Australia’s much lauded health system is under threat, so Passive Complicity looks at the American model and finds it wanting. Here is a further extract from Nortin M Hadler’s 2013 book The Citizen Patient (UNC Press)
Health in general, and good health in particular, does not lend itself readily to easy understanding because it has many components and reflects so much that is our humanity. In that regard it is similar to other hard-to-define concepts, such as “love” and “job satisfaction”. Many elements contribute to health, only some of which are defined and all of which display enormous individuality.
That being the case, what do we mean by “health care”, the “health-care system” and “health-care reform”? These and many similar terms are no longer the language of policy; they have become common parlance. They all presume that good health will result if we prevent bad health. Further, if “bad” health surmounts our defenses, we can call on trained professionals whose job it is to identify and try to fix the diseases and disorders that render health “bad” so that “good” health will re-emerge. I (Dr Nortin Hadler) am a man of this cloth. I am trained, experienced and committed to this strategy. I am also convinced that this strategy encompasses but a small component of health care, and an exclusive focus on it perverts the health-care system and diverts the goal of rational health-care reform. I am writing this book to recruit the reader to this expansive, perhaps radical, and certainly iconoclastic view.
This is not to say that a strategy of prevent-treat-cure is worthless. To the contrary it is my life’s work. It is what we think of when we exalt “medicine”. However it is a strategy that demands an exquisite moral compass. It is a strategy that must have no agenda other than to benefit the individual patient. If the process that serves the strategy becomes the goal, the patient is placed at risk of becoming the excuse rather than the beneficiary. The more the process is valued and rewarded for its own sake, the greater the personal price paid by the patient. I argue that this dialectic is approaching the extreme in America and thereby setting precedents around the globe.
This is a counterintuitive argument in a country wont to flaunt its medicine as the “best in the world”. It becomes a compelling argument when one critically examines the process from the perspective of the patient enmeshed in the health-care system, not from the perspective of the system that promulgates the process.
Dr Hadler is looking to change the question from “What’s good for me?” to “What’s the best way to organise health care so that I can have more confidence it will deliver what’s good for me?” Hadler goes on to explore the costs of health care where in America it consumes almost 20% of GDP, the conflicts of interest where medical schools are often funded by industry players – drug companies, devise manufacturers, hospitals, – such that the medical schools are thought of as ‘loss centres’, where faculty deans regularly have positions with these companies, where the companies sponsor research and conferences. Over half the spending on ‘health’ goes ‘into the pockets of “stakeholders” without advantaging a single patient”.
PC will bring more of this at a later date.