions that weigh one cost against another. What is a higher priority? Saving lives from venomous snakebites, or extending lives a few days longer with heroic end of life care? Is more good done by investing in vaccines than in transplant technologies? Are more lives saved through clean water systems or dialysis? We face some really tough choices.
In the meantime, I think it is good, from time to time, to remind my physician friends of the reason they went into medicine in the first place. They really are capable of accomplishing a lot of good in the world.
They do, however, operate in an arena where there is a lot of money. All practice medicine in offices that are newer than the span of their careers. The offices of the previous generation, even those built at the end of the 20th century, are simply not large enough and not well-equipped enough to meet the standards of contemporary medical practice. My doctor friends go to work in buildings that have hotel-like lobbies with rows of receptionists and rooms full of clerks who process insurance claims. Their offices are filled with original artwork and undergo regular renovations with the addition of very expensive equipment. State-of-the-art computers are assumed. Sound systems are standard. Access to the latest diagnostic equipment is required. Systems need to always work which means that they tend to replace equipment before it fails and there is a constant pressure to have everything new and shiny all of the time.
Even though their homes are modest in comparison with their offices, my physician friends tend to live in homes that are palatial by neighborhood standards. They are invested in their work and don’t do much home repair. For the most part they hire others to do the painting and remodeling and home repair. And, like the office, they tend to replace appliances before they begin to give trouble.
It isn’t my place to be judgmental of other people, but it does seem to me that the practice of medicine in our country is associated with a huge amount of money.
In stark contrast, there are places where medical care is difficult to obtain and when it is obtained it is definitely less than state-of-the-art. Those places are impoverished communities without access to much money. Half a world away, in Sub-Saharan Africa, there are shortages of all kinds of medical equipment and supplies. According to Doctors Without Borders, an important medicine - an anti-venom for ten different kinds of snake bites - is in critically short supply. They expect to run out all together by the end of next year. There is no company that currently makes the medicine. It has been proven safe and effective and has saved countless lives. The medicine is called Fav-Afrique and the last batch will expire in June, 2016. The manufacturer, Sanofi Pasteur says that it can’t make enough money on the product and has turned its attention and drug producing facilities to making other medicines - ones with higher profit margins.
On the one hand, it is simple capitalism. Supply and demand are not measured in terms of actual need, but rather in terms of the amount of revenue that can be generated. Shortages drive up prices and when the price gets high enough then supplies will increase. Simply stopping production of a needed medicine guarantees higher prices - and higher profits for companies.
In the gap, people will die of snake bites that doctors know how to treat. These are unnecessary deaths, unless you consider the profits of the companies making the medicine to be “necessary.”
The quality of health care available is directly related to the amount of money available. And that brings me back to the beginning of this blog post. In my experience money simply isn’t the primary motivational factor for doctors. They didn’t go into medicine because of the lure of money. The system in which they have to practice medicine, however, is driven by profit. A non-profit hospital generates millions of dollars in profits for all kinds of companies. The hospital may not be making a profit, but their equipment and drug supplies are. Their consultants are. Their contractors are. The insurance companies are. There’s plenty of profit in the health care business in the United States.
The result is that the quality of care obtained by people is directly related to their economic status.
I do not have a solution for this problem. I don’t have a better system to offer. But I do believe that we, as a society, have got to get serious about looking at ways to decrease the amount of profit associated with contemporary medical practice. We probably also will need to be willing to accept a slightly lower level of luxury in the care we receive.
I, for one, don’t have a need for leather armchairs and original artwork int he waiting room. I can live without stunning architecture and multiple-story glassed in entryways at my doctor’s office. Although I haven’t spent much time as a patient in hospitals, I visit them a lot and I’m pretty sure that all private luxury suites aren’t required. In fact, I think healing might be promoted by keeping the motivation to go home a bit higher.
Much harder are decisions that weigh one cost against another. What is a higher priority? Saving lives from venomous snakebites, or extending lives a few days longer with heroic end of life care? Is more good done by investing in vaccines than in transplant technologies? Are more lives saved through clean water systems or dialysis? We face some really tough choices.
In the meantime, I think it is good, from time to time, to remind my physician friends of the reason they went into medicine in the first place. They really are capable of accomplishing a lot of good in the world.