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The God in the Machine


The ordinary course of a cure is carried on at the expense of life: they incise us, they cauterize us, they amputate our limbs, they deprive us of food and blood. One step further, and we are completely cured.
--Michel de Montaigne

President Barack Obama during his first months in office seldom has missed a chance to liken the country’s healthcare system to an unburied corpse, which, if left lying around in the sun by the 111th Congress, threatens to foul the sweet summer air of the American dream. The prognosis doesn’t admit of a second or third opinion. Whether on call to the Democratic left or the Republican right, the attending politicians and consulting economists concur in their assessment of the risk posed by the morbid emissions. The country now pays an annual fee of $2.4 trillion for its medical treatments (16 percent of GDP); the costs continue to lead nowhere but up. Fail to embalm or entomb the putrefying debt, and it’s only a matter of time—ten years, maybe twenty—before the pulse disappears from the monitors tracking the heartbeat on the floor of the New York Stock Exchange.

So say the clinicians in Washington, and I don’t quarrel with the consensus. If I can’t make sense of some of the diagnoses or most of the prescriptions, at least I can understand that what is being discussed is the health of America’s money, not the well-being of its people. The symptoms present as vividly as the manifestations of plague listed in Thucydides’ History of the Peloponnesian War, but they show up as an infection of the body politic caused by the referral of the country’s medical care to the empathy of accountants and the wisdom of drug dealers. Thus the suppurating cruelty and the malignant disparities, among which a few of the most apparent attest to the severity of the disorder:

The United States leads the world in the advancements of medical science, its hospitals splendidly equipped with Magnetic Resonance Imaging machines and artificial hearts, its doctors gloriously decorated with Nobel Prizes, but between 44,000 and 98,000 patients die every year in American hospitals of iatrogenic infections or as the consequence of a mistaken diagnosis or a bungled operation. Medical error ranks as the country’s eighth leading cause of death, more deadly than breast cancer or highway accidents.

American hospitals and doctors are paid for the amount of care they produce, not for its effectiveness or its quality. As often as not the doctors don’t see the patients for whom they prescribe remedies; they look at test results and consult computer screens—their first care is for the treatment of paper.

Americans in 2007 paid $7,421 per capita for healthcare as opposed to $2,840 paid by the Finns and $3,328 by the Swedes, but life expectancy in the United States is not as long as it is in thirty other countries, among them Finland and Sweden; the first-year infant-mortality rate in the United States is higher than it is in some forty other countries, among them Slovenia and Singapore. A newborn child stands a better chance of survival in Minsk and Havana than it does in New York or Washington.

The money allocated to healthcare in most other developed countries (in Canada and France as well as in Germany and Japan) provides medical insurance for the entire citizenry. Not in America; 46 million citizens (15 percent of the population) are uninsured. Patients with sufficient funds can buy a brain implant or a bionic eye, but an estimated 22,000 people died in 2006 for lack of insurance; 59 million other people reported their inability to receive needed medical attention.

Together with the cornucopia of drugs for all seasons (Zoloft, Lipitor, Botox, Viagra, etc.) the American healthcare shopping mall now offers expensive diagnostic tests (CT scan, bone scan, spinal tap, etc.) that allow upward of six million Americans to enjoy the benefit of high-priced bodily home improvements—titanium knees, Peruvian kidneys, two-hour erections, and a sunny disposition. Of the 1.5 million Americans expected to declare personal bankruptcy this year, 60 percent will be forced to do so to pay their medical bills.

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  • What a happy accident of sampled readings: when Volume II, No. 4 arrived, I did the usual browse, table of contents, quick sampling of the amazing artworks, noticed the Magic Mountain meditation at the very end, opened to Mr. Kipling somewhere in the middle and paused to read him (what a fine tonic!), jumped back to and read the Bamforth piece (a take on period middle European intellecting that goes down like a vintage Mosel, or honeyed mead), and -- saving best til last -- read your preamble./Once again, Mr. Lapham, your first words are very nearly the last words needed (and how I miss having them every month when Harper's arrives). The last word would be the miracle drug, the galvanizing presidential speech or the legislative coming together that changes the course of our misguided ship of state./Until that time, we at least have your mantric words, which offer the sort of perspective one gets from well tempered music, and which make clear that the bombardment of all those other words that profess to fix our medical mess are but so much noise./No, you haven't fixed my problem; I had to drop my retirement medical insurance before its premiums grew larger than my pension. But then, as you and the folks whom you have admitted to your quarterly make clear, how can it be otherwise?/Good luck to us all.

    Posted by Richard Alnutt on Thu 24 Sep 2009

  • I think that this article, The Medical Paradigm Is Fatally Flawed, tells the tale with more precision.

    The truth is that the harms done by modern medicine are far more common and egregious than described by The God in the Machine. Anyone who has found him or herself on the wrong side of this system is only too aware of that. Yet, the harms done are pervasive, with diabetes and heart attacks caused by one of the most prevalent drugs, cortisone, used on the most helpless, children with eczema and asthma, in spite of the fact that their initial ailments are at best masked and often made worse. These, and so many others, aren't even counted in the medical carnage--and there are so many others.

    Posted by SpiderWoman on Thu 24 Sep 2009

  • "The God in the Machine" reminds me of a poem I wrote in the 90's:

    Quick closures repeal
    Endless hours
    On the couch.

    Pills for joy steal
    Supplication, pirate the
    Perils of Job.

    No pitfalls in Pop
    and Op. No dissolution.
    Resolve, resolve, resolve

    To "move on with your life, to
    Gather that 'ole "feel good" feeling
    And "hip hop hurrah" for Oprah!

    Posted by Eleanor Hart on Thu 14 Jan 2010

  • It is really a shocking situation to get such a high death rate in what was suppose to help us live a bit longer. This topic of "Deaths due to medical errors", is very sensitive to me because I will be defending a diploma on this at by the end of this year. Please can you forward any info with Cameroon as case study?

    Posted by Eric Ndengho Abongho on Sat 22 Jan 2011

  • I suggest that Mr Lapham here confuses two distinct, albeit not unrelated, discourses which profit from being held apart - the first being the costs of a reasonable healthcare system, which lends itself to comparisons of the type he makes between per-capita spending on health in the United States, on the one hand, and Sweden (where I reside) and Finland, on the other, and the second being the influence that a desire, whether innate or induced, for immortality can and does exert on a healthcare system. It is obvious that the 2.4 million million ()10^12) USD figure for annual spending on healthcare (approximately twice the more than one million million USD the government annually devotes to its bloated military and its interminable wars of aggression abroad) could be greatly reduced while providing for superior outcomes in term of, e g, longevity and perinatal mortality were a more rational system, driven by the needs of the population at large as expressed politically, rather than the profit incentive of the great corporations and the greed of their top executives, to be instituted in the United States. But it is rather less easy to find a cure - or even a brake - on the general desire for immortality, which applies just as well in Finland or in Sweden as it does in the United States (with the caveat that we here in Scandinavia are less subject to religious influences which tend to make us feel that immortality is our birthright and death an aberration). On the other hand, citing Platon as to which medical conditions merit treatment or which lives are worthy of being prolonged does not impress - at least not me ; Platon, with his [ig]noble lies and his contempt for ordinary is not the mentor I should choose to take as a guide to either a good society or a reasonable healthcare system....


    Posted by M Henri Day on Sat 3 Sep 2011

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Lewis H. Lapham is Editor of Lapham's Quarterly. He also serves as editor emeritus and national correspondent for Harper's magazine.
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