Corporatizing American Healthcare: How We Lost Our Health Care System

A number of career pathways appeared before me after I finished medical school and advanced specialty training. I chose Academic Emergency Medicine at a University Medical Center, which provided time for research, teaching, and direct patient care. Over the years, and through the frontline care of tens of thousands of patients, I witnessed the progression of medical care from a personalized user-friendly cottage industry to an impersonal, complex, and outrageously expensive corporate-based industry.

But the motivation to write Corporatizing American Healthcare: How We Lost Our Health Care System, only came after I transitioned to "Professor Emeritus" status. I then had the opportunity to work for several years as a primary care physician at a small-town rural clinic.  It was there that I learned I needed to fight corporations daily to ensure good patient care. These were fights with Healthplans to get needed drugs, specialist care, urgent surgery, and imaging (e.g. MRIs); fights with hospital systems to get care for sick patients; and fights with for-profit laboratories to get appropriate and timely testing.  Knowing that I had helped my patients provided great fulfillment.

Forty years ago, a simpler and friendly world welcomed patients to medical care. Most "doctor offices" consisted of a solo physician, or a small group of physicians, who could truly provide "one-stop shopping" at affordable prices. Patients experienced warm and caring physicians, who listened and offered help in the form of advice, medications, wound care, orthopedic care, and many office-based procedures. Most laboratory tests and simple x-rays could be performed in the office. People who required hospitalization were treated by their family physician, and the local hospital served physicians by ensuring that resources needed for good patient care were readily available. But the U.S. Congress destroyed this personalized cottage industry, in part by directing higher payments to corporate entities.

Fast forward to the present: too many independent free-standing physician offices have been replaced by corporate-style hospital clinics, and doctors now serve hospitals to ensure a profitable bottom line. Patients complain that physicians spend most of their time glaring at a computer screen in the exam room, and physicians complain they spend too much time entering data into computers. Doctors have been renamed "providers" by corporations, and assigned computer data entry tasks occupying up to 50% of their time. For some, treating the computer has become more of a priority than treating the patient.

The changes from bedside medicine to corporate medicine are illustrated throughout the book. The system we lost was that of individualized, compassionate, and personalized medical care which has been replaced by computerized algorithms, Healthplan denials of care, expansive prescription drugs, redundant hospital rules, and many frustrated patients and physicians.

Corporatizing American Healthcare differs from many other books about our health system. First of all, it explains how our complex healthcare system works in simple terms and engaging dialog.  After all, I originally formatted the book to stimulate debate in classes I teach to undergraduate students, and my students will not read a boring book.

Unlike other books, I point to the U.S. Congress as the cause for many of the unhealthy changes. Many Federal laws governing healthcare serve large corporations more than patients, either overtly or through loopholes. Too many members of Congress have been persuaded by armies of well-paid Capitol Hill lobbyists who provide one-sided arguments that favor corporate profits. I too, have walked the halls of Congress as part of a lobbying delegation and seen this first-hand. But corporate campaign contributions to members of Congress have the greatest influence. In 2016, I also learned as a candidate for the U.S. Congress in California's 4th district that a successful campaign costs three to five million dollars.

The book also contrasts our system of healthcare with Western Europe. I have been fortunate to serve as a visiting professor in many European nations and witnessed first-hand their healthcare and hospital systems. I learned that equal or better healthcare is provided for half the cost overall. Translated into dollars: Europe spends $6,000 per person/year on healthcare compared to $12,000 in the United States. Why? As the book details, we spend too much of our healthcare dollar on profit and inefficiency.

Finally, the book describes the worries of many of my patients in their day-to-day lives. Like the man who removes the distributor rotor from his pickup truck each night, fearing a hospital collection agency will steal his sole means of transportation. Or the tired waitress who struggles each month to pay down her corporate medical bill, and whom I advised to just declare bankruptcy. Or even the man almost too shy to ask for a $5 loan at the clinic to buy gas so he could drive home in a snowstorm, instead of walking. And it is these people that the U.S. Congress needs to care for, with legislation that benefits people, not corporations.

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Robert W. Derlet, MD, is professor emeritus of emergency medicine at the University of California, Davis. He is the author of Corporatizing American Healthcare: How We Lost Our Health Care System.