Guest Post - David Spero

by: Heather on 08/21/2007
Posted in: Sustainable Living

As mentioned, we are excited to be featuring guest posts from our authors. David Spero, author of Diabetes: Sugar-Coated Crisis has contributed this critique of the American, profit-based health care system. Thanks David!

Sicker than "Sicko"

I've never been a Michael Moore fan, but "Sicko" is way better than anything he's done before. He really exposes the madness of the U.S. medical system. But more important, he shows how and why societies such as England, Canada, and France are far healthier than the USA, while spending far less (44-62% as much per capita) on medical care. Even Cuba, a very poor country that spends 4 cents on health per person for every $1 the USA spends, has similar life expectancy and health outcomes.

There's a scene in "Sicko," where Moore interviews American expats at a dinner in France. They tell him how much easier and better life is for them there. Some express guilt feelings for living as they do when their relatives in the US are so much worse off. Moore asks them "How much sick leave do you get a year? 3 days? A week?" They don't even understand the question. "When you're sick, you don't go to work. It doesn't matter for how long."

This kind of thing explains the health differences much more than the medical system does. Health care probably contributes at most 15% to overall health in any society. Things like inequality, social support, stress, and opportunities to be physically active play much bigger roles than medicine. But as "Sicko" shows, both American society and our medical system are profoundly unhealthy.

When it comes to health care, other countries' health systems are better because they a) cover everyone for basic care, and b) focus more on prevention and primary care, and less on expensive treatments of advanced disease. This has the effect of helping people stay healthier, which saves a lot of money and improves quality of life. The U.S. system, in contrast, doesn't pay much for prevention or wellness, but spends billions treating advanced complications and keeping very sick people barely alive.

I write about the failings of American medicine in my book Diabetes: Sugar-coated Crisis - who gets it, who profits, and how to stop it. (New Society 2006.) I explain how our $2,000,000,000,000 medical system may actually do more harm than good. One interesting example: in the 1990's four diabetes treatment centers operated in Manhattan, teaching and supporting patient self-management of their diabetes. All had excellent results in controlling blood sugars and preventing complications. Their patients were living good lives. Clinically, they were great successes.

They closed within ten years. Why? Because insurance paid so little for these prevention services that the clinics all lost money. The only time they could get paid was when they failed. When someone needed an amputation or laser eye surgery, they made money, but when people stayed well, they operated at a loss. So they had to stop.

Meanwhile, in this same time period, nearly 50 dialysis centers opened in New York Almost all their patients were people with diabetes' worst complication, kidney failure. Many had very low qualities of life, but they were kept alive. Insurers paid for the service, and the dialysis companies made nice profits.

This is what happens when you have a medical system based on profit. Drug companies and other profitable, high-tech ventures take over more and more of the system. Low-tech interventions like helping patients self-manage their conditions, struggle to stay alive.

Some forces within American medicine are trying to change the twisted power relationship and economics of medicine. They are trying to help health care providers, patients, and communities work together to help each other do a better job. Patients get support in taking care of themselves, while systems find more economical ways to work with chronic illness. You can see more about these efforts at

I'll have more to say about what makes a society healthy or unhealthy in future posts. I'd be interested in what you have to say about these issues. Comment here or contact me through my web site


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