An American Sickness

With Barack out of the White House, Obamacare now looks something like a 7-year-old orphan: the unwanted child of yesterday’s Washington; a needy patchwork mega law with holes in its coverage.  Strange part is that Obamacare is still on its feet, doing pretty much what it was told to do: extending breaks to some poor people, to 20-somethings, 20 million formerly uninsured.  Stranger still is that the reform legislation that Democrats are having to defend left so much of a broken system in place: hospitals, doctors and drugs at twice the world price, way underperforming Europe, Japan, Singapore, Colombia in healthy results. We know there’s been genius in American medicine, but it seems to have been lost while we were arguing over it and taken over by money and big business. 

Elisabeth Rosenthal, author of the recent tell all on our national disease—An American Sickness: How Healthcare Became Big Business and How You Can Take It Back—is our main guide for the hour. She gives us a tour of the rickety foundations of today’s health care system, its responsible architects, and the fixable future.

via Adam Gaffney / The Lancet 

Adam Gaffney, writer and pulmonary doc, thinks we need to put up a more radicalized fight – a single payer plan—to deal to with the serious inequality in health care today. While we can recognize the gains made by the ACA, we shouldn’t settle for the system we have.

Jonathan Bush, CEO of the cloud-based service company Athenahealth, is our disruptive “data geek” and technoutopian in Watertown, MA. He’s also the nephew of one President Bush, the first cousin of another, and the poster child of the rising force of markets in medicine. He gives us what might be a considered a more optimistic view of the future.

Along the way, we’ll have drop-ins from one of the major economic minds behind both Romneycare and Obamacare (Jonathan Gruber) as well as one of the ACA’s more wonk-ish critics on the left (Matt Bruenig). We’ll also get a short course on the influence of capitalism in medicine—via Prof. Nancy Tomes, recipient of the 2017 Bancroft Prize — as told through a historical tour of your favorite local drugstore:

 [Video by Zach Goldhammer, lead illustration by Susan Coyne]
Guest List
Elisabeth Rosenthal
doctor and author of  An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
Adam Gaffney
writer, staff physician at Cambridge Health Alliance  instructor in medicine at Harvard Medical School
Jonathan Bush
CEO and co-founder of Athenahealth
Nancy Tomes
professor of history at Stony Brook University and author of Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers
Jonathan Gruber
professor of economics at MIT
Matt Bruenig
former Demos blogger and freelance writer on economics, politics, and political theory

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  • Gordon Adams

    Great program! Not mentioned is the added cost of elaborate architecture for hospitals and medical offices.

    My rule of thumb, e.g., for finding a vet is if the reception area is tiled with expensive stone and fixtures, it’s gonna cost extra to heal my pet. And the expense likely won’t fully address the needed treatment.

  • Michael Beaton

    Another great show. ROS is one of the top 5 Podcasts/Shows available..The leader in what you do. thanks.
    And fyi, I bought her book as a result…

  • Floyd C. Wilkes

    Included in the intangible benefits enjoyed by the commonwealth of these USA in transitioning to universal coverage will be an improvement in civic coherency, thus marking a long stride towards achieving the mission bequeathed to us by our Founding Fathers in the Preamble to the Constitution, namely, to form a more perfect union.

    As a heightened sense of inclusiveness promotes better social cohesion and wellbeing especially among segments of society currently feeling ostracized and marginalized, all will enjoy a substantial and health-promoting reduction in stress levels, diminishing the prevalent malaise.

    Additionally, universal coverage will stimulate the economy, reduce inequality and promote entrepreneurship; By eliminating the risk of loss of coverage, and burdens of carrying coverage from the calculus of startups, small business, innovators and entrepreneurs, and eliminating the current constraints of a market dominated by employer provided coverage plans.

    Another excellent discussion. Thank you Open Source.

  • Price transparency?

    https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/

    By what mechanism does society determine that an extra, say, $100 billion for health care will make us healthier than even $10 billion for cleaner air or water, or $25 billion for better nutrition, or $5 billion for parks, or $10 billion for recreation, or $50 billion in additional vacation time—or all of those alternatives combined?

  • Potter

    Americans of a certain stripe (ahem) want their FREEDOM even if it interferes with someone else’s or everyone else’s rights to theirs as well as shooting themselves (sometimes literally) in the foot. The trench we apparently leaped over with the ACA is that now many more feel that the government has as a role, maybe a large role to play.

    From an assessment after 5 years of ACA in the NEJM:
    profound philosophical objections to federal initiatives in health and other policy areas have deep roots in American political discourse and will probably persist, guaranteeing that the ACA will remain controversial. Time will tell whether the contributions of the ACA to the health and health care of Americans will moderate these philosophical objections and create the kind of broad public support for the ACA that Medicare and Medicaid — also controversial when they were passed — now enjoy.
    http://www.nejm.org/doi/full/10.1056/NEJMhpr1503614#t=article
    The sick, the old, the poor, I can’t imagine want or need or even know how to assess and negotiate a marketplace.

    Thanks for this discussion

    PS. The $400 per vial of eyedrops my specialty Dr. was going to RX for me after I finished his drug company sample made my mouth drop open. If I bought three the price would have been only $500. That’s under Medicare. My PCP told me to get another, maybe not so “improved” but essentially the same,over the counter, made by the SAME company for $11. Gosh there must me so many such stories just re drugs.

  • Shirley

    Loved the discussion but dismayed that a participant repeatedly referred to the Medicare drug program as Part A. In fact drugs are covered under Part D. IMHO Part D does a remarkable job of allowing people to compare plans and choose the cheapest, most extensive formulary and/or most convenient plan. Similar tools for other covered services would be very helpful.

  • Gordon Adams

    The “market” approach for buying health insurance is also problematic. Deductibles, coverage, prescriptions, etc., all of these make it difficult for the average person to shop around. It’s not like buying a car or groceries.