Doctor's prognosis: Health care ills rooted in market-based system, by Maryann Ullman, in the Vermont Guardian

The U.S. health care system is in a state of emergency due its focus on commercial, rather than health, values according to a former family doctor turned activist.

Dr. John Abramson, author of the book Overdosed America: The Broken Promise of American Medicine, spoke in Brattleboro Thursday evening at an event sponsored by Vermont Citizens Campaign for Health.

“He’s questioning long-held assumptions held by the medical community,” said Richard Davis, executive director of VCCH, which is sponsoring an ongoing series of talks to help foster support for a single payer health care system in Vermont.

“He’s bucking the trend that health care should be based on profit. He’s providing some very defensible arguments and information for moving to universal health care, and moving to a system that actually keeps people healthy. That’s radical to some people,” Davis said.

One of Abramson’s arguments is that medical spending has little to do with actual quality of care, and may even have an inverse relationship. In a graph of 22 industrialized countries, Abramson showed that Japan spends among the least on health care per person, and has the highest rate of life expectancy. Twenty other countries cluster around the middle, and the United States, in the opposite corner by itself, has the most expensive health care, and the lowest life expectancy.

“We’re the only industrial country that doesn’t have universal health care,” Abramson pointed out. “We’re the only health care system that is run like a free-market entrepreneurial system.”

A lot of money gets wasted on endorsing products and services that don’t necessarily even help people, he said, and sometimes even harm them. For example, he compared the United States to Canada, saying far more people get bypass surgery here who don’t need it, despite the fact that it causes cognitive problems in 50 percent of the elderly. But they do it because hospitals stand to make $20,000 to $40,000 per surgery.

According to Abramson, $600 billion gets spent every year in the United States on unnecessary and often harmful medical care. “You could have universal health care three times over for that,” he said.

He concedes that Canada does need more money in its health care system, but says that’s because the country made a political decision to cap it, not because the system is flawed.

According to the Institute of Medicine, 70 percent of preventable health problems are due to lifestyle and environmental factors. But most of the money goes to direct medical care.

“We’re spending 75 percent of our money on 30 percent of the problem,” said Abramson. “One of the reasons why we don’t do it, why it’s a threat to have universal health care, is that it would threaten the profit structure. We would have to find real determinants of health problems.”

He pointed to 1980, the onset of the Reagan era, when university medical researchers began accepting funding from drug companies for their work, as funding from the National Institutes of Health dropped. “As there’s been this privatization of knowledge, there’s been a weakening of oversight,” he said. “Universities aren’t going to so it anymore. They’re addicted to the drug money. We can’t count on them anymore. Why not just consolidate everything and have the advertising agencies oversee it all?”

According to a 2003 poll by the Kaiser Foundation, 79 percent of Americans favor health coverage for all, even if it means giving up tax cuts.

Two recent polls in Vermont find wide support for universal coverage. One poll, for WCAX-TV, found that 67 percent of Vermonters favored a publicly-funded health care system, and a recent Vermont Public Radio poll found that 42 percent of Vermonters favored such a system.

The Democratically-controlled Vermont Legislature passed a bill that would have moved Vermont toward a universal health care system, but Gov. Jim Douglas, a Republican, has pledged to veto the bill. Despite the veto, the state's 2006 spending plan does include funding for a commission to evaluate various approaches to providing publicly-funded universal health coverage.

“There’s a real failure of our system to implement the will of the people,” said Abramson.