Refuting healthcare myths

August 21, 2009

David Magnus– David Magnus, Phd, is the director of the Stanford Center for Biomedical Ethics. The views expressed are his own. –

The public discussion of healthcare reform has been full of so many lies and myths that it is less a policy debate than bad theater.

Critics of reform (conservatives hoping to score political points and oppose Obama on anything; free market ideologues; those with threatened financial interests) have stooped to absurdity in their public pronouncements. One publication declared that severely disabled physicist Stephen Hawking would never get life saving medicine in a national health system, ignoring that Hawking is British—virtually all of his life saving treatments were done through their National Health Service.

As debate over reforming health care continues, these are some of the key myths that get in the way of truly meaningful discussion.

Myth #1—We have the best health care in the world

This is probably true for some Americans. But on the whole our system is among the poorest of all developed nations. We spend far more per capita than any of our peers on healthcare, yet health outcomes measures are no better in aggregate. The World Health Organization ranking of health systems rated 36 other countries as having better health systems despite spending far less. The U.S. was right behind Costa Rica (and only two spots ahead of Cuba).

But the reality of the failure of our health system is best seen by the thousands of people being turned away in Los Angeles last week at the massive free clinic set up by the Remote Area Medical Foundation (see Reuters story). When the country spending the most money can not meet the basic medical needs of so many of its citizens, it does not have a good (or just) health system, much less the best system.

Myth #2—Health reform will lead to less personal freedom

There is nothing in any of the proposals that requires anyone to give up her existing health plan. In fact, Medicare proves that public-private partnerships can result in individuals choosing their own plans and their own physicians. Opponents of reform have argued that any government involvement means loss of freedom. This ignores the reality that insurance companies, employers, and financial limitations are already curtailing freedom for many individuals. When co-payments are too high, or someone has no insurance and health care means going bankrupt, those are real losses of freedom. It is ironic that unwavering faith in the free-market (and contempt for any government role) is being expressed at the same time the country is recovering from an economic meltdown caused by too much greed and too little government oversight.

None of the proposed plans involve socializing medicine, creating a single payer system, or government run or owned hospitals. They merely acknowledge the reality that a morally defensible health care system will only come about with some government involvement.

Myth #3—Health reform will control costs by depriving patients of needed medical treatments

There is absolutely nothing in any of the reform measures that suggests or requires that needed medical treatments will not be available. In contrast, within our existing system, those without insurance or “under-insured” patients who can not afford rising out of pocket payments are denied needed medical treatments on a routine basis. Reform makes it more likely that patients will receive needed medical treatments (not less likely).

Myth #4—Health Reform will deny older Americans medical treatments at the end of life

The lies about “death panels” that Palin, Gingrich, and others have been spewing have led the Senate to withdraw one element of the House legislation that would have both reduced costs and increased patient freedom. This is the proposal that would have allowed payment to primary care physicians who spend time with their patients talking about the patient’s wishes with regard to end-of-life decision-making. Right now, 25 percent of Medicare is spent on the last two months of life. Families in these contexts often face difficult decisions with no idea of what a patient’s wishes are. In those settings, we typically default to providing more aggressive measures, even if it increases suffering and may be at odds with a patient’s wishes. Encouraging patients to make choices ahead of time–whether for more aggressive measures or for a greater focus on comfort at the end of life– promotes freedom and has the potential to reduce costs (since 80 percent of people prefer less aggressive care).

This is the precisely the role that government should be playing—creating incentives for good medicine that promotes patient autonomy—and to counter existing incentives which all too often lead to less choice, more suffering, and increased costs. When Palin, Gingrich and others portray talking about our wishes with our doctors as “death panels”, when they attack scholars’ work out of context, when they misrepresent what is in proposed legislation, they undermine any hope of rational dialogue about the ethical challenges presented by health care and the very important and very real challenges and trade-offs that should be the subject of debate.

49 comments

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Even criminals (the least among us) deserve civilized health care.

If we can afford to bailout Wall Street, then we definitely can afford to provide health care for Americans. Priorities.

Posted by Hilary | Report as abusive

DEAR JACK: I do feel and I’m proud people have stood up in the Town Hall meetings. They do represent my thoughts. And I WAS NOT PAID by the GOP or INsurance Companies. Sorry to burst your bubble

