Zombie Patients

This past week, my eighty-five-year-old aunt had a heart catheterization and she received a pacemaker. Since she has no children, I was down in Florida for the surgery. Although her surgery was prompted by heart irregularities, the surgery was elective. The surgeon was a decent and competent man; yet I cannot help but reflect on the economics of her surgery.

My aunt is about 100 pounds overweight; she eats terribly and has done very little exercise, even walking, for at least 30 years. After her hospital stay, she was transferred to a rehabilitation center. Not pleasant for her or the taxpayer.

According to Shannon Brownlee’s excellent book Overtreated, there are more than 2 million heart catheterization procedures performed in the United States each year. Of those 2 million, 1.2 million are elective—meaning, like my aunt, the patient has symptoms but is not in immediate danger of dying. Of the 1.2 million elective procedures, 160,000 are inappropriate, “according to cardiologists’ own rules.” Most importantly, Brownlee writes, “The latest research…suggests that the vast majority of elective cardiac procedures are no more effective at preventing heart attacks and death than medical management, which involves giving patients drugs and counseling.”

I don’t know if Brownlee includes dietary and exercise advice as “counseling.” By my own observations of the number of overweight health care professionals and the horrific food served in hospitals to sick patients, I’d conclude that the medical industry is singularly unqualified to provide such counseling.

Dean Ornish is perhaps the most well-known physician promoting dietary and lifestyle changes as alternatives to drug and surgery for heart patients. He observes that, “More than $30 billion were spent last year on angioplasties, yet randomized trials clearly show that they don’t prolong life or even prevent heart attacks for most people. In contrast, studies show that most heart disease is completely preventable today, simply by changing lifestyle.”

To be sure, the dietary portion of the Ornish program is rigorous—whole grains, beans, fresh fruits, and vegetables are stressed—while animal food, fats (less than 10%) and processed foods are minimized. Ornish is not the only one who has come to these dietary recommendations. No, I am not naïve enough to believe in magic bullets; but the evidence is overwhelming that health care expenditures would fall dramatically if Americans moved toward this type of diet.  This raises many questions:

  1. Should individuals who don’t take responsibility for their health be allowed to transfer their healthcare expenses to the rest of society?  In other words, should they be bailed out?
  2. As long as the medical industry is set up to focus on treating acute sickness through expensive drugs and surgeries, how will medical costs ever be significantly reduced?
  3. Why do so many Americans grow up without even a rudimentary knowledge of what contributes to a healthy diet and a healthy lifestyle?

And there is a larger question: When will our current health care system collapse? The current system is simply too expensive and wasteful. We cannot afford it!

We have seemingly learned nothing from the collapse of our housing and banking industries. When the housing bubble was well underway, experts assured us that housing prices could go up at a rate of 30% per year for many more years. Anyone who had even some knowledge of the history of bubbles understood that these forecasts were made by people who were ignorant, or by government officials, or industry shills.

Should we now trust so-called healthcare experts who tell us that more government involvement will fix what ails our health care system? More government involvement?  What has government involvement given us already? How about financial incentives to pay for expensive drugs and procedures rather than incentives that encourage prevention? How about an educational system that teaches little of what promotes health? How about privileges to the drug companies and the AMA?

Mish Shedlock has called taxpayer supported banks “zombie banks”—they are the living dead of the financial industry and they would collapse without bailouts. But what of zombie patients—those who take little responsibility for their health and consume much of our healthcare resources? I have no easy answer. Americans are bighearted; we give generously to charities that help those who played no part in their misfortune. But we cannot continue to fund zombie patients.

Am I being cruel and heartless? The day will come when the healthcare bubble will burst; we will no longer be able to afford the current health care system. Those who take little responsibility for their own health will be suddenly wrenched off their support system; that will be real cruelty. It is far better to begin the process of change now while there is still time for individuals to get the care they need as they wean off the old system and adjust to new realities.


