Flatlined: Resuscitating American Medicine

Preface

PREFACE Iam a neurosurgeon, perhaps the last person you might expect to write a book calling for reform of the medical industry. Yet despite all the good in medicine, I have witnessed bedside tragedies that no one would expect in the United States. After studying the U.S. health care system, I became so disturbed by my discoveries and experiences that I left my practice and my home to undertake a yearlong stint as a Senate staffer, focusing my efforts on health care reform. I also decided to write this book. In Flatlined I have worked to make my ideas understandable to a person whose only experience of health care is as a patient. You will find no unexplained medical jargon or highly technical terminology, just the stories and the necessary facts that describe the current—and unacceptable—state of affairs in American medicine. The stories are all real events or composites of real events that I have seen unfold. During my thirty years of medical practice, I have found doctors, nurses, and the staff and administrators of hospitals to be unusually principled people, and I have always been proud to be among their ranks. My stories are not about bad people but about good people working in bad systems. The term flatlined refers to loss of the heart and brain’s normal, rhythmic electrical signal when a patient hooked up to a machine dies. Between 1999 and 2005 I watched patients die of injuries that should not have killed them. They were flatlined by the failures of the medical system. At present, being insured does not guarantee timely care or protection. An ambulance is waved away from an American emergency room every minute without regard for who is inside the vehicle. This situation will only grow worse without immediate reform. Flatlining also faces the U.S. health care system as a whole if it continues on its present trajectory. In 2007 Medicare and Medicaid xi Prelims.qxd 10/10/08 3:27 PM Page xi accounted for 23 percent of the federal budget and are on track to consume one-third of it by 2018. At any given time, 47 million Americans are without coverage or access to standard medical care, but that figure understates the problem. More than one-third of the non-elderly population—82 million people—has either insufficient, unstable, or no health insurance coverage. As a percent of wages, business spending on health care is at an all-time high; and small businesses are dropping coverage because they have been priced out. Health care costs are growing at twice the rate of the economy; meanwhile, American businesses face relentless global competition from companies that do not bear such costs. The overall budget for health care is already exorbitant. But at least 30 percent (about 700 billion dollars) of all delivered health care services are unnecessary for treating illness or ensuring wellness. Many procedures are also harmful. There is no just reason for a country as wealthy as ours to be delivering and consuming large quantities of wasted medical services when so many of its citizens have insufficient or unstable access to standard medical care. There is no excuse for disenfranchising so many people from medical services when they could be covered by the simple creation of a more efficient system. Full-access coverage and the reform of medical practice to reduce waste would also improve the quality of medical care. Too many people are victims, both the insured who get excessive or poor-quality medicine and the uninsured who get too little care, too late. Medical waste is a moral issue: it is the wrong use of money, and it hurts innocent people. When I began considering the best manner of paying for and providing health care in the United States, I did not begin with any biases. I have visited Canadian hospitals, and I know many Canadian doctors. I have a good opinion of that country’s health care system, which is managed through the government as the single payer. But the United States, with more than 300 million people, is not Canada, whose population is only about 34 million; moreover, their cultures are different. After spending a year in a Senate office watching the inner workings of Medicare payment policy, I cannot support a single-payer system. In the short run such a plan would reduce the considerable health care administrative waste, but in the long run there is...