Posted by Zacharia Leto | Report as abusive

The thing that strikes me as being a real and genuine problem is the transfer of accountability (if you will) from person to person, or more accurately, from administration to administration. Why is Obama being held responsible for the massive economic failures, excessively high defecits, and other issues that drive Americans away from Health Care reform??? Some members of the far right (who by no means represent the average American conservative!!) would have us believe that it is ultimately more expensive, and thus more damaging, to repair the health care system (perhaps the most massive dragnet on our economy in history) than to have our horribly flawed system remain in the same awful condition that it is in today. These same radicals would then have us believe that the economic problems affecting our country are caused by Obama, and that all of the steps he has taken to fix the economy (including his campaign for health reform) are simply making it worse. This may or may not be true, but tell me, Sarah Palin and Rush Limbaugh, when did the Recession begin? Care to forward a guess? Who wiped out a budget surplus and created the largest defecit in history? Any takers on that one? Who created a whole new definition for the words “Discretionary Spending?” Who lowered taxes on the ultra-rich so that they could afford to move all of their factories off shore? Who allowed a business model focused on greed and taking advantage of the mid-lower income classes to thrive and expand on Wall Street AND on Main Street?? Who has fought one of the most expensive wars in history for no benefits (tangible or intangible) in Iraq? Who alienated us average Americans from both our foreign brothers/sisters (they are just as human as the rest of us, they are not some “idea” that we can be compared against) and each other? Who ramped up government spending to levels not seen since all Eurasia burned and suffered under the boots of Nazi Germany and Imperial Japan?? If the answer to this question is not the actual perpetrator of these events (I will not anyone’s intelligence by naming him here) and if people cannot associate these same events with our present economic woes, then there truly is some force at work in the United States with the awesomely powerful ability to move accountability from one person or group to another. If this is true, then our country, that me and all of us reading here love so much, is in greater danger than it has ever been in before. I consider myself very patriotic, but sometimes being patriotic means being able to recognize and repair problems with one’s country. Stating that there is a problem with a country is not being unpatriotic, it is being honest. Right now, honesty, accountability, and the ability to distinguish between truth and fact is needed by not only our leaders, but by us as well. The fact is, health care reform will be expensive. There will be taxes. There will be uncomfortable financial situations.

The truth is, not repairing this troubled institution, and not sacraficing something to do so is tantamount to looking the other way as the hole in the dike gets bigger and bigger. Violently ignoring the problem (as poor old Rush and Sarah are doing) is not what this country needs, and is indeed useless. The truth is, sacrafices have to be made, and hard work has to be done, in order to repair a hole in a dike. Those who disagree on whether or not to repair the dike are unwise. Those who disagree on HOW to repaire the dike are trying to arrive at the most effective solution, and are voicing legitimate concerns with the plan. However, let us remember that in this struggle there is no room for those who would argue that band-aids are the most reliable treatment.

Posted by LS | Report as abusive

PN: the left is not persuasive, and did not make the arguments in this debate persuasive, and they have cost us health care reform as a result.

The facts are there for those who seek them.

Such as:
* European countries have Public Option Health Care that costs half as much as the US (about $3200/per person) and one may chose their GP or Specialist or Pharmacist.
* European countries have both Universal AND Affordable Public Option Health Care because service prices are mandated. This is necessary because health care is an oligopoly (too little Supply, too much Demand), which means competition is non-existent. (Ask your GP who his/her \”competition\” is … they\’ll recommend to you a psychiatrist.)
* European Public Option Health Care is single-payer and in some countries covers up to 100% of both Primary AND Secondary Care costs. No one dies because they cannot get either.
* European hospitals are built, run and managed by the government, thus able to impose lower vendor pricing by means of \”bulk purchasing\”.
* American private HC-insurance for employees is paid for by whom? The cost of the insurance policy is factored into the prices of company produced goods/services. They are thus an indirect tax that we consumers pay. And, those who do not have HC-insurance pay that indirect tax anyway …
* European physicians earn about a third the wages of their American counterparts (who earn $165,000 per annum). They do so because their Medical School and Internship programs are paid for by their governments. They do not graduate from Med School with the albatross of a $100,000 debt hanging around their necks.

All the above \”facts\” are verifiable, if you want to take the pains to do so.

What planet do you live on?

Posted by Lafayette | Report as abusive

Success Requires Admitting the US Lifestyle is UNINSURABLE and healthcare delivery is BROKEN

POINT ONE America: you are overweight, you feel you need to eat 3 tons of sugar per day, you drink 60 cups of coffee, you don’t exercise, you barely even go outside, when you do the air is polluted, your water supply is deteriorating, the number of chemicals in your food and environment is skyrocketing every year, you don’t teach your kids how to be active and healthy, you take 12 prescription drugs every day, there is still a good chance that you smoke or dip or chew (or used to), you drink a little more than you should (and then you drive), you don’t wear your seatbelt, you won’t wear a motorcycle helmet – or a bike helmet (God forbid these constrain your “freedom”), you work too much, and you are stressed out all the time because you buy houses, cars, and junk that you can’t really afford or pay for.

