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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