Still Not Enough Health

Health care remains in crisis. Despite the Herculean efforts made by the Obama administration and Democratic Party leaders in the House of Representatives in passing health care reform legislation, despite the frantic resistance by Republicans in opposition, we still have the same system that’s been in crisis because it consists of too much medicine and not enough health.

Even on its own terms of insuring the uninsured and reducing medical costs, the legislation Mr. Obama just signed into law with much celebration and self-congratulation is a failure. Numerous commentators are flogging that particular issue. For example, Progressive Democrats of America have a fine critique on their website titled Healthcare Torture by Laura Bonham. The core of the criticism is that a single payer medical system was abandoned for the interests of the medical industry, led by the insurance industry and pharmaceutical industry.

The one thing I haven’t seen discussed is how this reform is very much in the tradition of reform in the United States. The story goes something like this. Some social issue with serious consequences develops over time—in this case the cost and, to a lesser extent, the quality of medical care; in the past it’s included the oppression of workers, the greed of corporations, and the destruction of the natural environment. Popular sentiment and even acts of rebellion break out, fomenting social instability. More importantly what breaks out is potential or actual instability that threatens the political economy. It is then that the government steps in to restore order.

Since democracy, the voice of the people is our national religion, legal and regulatory actions are taken in the name of the people but in fact are designed to restore stability. Along the way, the enabling legislation is typically shaped to transfer wealth and income from the general population to the economic interests at the core of the legislation. In this case, the most important part of the new law is the 16 million new customers the insurance industry is guaranteed to pick up (guaranteed by the government for people unable to afford premiums and also guaranteed through punishment of people who do not join in). Equally important is the subsequent increase and stability of the revenue stream to pharmaceutical companies and other sectors of the medical industry.

The same logic is at work in climate change legislation with the misbegotten cap-and-trade system that has attached itself like a leach to the issue. But that’s another story.

The legislation we now have will solve some problems for some people. Some will be made worse. Some others will not be touched. One thing that enterprises organized to make money do very well is find the chinks in the legislation created to protect people, government, and other businesses. I look forward with little pleasure to what oozes out over the next several years.

But none of it goes to the heart of the health care crisis. That is why it will be with us for some time to come.

We named our book Too Much Medicine, Not Enough Health because the health care that’s in crisis isn’t about health. It’s about medicine. And not just any kind of medicine, but the medicine that is sanctioned by the institutions that are in the grasp of the political economic forces that shaped the legislation Barak Obama just signed into law and that he vigorously promoted and for which he so vigorously fought. It’s no accident that Mr. Obama as a United States Senator and as a Presidential candidate was the major recipient of contributions from the medical industry—not because they bought his soul but because they like the way he thinks.

Health care will remain in crisis so long as we think of health as being about medicine. Simply expanding the scope of what counts as medicine will not do. Alternative and complementary medicine is still medicine. It still makes health about getting fixed instead of about living life.

Yet we don’t have to think too far out of the box to know that the quality of our food supply (including the water we drink), of the built environment in which we live, work, and play, and of the social justice that defines our public life are all about health—not just in preventing the calamities for which medical treatment is required but to enable us to lead full, rich lives.

The medical industry will remain in crisis because its laws of motion have become defined by overdiagnosis and overtreatment. Having greater access to that system, whether through the anemic provisions of the recent legislation or through a single payer system, doesn’t solve the health care crisis because health needs to be about what we live for not what we live in fear of.