In short, you are 100% uninsurable. Many will say “ah, but if we are uninsurable why then do we have a private insurance industry that is profitable?” Answer: people, an industry that has to raise the price of its product by 14% per year every year for the past 10 years isn’t profitable, it is just positioned – unlike all other businesses – to be able to pass 100% of its cost increases on to its customers every year (so it appears to be profitable).

This doesn’t happen because we have an insurance lobby (go ahead and hate them anyway, because you can!), but it really happens because there isn’t an alternative. Remember – you are not insurable! If private insurance companies didn’t pass cost increases on to you they would soon be out of business (unless they sold product that didn’t actually cover anything). Does this mean that the government should “compete” with private insurance? Answer: no, because the government would then just switch places with the private insurer – i.e. would have to pass ever mounting costs on to the public in the form of ever increasing spending and debts (leading to national collapse) or would have to cover less and less every year (politically difficult). Everyone needs to realize that the dilemma we face isn’t about public or private schemes. It is about an American lifestyle that is uninsurable at any cost other than increasing costs by 14%+ per year! And any of you who think Obamacare can reduce the cost of health medical record administration enough to reverse this trend is a lunatic.

America – we could afford to insure everyone and we could achieve that through private, public, or a combination of private and public schemes… but only if you weren’t all a grossly uninsurable society in general. America – like energy policy, the recent financial crisis, or any other massive f-up that faces the country, we seem to argue about cures instead of root causes.

POINT TWO America: you have a healthcare delivery system that won’t succeed no matter how much money you throw at it. Healthcare deliver in America has been developed by the American Medical Association and the Department of Health and Human Services (the first favors expensive treatments and procedures and the other sets the parameters for law suites). American’s have put much, much too much faith in “MD driven medicine” and the perceived benefits of punishing the industry with malpractice lawsuits. Don’t for a minute underestimate how much the medical establishment has at stake with reform – especially if reform were ever based on moving to an approach that required less chronic condition treatment!

Our system was not developed by the American Nurses Association or the Center for Disease Control – both of which would be better suited to the task of developing a system to promote society wide prevention and regular screening and treatment based care systems… and so we miss out on the benefits of a “public health delivery” approach. The scary thing is that many, many countries do much better than the US at a fraction of the cost. If you go to the following web sites:

American Medical Association (AMA): http://www.ama-assn.org/
On this site the entire home page has been made over to show that “AMA supports national health reform”. In fact, you can get a document that will try to recruit you to support reform – in just the way the AMA sees things.

Department of Health and Human Services (HHS): http://www.hhs.gov/ocr/privacy/
This is the central nervous center of the bureaucracy that gets heaped onto the healthcare industry both public and private alike. Currently the home page is promoting health information privacy, insurance portability privacy rule, and patient safety quality improvement (all great, but bureaucratic and certainly not revolutionary stuff).

American Nurses Association (ANA): http://www.nursingworld.org/
More helpful site that makes mention of health care reform but has 70-80% of the space devoted to some useful stuff, especially for practicing nurses.

Center for Disease Control and Prevention (CDC): http://www.cdc.gov/osi/goals/people/
The home page of this site offers the following topics without even a single click: safe schools (obviously a seasonal topic), preventing obesity, parenting tips, H1N1 flu. Also on the home page, easy links to sub topics in the following categories: common diseases and conditions, healthy living, how to deal with emergencies, injury and violence, life stages, and workplace safety and health. folks, obviously this is the only government organ that actually has any clue about what will be needed to succeed – or at least it is the only organization that seems to understand that the mission is about education and health maintenance.

America needs more flexible health clinics that are placed very close to the community. Every school should have a very strong school nursing staff that can deliver primary care to attending adolescents. Most health maintenance should involve much more frequent visits to clinics located easily in communities (not in far off or big hospitals) and should be staffed by experienced nurses and physicians assistants with a smaller number of MD interactions per 1,000 patient visits.

The country is a leader in the most exotic types of medical research imaginable. But most of us will never need such care. How we pay for it for those that end up needing exotic care is hardly the problem. The problem is paying for chronic nagging conditions like diabetes that are preventable, the problem is treating diseases at later stages instead of at earlier stages due to failures in screening, and the problem is spending outrageously stupid amounts of money on people who are on their death beds with exotic and useless treatments.

Solutions: 1) citizens should be expected to live healthier lifestyles or be taxed into oblivion for making the rest of us pay for their poor resulting health, 2) we need guaranteed access to screenings for all know chronic conditions whether paid by private, public, or public/private schemes and the clinics need to be closer to communities (probably nurses and physician’s assistants need to be leveraged more effectively in these clinics with less direct required involvement from MDs), and 3) we have to admit that we can’t spend endlessly for exotic end-of-life treatments (these treatments should be paid directly by patient or patient’s family, otherwise just die in damn peace). This type of action could actually reverse the spiraling healthcare spending trend, but guess what America – you won’t get it because you won’t change your lifestyle and you aren’t smart enough to require your politicians to reform the system around prevention.

