Americans spend a fortune on healthcare, but it doesn’t seem to be making us any healthier. In fact, all the trend lines point to an increasingly obese, overmedicated, comorbid population. Why is this happening, and what can we do to reverse it? Johns Hopkins Medical School professor Dr. Marty Makary prescribes a remedy.
America is sick.
And getting sicker by the moment.
Is it any wonder, then, that health care costs continue to surge out of control, outpacing every other sector of the economy?
Starbucks pays more for health care than it does for coffee beans!
General Motors pays more for health care than it does for steel!
Seventeen cents of every dollar spent in the US goes to health care; that's one-sixth of all spending. 48% of all federal spending is related to health care. Not surprisingly, as of 2018 health care became the biggest business in the country.
And, the killer—literally—is that we're not getting healthier.
Why is that?
But we can boil it down to two things:
One: We don't pay enough attention to our own health. Strange, our health is our greatest asset, and yet we often abuse it. We eat food that doesn't nourish, avoid basic exercise, and ignore sleep.
Two: We doctors don't pay enough attention to basic patient needs. The healthcare system rewards us for doing things to people, not for people.
The result: a very expensive system to treat the most obese, medicated, comorbid population in the world.
Let's look at these problems a little more closely.
According to data from the National Health and Nutrition survey, 2 in 3 adults were considered to be overweight or obese. That was in 2014. This is a serious problem in and of itself. According to a CDC study of the COVID pandemic, 78% of hospitalizations were among those overweight or obese.
10 years ago we doctors prescribed 2.4 billion drugs. Last year it was nearly 5 billion. Did disease really double in the last 10 years? No. It's just easier to push pills than to push real solutions.
Let's take Type 2 diabetes as our example. It's been rising at an alarming rate, especially among young people. According to the CDC, new cases are increasing at a rate of 4.8% per year. This disease can lead to harmful and expensive complications like heart attacks, kidney dialysis, and even amputations.
Two groups are unhappy with how we treat these conditions.
Patients and doctors.
Surveys show rising levels of patient dissatisfaction with the medical care they're receiving; while other surveys reveal rising rates of physician burnout.
So, what does the future look like?
More sickness? More procedures? And more pills at an ever-increasing cost?
Well, if we keep doing the same things we've been doing that haven't worked for the last twenty-five years, the answer is yes.
But that's the very definition of insanity.
We need to take a fresh approach.
It will require the combined efforts of two groups.
Patients and doctors.
The best way not to become a patient is to be healthy.
Healthy people rarely need pills or expensive surgery.
Over 75% of health care costs go to chronic diseases. As a doctor, I can tell you that the hard part about chronic disease is not telling people what to do, it's helping them do it. That takes time.
It's almost impossible to do in quick ten-minute office visits where doctors have to bill for everything they do.
Again, the treatment of Type-2 diabetes is an excellent example.
It's a chronic disease for which people either take a medication or insulin injections. Yet most people with Type-2 diabetes can come off their insulin simply by changing what they eat. When a disease can be cured by a lifestyle change, medication should be the last resort not the first.
This requires a partnership between doctor and patient. Both have to make a commitment to get to the underlying cause of disease rather than simply treat symptoms.
Fortunately, there's a new wave of health care professionals who want to make this approach a reality.
We're treating diabetes with cooking classes, not just insulin.
We're treating more back pain with ice, stretching, and physical therapy than surgery alone.
We're treating high blood pressure with healthy foods, yoga classes, stress management, and better sleep, instead of just putting people on pills.
I go into all this in much more detail in my book The Price We Pay: What Broke American Health Care and How to Fix It.
America has the finest healthcare system in the world, the most skilled doctors, the most advanced diagnostic and surgical techniques.
It's there if you need it.
The trick is to reduce the odds that you will need it.
That's not your doctor's responsibility. That's not the government's responsibility.
We can have great health care, be healthy, and save billions of dollars. They're not mutually exclusive.
It will take two groups to get it done.
Patients and doctors.
I'm Dr. Marty Makary, professor of surgery and health policy at Johns Hopkins University for Prager University.