America is spending $3 trillion on health care every year. Does that number include toothpaste? Surely toothpaste is very important to your health. How about baby powder, diapers, condoms, soap, lip balm, nail clippers, detergents, mops, vacuum cleaners, washing machines, smoke detectors, air filters and air bags? How about everything Nike sells, diet books, your gym membership, bicycles, skateboards, everything Sports Authority carries in its stores, and all Weight Watchers products? And then there is quinoa and edamame, spelt, flax, organic kale chips and those scrumptious gluten-free kelp smoothies. You can also count the entire budget of the EPA, the FAA, the CDC, the FDA and the USDA, and while at it let’s not forget the war on drugs, the war on poverty and the war on terror, and of course education and vacation, sunscreen, traffic lights, firefighters, police and those weirdly bluish ice-melting crystals for your driveway. It sure looks like we are spending all our money on caring for our health.
In America, we spend $3 trillion every year on medical care, not health care. Medical care is what you get mostly from doctors and nurses, mostly in hospitals or clinics, and mostly when you are sick or hurt. Medical care is most often associated with pain, suffering and fear, and is something most people, most of the time, don’t use, don’t need and don’t want. The new thinking says that if we could spend less money on medical care, we could spend more on Bluetooth enabled holographic toothpaste, and that this is a good thing. After all, most of our $3 trillion is spent on a small fraction of sick and elderly citizens, most of whom will never get better anyway. Wouldn’t it be more fun to spend our money on nice things for the majority who is basically healthy, so they can be even healthier, and perhaps forever healthy?
Also $3 trillion is too much money to spend on regular people, who truth be said can’t really afford it anymore, because according to none other than J.P. Morgan, “US labor compensation is now at a 50-year low relative to both company sales and US GDP”, while “[corporate] profit margins have reached levels not seen in decades”, and miraculously “reductions in wages and benefits explain the majority of the net improvement in margins” [emphasis in the original]. When your wages and benefits are at a 50 year low relative to GDP, courtesy of the general plutonomy, and your medical care expenses are at an all-time high relative to the same GDP, courtesy of the medical-industrial plutocrats, you have two basic choices. Start a revolution, or let yourself be wooed by the thieves. Revolutions are hard and very inconvenient for consumers, so sit back and be wooed.
Medical care is sick care. Sick care sounds depressing, and sick care is expensive. Sick care is what happens where health care fails. Health care is cheap and pleasant. Better health care will obviate the need for sick care. Ergo, we should invest heavily in health care right here, right now, and quit funding exorbitantly priced products and services for sick care, because soon, very soon, there will be no sick people. For some, midlife crisis means buying a red Porsche, for Google owners it means spending $1.5 billion on the fountain of youth. For Peter Thiel, it means actually becoming immortal. For CVS pharmacies it means changing the company name to CVS Health. For Apple it means releasing a plebian version of the fountain of youth called simply Health. And for the rest of us, it means paralyzing fear.
The best is behind us. The American Century is over. Ebola is going to kill us all, and if not Ebola then the measles will. And if not disease, then surely we will fall prey to the toddler invasion from Guatemala, or the long-range nuclear missiles of the Russian Empire, or the marauding bands of sociopaths roaming the Arabian desserts in Toyota pickup trucks, raping and decapitating everybody in their path, not to mention the global ice age descending on Boston with the fury of a theory scorned. History teaches us that every great nation has to fail and every governance model is destined to perish and all societies will eventually disintegrate. Today is our turn to die. But then the drums begin to bang and the stars fall from the sky, the moon turns red with blood and the trumpet sounds its call.
Behold the vision of the saints as they go marching in, masterfully weaving the Narcissistic obsessions of the young and healthy with the helplessness and impotence imposed on the marginalized masses. An Apple a day keeps the doctor away. We will solve all your medical care problems caused entirely by your failure to be healthy. We will manage your wellness, your food, your activity, your thoughts, your desires and your disillusion, and we will make sure that you function within optimal parameters. We will take preventive actions at the very first sign of malfunction, long before it becomes sickness or injury. We will keep you, your children and your children’s children, healthy and productive. This is our solemn promise to you and we may even keep it, if you obey us and always do right. As the sign that you are keeping this promise, you must strap this bracelet on every man and boy in your family, and yes, of course dear, womenfolk too.
Here is a free app if you agree to swallow our drugs, and here is a free test if you let us decide what to do with the results, and here is a free toaster if you get a mortgage, and here is free health insurance letting you have any doctor or hospital you want, as long as it’s the one we picked for you. Here is your freely elected representative, programmed to say what you want to hear, on a soft bluish background because we know from your genomic sequence that bluish colors engender your trust in us. No sweetie, we don’t think you’re stupid, but you are weak and frightened. We are just trying to do what’s best for you and we appreciate your input, your tweets, your blogs, your amusing comments, your die-ins and even a little arson and looting, if done in good taste. One day you will be grateful for our guidance and the limits we are setting for you now. Or maybe not, but by then you’ll all be dead anyway, so frankly darling, we don’t give a damn.
If you are a Primary Care Physician and would like to express a thought, an opinion or describe an experience, this blog page is at your disposal. It could be a short note, a long dissertation or anything in between. Write it down and email it to me. It will be promptly posted here as is, unedited, uncut and anonymously if you so desire. You can send one or as many notes as you need. All are welcome!