Tuesday, January 05, 2010

Health care?

In the first chapter of Atul Gawande's new book, The Checklist Manifesto, reprinted here at NPR.org, I found this little tidbit:
On any given day in the United States alone, some ninety thousand people are admitted to intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an ICU from the inside.

I find this statistic both astounding and rather horrifying.
Reading a few lines further, I next found this stark sentence, "Fifty years ago, ICUs barely existed."

What is the trend revealed in these factoids? At the very least, I would say our unrestrained worship of technology. Coupled with our similarly unrestrained worship of profit, is it any wonder we strode into this health care mess in so short a period of time-- essentially, since WWII?

With the reliance upon technology comes the annoying corollary: reliance upon the technologists. We loves our gadgets-- but few people know how they work, how to build them, how to fix them. So, naturally, we are beholden to a minority class of technologists who can supply our needs; and even they are not the top of the heap. Most of the folks who know something of how our many machines and technologies work are merely product-savvy salespeople, high-level repair people (part-swappers), or well-trained and experienced industry insiders who, through long familiarity, have acquired a wide knowledge base from which to draw. Those who actually know how the stuff works, on a nuts-and-bolts (or, more likely, transistors-and-lasers) level are the true technologists, the upper-class of the technology food web: we can call them the Sci-Tech Elite. And who directs this Elite? The economic upper-upper-class-- the profit-mongers, of course! Even if the R&D is done at a major university or branch of government, the goal, somewhere along the line, is, or ultimately becomes, the production of profit for the top dogs.

This little diatribe is already going in an unintended (though interesting) direction. The point in the discussion of health care that I set out to make is that we've placed our reliance-- indeed, the greatest measure of our faith-- in the health technologists. Who are they? Through habit and social history, we equate them with our healthcare providers-- the physicians who, for a few precious minutes at a time anymore, still see us and thump our chests and look in our orifices. Though they are not the true technologists behind the modern medical mistake we call healthcare, they have become the front-men and -women, the priest-class through which we access the glorious Technology in which we have so fully vested our faith; in point of fact, I'd say they are our pimps and pushers.

Generalities, all just generalities. There are still "good" doctors out there-- those who know what health and care really mean, and do not misplace their own faith in "the machine that goes Ping!" But by and large, their traditional Hippocratic skills and instincts have been subsumed into an enormous Health Machine-- a radiometric, laser-guided, computer-controlled, digitally-enhanced, sterile, disposable, and very expensive Health Machine.

What would happen, do you think, if we were to reclaim ownership of our own health and health care, by-- for example-- practicing sensible lifestyle habits and preventive care? Would we really miss high-tech medicine? (Sure, when you're smeared across 3 lanes of superhighway and you need to be reassembled; or when your congenital heart defect finally gets the better of you and demands a valve replacement; and the like.) But really-- in most cases, how much better could we make our lives by taking charge of our own health and health care, and no longer leaving it in the hands of the technologist-profiteers?


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