Posted by Bob | Report as abusive

I agree with LS Aug 24, 2009. This person speaks my same thoughts so eleoquently.
Our country is not enjoying a healthy life, when so many people cannot afford any health insurance, or are refused insurance due to pre-existing conditions. When they are turned away from medical health, illnesses get worse. Prenatal care gets ignored. Women’s health is always being threatened by zealots who live with their heads in the sand. People die who should not be dying. Now that is more like “the death panel” we are dealing with. Those who fight Obama’s healthcare efforts with lies, scare tactics, threats, total rigid heel digging irresponsibility, are the very people who likely have their best health insurance in place and enjoy good wages every government payday, and who’s children were excluded from having to participate in the Irac War.
I have experienced the furror of an ignorant non-thinking tag along who is totally against Obama’s health inititive, but whos wife enjoys a clean nursing home, medication, good food, a doctor, nursing care around the clock, all covered by his insurance. How does this make sense? Why should one count on healthcare, but another is forced out because he lost his job, because our economy went South with the former administration and greedy companies moved to China and other contries so they don’t have to pay respectable wages, much less pay into our social security system. American citizens frequently have less to enjoy in their homes than prisoners in the big houses. We need to wake up and get our priorities in order. That means educating our minds correctly regarding the ills in this country that Obama is trying to correct and stop puppeting these nay sayers lies, myths, and scare tactics. Wake up! Get your heads out of the sand before YOU find yourselves without too and little hope of help for your heath and wellbeing.
Now our souldiers return wounded mentally as well as physically and the VA has not been properly set up to handle our men and women who severely need and definitely deserve the best care a country can give.

Posted by kathy Warren | Report as abusive

I do admire the progress medicine has made in the USA. But along with the progress, the welfare of the citizens of U.S.A regarding health care has taken a back seat. On my few visits to U.S.A I was always happy to be back in the U.K. I have all the security I need here, to survive and live a decent life, which I do not have in your country. My impressions of life in the States is based on my experience as stated below.

I had an american couple as friends in Germany in 1972. When the wife was admitted to the hospital for delivery, the husband, being a foreigner was asked to pay the costs. He was surprised to find that although he was insured, his insurance in the United States did not cover his costs. He was very disgusted about it.
On my visits to your country, I had the opportunity to meet many physicians and surgeons. Whenever there was a group of doctors at a party, I was surprised to find that their talk evolved totally on their income, number of patients they have and also how they were spending their money. Their life style was to the point where it could be considered vulgar in european countries. The wives competed as to who had bought the latest car and what their husband was planning to buy next.
Arshad Khan
I believe that Obama’s reforms will be stalled by the doctors, insurance companies and of course by the right wing groups. It is very obvious here in the U.K what the neocons are attempting to do by the vitriolic, rhetoric statements about the reforms. The mind bogelling statements of some politicians in your country shows the narrow vision of these people and the seeds of discontent they are sowing. They are holding american public hostage because of their lack of knowledge about other developed countries. It should be embarassing for the americans when Palin opens her mouth and blurts about health care when she was at sea to explain the Bush Doctrine.
I believe the americans can make a better choice without lookin at their TVs and reading the newspapers. I do believe that americans can then make a better choice and so will really make USA a truly great country.

Posted by Arshad Khan | Report as abusive

Does the USA deserve a World Class Health Care System? Yes, it does. Do I believe the Federal Government can impliment and effectively run such a system? No, I don’t. All the Government ever had to do was watchdog the existing industry and occasionally make laws to ensure it didn’t run roughshod over the citizenry. That’s all Government ever has to do with any industry be it banking, automotive, what have you. Instead, they do nothing, or create laws that make things worse. Then when things ultimately implode they stand on a soap box and insist on Federalizing everything. My simple question is, where were they before the dung hit the fan? And, as a follow-up, since they let us down by allowing the mess to happen how can we trust them to reinvent the wheel?

Posted by GLK | Report as abusive

Folks–Thank you!! Although, people can’t seem to help adding far-right this and far-left that examples, you are providing people a sound structure with which to debate! I hope everyone that is reading mails this article and its comments to their congressional representative!

I think the Democrats and the President have given the American public a reasonable start to what they are proposing for health care, but it is only a start! There are questions asked by reasonable people above and I want to hear the answers! I want to know how adding millions of people to the load of hospitals and doctors in this country will effect care, or not effect it!

Can we not get the best minds in this country to think about reasonable questions and discuss them? I would much rather hear all the news shows pouring over points made by people in these comments than an unending stream of left yes, right no, with no real thought or challenge behind their statements!

So thank you! You’ve given me more information than every news show to date!

Posted by Tim | Report as abusive