In the 70's Dr. Thomas McKeown wrote one of the most important books on the subject THE ROLE OF MEDICINE. He emphasized the fact that 92% of all improvements in health in the 20th century came from pasteurization of milk, chlorination of water, adequate handling of sewage, and adequate protein. Dr. Franz Inglefinger, editor of the New England Journal of Medicine, wrote a stunning editorial on that book in which he suggested that 80% of illnesses are self-limited or not curable by modern medicine, 10% are miraculously cured and 9% are made worse. "Thus, we wind up barely on the positive side of zero". Shortly after that Dr. John Knowles wrote in "The Responsibility of the Individual", that 99% of us are born healthy and become unhealthy because of human misbehavior. He emphasized that 80% of illnesses are the result of unhealthy behavior!
Early in the 80's Paul Starr wrote THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE, essentially predicting worse to come. Early in the 80's Medicare instituted one of the most stupid rules ever, Diagnosis Related Groups (DRG's) so that essentially an ingrown toenail was given the same time in hospital that was given to gangrene of the foot! After all, both involve the foot. The private profit-making insurance mafia quickly followed suit. By the late 80's an editorial in the New England Journal of Medicine summed it up "DELAY, DELAY, DELAY, DENY. By that time physician overhead had grown from 40% to 60% of income. And bureaucratic paperwork required 10 pages for every one page of medical notes! Another error of the 80's was allowing advertising of prescription drugs on TV. Physicians have more than enough difficulty determining which drugs to prescribe. There is no way a lay person can make a rational decision about a prescription drug without significant information from a physician.
Today, we have one of the unhealthiest countries in the world, with by far the highest costs. The insurance mafia is one of the greatest enemies of health and it creates more conflict and stress than any other single industry. Medical costs bankrupt more individuals than any other cause. And according to the JAMA in July, 2000, the third leading cause of death is the American Medical System! Having hospitals compete in this quagmire is ridiculous, just as ridiculous as their owning physician practices. Ultimately there is a solution:
1. We need a SINGLE, NON-GOVERNMENT, truly NON-PROFIT Medical Insurance Corporation, carefully controlled by the public, with revolving trustees to insure no insider manipulations. Every American must be included in this coverage.
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