On the State of US Healthcare

“Monday Musings” for Monday August 7, 2017
Volume VII, No. 32/344


Duke Chapel

America’s Health Care System is a Mess

By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA

There is one constant thread that runs in all of the Socratic dialogues and that is: Socrates always asked his interlocutors “what do you do? What are you selling? How are you making a living?  And above all, how are you measuring your success?”  I think the master’s method of 2300 years ago, is applicable to today’s American medicine.  We really do not know the value of our treatments to our patients.  We do not know how to measure health gain.  All this result in less focus on improving health and more on minimizing cost.

Medicaid expenses are bankrupting the county governments, especially small rural counties throughout NC and the nation.  Medicaid cost is eating into education and public health budgets.  Medicare rules conceived by what appears to be chaotic minds of a group of bureaucrats known as health policy makers, running around with no direction, are crippling to the practicing physicians who are taking care of patients. The focus is to contain and minimize cost.  No attention to improving health.  We are an illness-oriented system.  We need to become or be transformed to a health-oriented system.

In a book generated by Washington DC’s American Enterprise Institute, “The Diagnosis and Treatment of Medicare”, authors Andrew J Rettenmaier and Thomas R. Saving describe the ills of Medicare and seek solution to the problem.  In fairly intelligible and clear language, much of this 179 page book’s 14 chapters is spent on outlining the two basic problems with the Medicare system:

1)  Medicare simply can not afford to provide coverage for elderly health coverage, especially with the baby boomers approaching retirement age.

2)    There are no limits on payment of claims submitted to Medicare by health providers and clinicians.  The system lacks rigorous accountability and transparency.

3)    The system lacks means-testing.  A Mr. Rockefeller, if 65 and over, may not pay for his care out of his pocket.  He is obliged to go through the system and file papers for his treatment.  Means-testing is a very useful instrument to lighten the burden on Medicare.

At the end, the book does not offer any serious and systematic solution to the Medicare system that is universally known and agreed upon.  America’s health care system is like a patient in an Intensive Care Unit (ICU).

I submit that the ultimate solution is to focus on health and the turn the medical care system to a huge public health/prevention machine.  Prevention should be paramount in medical curriculum, medical practice and medical clinics.  Like Socrates, we need to constantly ask ourselves what is it that we do, how can the efficacy of what we do be measured, and how can we avoid the slippery slopes of medical profession becoming a commodity, business or industry?


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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