5 Responses to Zombie Patients

  1. James D. says:

    I have to disagree that Americans don’t know what contributes to a healthy diet and lifestyle. I’m still in the first half of my life (not quite 40), but I remember having the food pyramid drilled into my head and exercise being touted as a good thing in elementary school. The recipe for good health hasn’t changed in nearly 100 years: eat right, get regular exercise, don’t smoke and drink in moderation. Stick to those 4 things, and I think we’d see the need for healthcare plummet dramatically.
    You’re definitely right about those leading unhealthy lifestyles being subsidized. Imagine the enormous backlash of proposing that health insurance be handled like car insurance. If you drive smart, keep close to the speed limit, don’t drive drunk and obey traffic laws, your rates are generally much lower than those who drive while impaired, drive recklessly, etc.
    Healthcare costs also face 2 other issues, both related to how we decide to live our lives. First, related to items discussed above, is healthful living. I’ve been trim and healthy, and I’ve had periods where I’ve been slothful and 50lbs overweight. I definitely like it better when I’m fit, eating right, and living consciously aware of my life and how my decisions effect my body and the consequences down the road. If I treated my car like many people treat their bodies, it wouldn’t last long, either, and would require major repair frequently. But even a little periodic maintenance, and most cars today will last a very long time, just like our bodies.
    The second issue is how we in America relate to death. We spend more than 50% of our healthcare dollars on the last 6 months of life, treating the terminally ill or the very old. Now I don’t want to dictate to anyone what kind of treatment they should get and when they should get it, but we fight very hard to delay the inevitable for every second, despite the nearly parabolic cost curve involved in each extra day. If we lived our lives more openly, more consciously, more aware of and in tune with the cycles of life (and death), maybe we’d stop filling our hospitals with people we cannot really help unconsciously curled up in the fetal position stuck full of tubes. If we learn that it is death that ultimately allows us to define our lives and find meaning in them (and not our egos), we become much more comfortable with death. If we live our lives with our families instead of our coworkers, doing things we want rather than things we have to, we can come to the end much more ready than kicking and screaming for more time to go back and fix what we’ve ignored all these years.

  2. Jim,

    I think our collective ignorance is far deeper than we may realize.

    The food pyramid that most of us grew up with called for multiple daily servings of dairy and meat products. Most of us grew up thinking we needed to drink milk “to grow up strong.” Like other industries, the dairy industry has had a partnership with government for a long time.

    I would venture a guess that if you told the average American that they should go buy bulk whole grains and beans and then cook them, they would have no idea how to accomplish that task.

    Since most Americans eat so much processed food we have lost our taste for fresh vegetables and fruit–we think like little children and say they taste “yucky.” Case in point–our annual per capita consumption of sugar products is over 200 pounds a year, yet we consume only about 5 pounds annually of broccoli per year.

  3. James D. says:

    That is certainly true, and while you’ll agree with me that gov’t regularly lags behind research in what reaches the schools, the pyramid has been updated, and gets better with time. There is also no dearth of advertisement for many different systems of eating, some fads, some from legitimate research, that tell us that eating fresh veggies and such are better for us, but we lack the time (or will) to go to the farmer’s markets (which have such limited hours as to be nearly useless to anyone who doesn’t work night shift). Then there’s the matter of the time to prepare fresh food, as it often takes much longer than our processed foods to prepare and cook. I’m not saying that the good stuff isn’t worth the time and effort, but I relate the problem back to the point I made about living more consciously. Its not easy to disengage our egos and step back from our busy lives and do what’s good for us long term. Beyond the food being better for us, there is value in the process of taking the time to prepare it, both valuing the process itself, and the ability to bring our children into it with us and teach them the same deep, simple joys.

  4. Jim,

    Indeed, it does go back to individual responsibility.

    Michael Pollan has written two outstanding books on “industrial food”: The Omnivore’s Dilemma and In Defense of Food.

  5. m says:

    i have to say that most phD’s routinely criticize md’s. like i said earlier, if any doctor does not follow basic care guidelines, they’re leaving themselves open to a lawsuit. also, i can guarantee that your aunt was counseled numerous times about a change in her lifestyle. but she either refused or changed doctors to avoid making any changes. we are a nation obsessed with our likes and dislikes. every decision is based on these 2 parameters.

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