Not Enough Preventive Medicine in Healthcare

Healthcare System in the US

President Obama set about addressing the needs of the healthcare system in the US with the Affordable Care Act (ACA) of 2010. In 2016, Obama wrote, that the main purpose of the ACA was to address the “long-standing challenges facing the US healthcare system related to access, affordability, and quality of care” (525). Obama might have meant well with the ACA, but the problems in the healthcare system in the US go beyond the challenges related to access, affordability, and quality of care. They go to the very heart of healthcare in the US—the issue that plagues the healthcare system at its essence, core, and foundation: that problem is a problem of treating people rather than preventing illness; it is a problem of putting profits before people, ultimately. And that problem is made all the worse by the fact that the US government subsidizes the system: it has enabled a healthcare monopoly, which focuses on treatments, prescriptions, diagnoses, and so on to ensure an ever-revolving door of patients and profits for the healthcare industry. It is a system that has been set up precisely for the purpose of profiting from what it calls health care but what in reality is nothing more than a constant treating of people with drugs and tests, as Glasziou et al. explain in their article, “Too Much Medicine, Too Little Care.” If the health care system genuinely cared about people’s health, the hospitals would go out of business because people would be healthy. All it takes is a little preventive care—which the ACA was supposed to promote, but in effect simply got more “patients” in the door to receive treatments paid for by the US government.

In Goldhill’s opinion, the healthcare system is simply broken and needs to be completely deconstructed. It is a system that is so overbloated by subsidies from the government that it can no longer think or see straight. It is a system focused too much on profits. On the surface it appears to be concerned with health, as hospitals have the latest and greatest technology for diagnosing illness, and pharmaceutical companies are constantly investing in and producing new drugs. Yet people in America are sicker than ever. Goldhill comes to the conclusion that the problem of health is not one that the healthcare system is actually designed to fix—rather it is a problem the system is designed to prolong and exploit. And as a result, “nutrition, exercise, education, emotional security, our natural environment, and public safety may now be more important than care in producing further advances in longevity and quality of life” (Goldhill).

I agree with Goldhill’s conclusion: everything that a human being needs to be healthy can readily be obtained through health literacy, education, information; through proper dieting, i.e., eating healthy foods, organic foods, less sugar, less pre-packaged American junk food; through exercising and abstaining from unhealthy activities. This is the essence of preventive medicine and even of natural medicine—but the healthcare system is not interested in these types of approaches to health; the system is set up to see every person as a potential source of profit—and to get that profit out, the person must be put through a series of constant tests, screenings, consultations, drug therapies, and so on. If anyone has ever watched a pregnant mother go through the endless rounds of testing and check-ups, more testing and more check-ups, in the months leading up to the birth of the baby one knows exactly what I am talking about. Some women have figured this out and skip the whole health check-up rigmarole altogether and birth at home without ever needing to see a nurse or physician! Yet, as a society, we’re taught that every pregnant woman needs to go see an OB and undergo stressful check-ups and consultations, have half a dozen ultrasounds to make sure the baby is still in there, schedule the cesarean because natural births are just too painful, and get the epidural (which adds on another few thousand dollars to the bill—I hope no one was planning on paying out of pocket for all this, by the way). The system is set up so that women are disempowered from doing one of the most natural things on planet earth—something women have been doing from the beginning of human history, which is giving birth. They are told they cannot do it without the hospital, the doctor, the nurse, the shot, the cesarean, etc. But all of this is a modern phenomenon—an effect of the way the system has been designed. And we’re told it is all for our protection—but as Goldhill explains the truth is quite the opposite: it is this system that ended up killing his father.

Others are of the same opinion: Lichtenfeld states that “our technology and our treatments have taken us places that have provided effective treatments for some, but may be causing harm to others. We have entered an era in which we can find diseases and illnesses in many more people — thus giving them a lifetime of ‘illness’ — but it is not clear that, by making everyone a patient, we are necessarily improving their health” (2954). His opinion is based on the book Overdiagnosed by Welch et al.—doctors who have seen the effect that overdiagnosing and overtreating patients has on a person’s life, quality of life, and overall health. Lichtenfeld argues, moreover, that the healthcare system is predicated upon legalistic practices that are implemented not for health purposes but rather for legal purposes so that a doctor or nurse cannot be successfully sued later on by a patient: “there are many circumstances in which the medical evidence of benefit doesn’t support the clinical use of a test or procedure, yet custom demands that it be done, lest a poor outcome be blamed on the physician or other health professional, and substantial damages awarded in the inevitable malpractice case” (2954). I agree completely with this line of reasoning, as it is consistent with what I myself have seen and can logically deduce from observing the experiences of others. It is a line of reasoning that is also completely consistent with the argument of Glasziou et al., which is that “too much testing of well people and not enough care for the sick worsens health inequalities and drains professionalism, harming both those who need treatment and those who don’t” (1). Yet that problem is not going to go away so long as the US government continues to subsidize the unnecessary treatment and check-up of everyone and anyone under the sun.

And it is the purpose of the ACA to keep the system subsidized, even if Obama says otherwise. The ACA came together under the watchful oversight of the same healthcare industry lobbies that benefit from the continued subsidization of health care. As Goldhill explains, the healthcare lobbies are mighty influencers in Washington, D.C., and it is thanks to them that the government will never get out of health care or allow it to be primarily a means by which health is the number one priority. So long as the lobbyists have their way in Washington, the number one priority of the healthcare system will always be profit—and so long as the US government continues to subsidize that the treatments and check-ups, the profits will be there.

What, for example, would happen if the US government suddenly stopped subsidizing the healthcare system? Overnight, the check-ups and treatments that we all take for routine would suddenly stop. There would be no explanations, no discussions; it would simply be the case that millions of Americans would now not be given the option of having that fourth ultrasound because the government has said it will no longer foot the bill for it. And if the patient is not paying out of pocket (because he or she cannot afford it) and has no insurance to cover the cost, the hospital is not going to be giving away services for free. The patient will simply be told he or she is fine and sent away. The patient would not know any differently anyway, and life would go on accordingly, minus the stress and anxiety that hospitals routinely cause people with their endless rounds of testing, treating, diagnosing, and check-up on the patient, as Lichtenfeld points out.

The ACA that Obama ushered into existence was said, by Obama, to address issues of access, affordability, and quality—and the system erected around the ACA to support the new regulations has certainly been such that these three issues have been addressed by the monopoly of health care providers that more or less run the system. And yet what has all this “access” to care done of the problem of obesity or heart disease or cancer? Obesity is an epidemic in the US, particularly among children—and yet the only thing you would think is a health issue in America right now is the “flu” called Covid-19. That’s not a problem for insulin manufacturers, however, for they stand to benefit from the obesity epidemic; nor is it a problem for the fast food industry, for they contribute to the obesity epidemic and will continue to do so; nor is it a problem for the junk food industry, the sugar industry, the cola industry, or the TV and gaming industries, for they all benefit from the problem—just as the health clinics do. The health clinics do not want to tell people to cut out the sugar, eat organic, get exercise, and avoid junk food. That would be preventive medicine and it would work to eradicate obesity and all of its related problems—but the healthcare system only focuses on things like “access” because “access” does not cut into the bottom line the way preventive health would.