Physicians

The Cost of Success

For those of you who didn’t know, I entered the National Novel Writing Month “contest” (which has no winners).  I got to the goal of 50,000 words yesterday.

One of the main questions that is asked in my novel (which may or may not ever see the light of day) is this: What would happen if a wonderful cure came along that would take away most, if not all sickness? Remember, it is fiction.

The answer is, of course: utter chaos and collapse of our system.

Our system is designed to deal with sickness.  It is designed to fix problems.  If a wonder-drug came along, here’s what I think would happen:

  • Pharmaceutical companies and hospitals would have to oppose it, as they would suffer financial ruin if people became healthy.
  • Doctors, especially those focused on chronic illness or treatment of serious problems, would take a huge cut in pay.
  • A huge number of healthy people would enter the workforce, disrupting an already fragile economy.

Human stupidity, of course, would remain.  There would be some work for those in the medical profession, but only a fraction of what is there now.

I don’t think anyone expects this “wonder drug” to appear any time soon, so what’s the point of entertaining this scenario?  Looking at the extremes can often give us insight to our current problems.  One of our biggest problems is this: our system thrives on its own failure.  If we fail to keep people well, the healthcare economy improves.  There are more jobs to be had to treat and take care of these sick people.  There is more need for new drugs to treat the increased number of sick people.  Hospital beds are full, and doctors are busy.

Life is good for those of us in medicine when we fail.

I think this truth is not lost on some of those people who are cynical about traditional medicine.  They see the motivation to keep people sick, and assume that there is a conspiracy afoot to accomplish this goal.  Now, if there is a conspiracy, it doesn’t include me.  I do see success in keeping people healthier than if they didn’t see me, and nobody has tried to bump me off yet.  I’ll let you know if they do.

But despite the fact that I don’t see a conspiracy to make people sick, I do see a lack of a conspiracy to make people well.  It’s not an organized conspiracy; it’s just a sin of omission.  Success of our system, defined as people being kept healthy, comes at a huge cost.  Why would people strive for success when the prize would be a pink slip?

Again, I am not saying that this is a conscious decision.  I don’t think there is a back-room deal between pharma, hospitals, and the government to prevent wellness.  No, I just see a total lack of an organized effort to fix things.  We are giving absolutely no motivation for success.  There is nobody in the healthcare industry who truly benefits from health.  If this is our goal (and I think it should be), shouldn’t we somehow make it worth someone’s while to keep people healthy?

Why aren’t we setting goals to shut down hospitals, not keep them profitable?  Why aren’t we trying to motivate well care and prevention so that sick care and intervention will stop being so profitable?  This can’t be lost on those whose livelihood depends on the failure of the system.  There will be great inertia to the sacred idea of treating the sick, and a reluctance to abandon it for the idea of eliminating the sick (through prevention, not euthanasia).

Would your kids clean their rooms if you docked their allowance for doing it?  That’s what we are doing.  That’s how our system is designed.  We should not be surprised at failure when success comes at such a high cost.

Until things are changed at the most basic level, success in healthcare will be a purely fictional idea.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

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6 replies »

  1. If all people got healthy, that money would be spent in other walks of life leading to employment in those sectors. Also the productivity would go up in office and health related bankruptcy go down.

  2. The point is, however, not what would happen if people got totally cured, but the fact that our system encourages the avoidance of cures. Sometimes you need to look at the heart of the system to figure out why the rest is in trouble. Our problems of spending have a root: we encourage it. We reward spending and create an environment in which the ultimate success of the system would be its downfall.
    That is why I wrote this.
    I am a little kind to pharma, I agree. The problem is that people lay so much at the feet of pharma greed, but don’t look at the system that allows them to be greedy and get what they want. It’s easy to take aim at them, but it would have distracted from the purpose of this post.

  3. Sounds like we need a lesson in economics.
    What would happen to the medical industry if a miracle drug was found? It brings up an interesting point, similar to the climate scientists who depend on finding evidence of a climate apocalypse in order to maintain funding for their profession. But, unlike climate science, medicine has a competitive market.
    Someone would get unimaginably wealthy if they were to create such a drug. Yes, it would come at the expense of the rest of the medical industry, but not at their own expense. In economics this is called “creative destruction”. And it’s a good thing.
    Farming innovation has put hundreds of thousands of farmers out of work (our nation was once 90%+ farmers). The jet has reduced the rail industry to a pittance. The computer has destroyed many a secretary/clerk position. Yet the economy grows.
    If the medical industry was destroyed by innovation, the lives of the masses would be incredibly improved, but doctors would be out of work. What then? They would simply have to find other ways of bettering the quality of life of their fellow man. It happens all the time, with every new idea that makes our lives a little bit easier. People lose their jobs as their companies lose business to better companies, and they find jobs elsewhere. Were it not so we’d all still be farmers.

  4. Great post, Rob. Sounds like paradise, or ‘the Garden of Eden’ (Genesis) We had it, but lost it, perhaps it will be found again.

  5. Great post. This kind of thing needs to be said over and over in public forums to let the public understand how incentives and institutions are set up against their interest.
    I do wonder if you are being a little too kind to pharma in particular. From what I’ve heard (from someone who has worked in big pharma for years), these companies know very well that it isn’t in their interest to find cures, and that is exactly why they want to manage symptoms of chronic disease with new drugs, rather than remove the disease. They direct research projects accordingly. Maybe not a “conspiracy” but deliberate nonetheless.

  6. Rob
    To Wit:
    It you came up with this pill, would Virginia, Florida, Texas, etc., opt out of use due to enumerated powers?
    Naturally, by fiat, the Federal government cannot encroach on any facility supported by State dollars, and therefore, it would be within their rights to give the citizens within its borders all episodes of bronchitis, venereal disease, and angina attacks to which they are rightfully entitled, and the Creator endowed.
    Who are these kooks at the NIH to tell us what to consume? Secession now!
    Brad

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