Dr. Charlie is away so Dr. Mike will get to play.

An Editorial.

As you may have guessed Dr. C is more optimistic than I that someone with deep pockets will care about the health of the nation. You know the idea: the government will pony up or the insurance companies or the vested corporate interests or some other utopian “Angels and ministers of Grace” (Hamlet if you have forgotten) will recognize the economy of good health insurance and fix our broken health insurance system. Ain’t gonna happen.

Here is why: there is no health care system as inexpensive as death. It will always be so. Let me walk you through this grim truth. Political adversaries tell two different versions of the same set of facts. On one side we are told the single payer system of Canada or England or wherever is great, everyone gets good care, it costs less than our system and everything is wonderful. On the other side we are told of long wait-times, rationing of services and the inability of Uncle Joe to get his new hip unless Aunt Judy is demented and needs in-home healthcare; thus the need for Uncle Joe to be able to provide it, which he can’t without a new hip. Did you get that? He needs a hip to save the government some money not because he is in pain. Both sides tell the part of the truth they wish to highlight and they tell the part of the lie that hides their agenda.

Even when I was at Stanford a hundred years ago plenty of people getting their heart bypass procedures there were fugitives from the Canadian healthcare system. Just a fact.

On the way to the office this morning I heard a disingenuous lie told in a smooth, nurturing voice about how our nation’s health was ‘near the bottom’ and yet we ‘spent more than twice what other countries do’ on healthcare. The cure on offer was ‘America’s Family Practitioners.’ Notice the single quotes; not literal but very close, I just don’t want to Google the detail. The complexities of our cost structure and the details of the unsurpassed quality of our health outcomes was reduced to the fantasy that if everyone just got to see a good primary care doc more often everything would be great.

Look, Medicare is thinking of creating financial penalties, and eventually license loss, for docs who overutilize the PSA screening test. Their definition of ‘overutilize’ is tightly related to ‘how can we save money?’ and not to ‘how can we save lives?’

You will note that, so far, I am stringing together related things but not tightly argued things. You may wonder where I am going with this tirade.

Here is the reveal: health is not the avoidance of debility and disease. An insurance actuary is someone who knows – this is an appropriation of an old Oscar Wilde quote – ‘the cost of everything and the value of nothing.’ You can save money on heart transplants and hip replacements all day and will have only kept the Affordable Care Act from going bankrupt a few more months. Keeping someone from needing a heart transplant or a new hip won’t show up in the equations. More important(!) the one who avoided needing a heart transplant will have enjoyed more sunrises, more floor time with the grandkids and more opportunity to mentor the rich young tech fool who thinks he knows more than he does because he hasn’t been around enough old fools to know they know something he doesn’t.

The other side of ‘cost’ when it comes to healthcare isn’t less cost, it is the value of better; of better at thinking, at creating value at work and at home, the better value of smiles and friendships. The other side of cost, the other side of healthcare is value. Value-added doesn’t show up in the bottomline of the self-insured multi-national corporation as it tries to cut healthcare costs by an in-house clinic with herbal medicine and massage therapy – all good things less I be misunderstood.

So, while one of my lucky days was when Dr. Charlie showed up to co-author my book on Quantitative Medicine, he doesn’t entirely know my goal was to eliminate the medical profession as the high-priests of the healthcare system. I want docs to be part of the only true health system that works: the collaborative community of docs, trainers, nutritionists, chefs, families, singles, companies, data – and more data – on each of us as we wend our way through the complexities of our biology adrift from our history as hunter-gatherers. A nearly timeless, boundaryless, sea of the possible without direction or hope, if we are without each other and the deep tether of information about our individual biology and adrift from the tides of the terrible history of genetics hewing our flesh to the wonderful animals we are; still we are weak and sick and suffer. We need not, at least we need not so much if we can create the collaborative communities of knowledge, of data, of kinship and friendship which are the hallmarks of true health. Quantitative Medicine is really about creating such communities; such collaborative communities.

Dr. Mike (Dr. Charlie is blameless for this piece. I now return you to our usual collaborative work.)