October 1, 2014
Despite the political mudslinging that continues to erupt at mere mention of the Affordable Care Act, it’s clear that the law has opened up the healthcare system to millions of Americans. A Gallup poll recently found the adult uninsured rate fell from 17.1 percent in the fourth quarter of 2013 to 13.4 percent in the second quarter of 2014, the lowest level in six years. But while this expansion of coverage is a boon to the many who lacked sufficient access to medical treatments and services, it draws attention to questions that cut to the heart of healthcare reform: To what extent is our consumption of healthcare extraneous, and to what extent is it harmful?
Though the US economy is still struggling to recover from the recession, spending on healthcare is on the rise. In fact, the US spends more on healthcare than any other country. According to the California HealthCare Foundation, total healthcare spending is projected to hit $3.1 trillion this year, an amount that the Centers for Medicare & Medicaid Services expect will climb approximately 6 percent per year from 2015 through 2023.
While the largest segment of those expenditures—about 32 percent—go to hospitals, it’s pharmaceutical corporations, as well as their distributors and benefit management services, whose earnings are the most concentrated. McKesson, the largest drug distributor in the US, earned revenues of over $120 billion in 2013. The country’s biggest pharmacy benefit management service, Express Scripts, landed over $100 billion, and pharmaceutical company Pfizer collected over $50 billion. For some perspective, in the last fiscal year, the revenues of McKesson and Express Scripts were each greater than those of Citigroup, Amazon, or PepsiCo.
Such dramatic figures are the result of an inefficient and economically unsound healthcare system, one fueled by overtreatment, argue Shannon Brownlee and Dr. Vikas Saini of the Lown Institute, a Boston-based nonprofit committed to “building a compassionate and sustainable health care system based on people receiving the care they need and eliminating unnecessary care that can cause harm.”
Brownlee, a former medical reporter for U.S. News & World Report and current senior vice president of the Lown Institute, investigated the overblown nature of the healthcare system in her book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. Saini, a clinical cardiologist, lecturer in the Department of Medicine at Harvard Medical School, and president of the Lown Institute, helped convene the Avoiding Avoidable Care Conference in April 2012. Through the Lown Institute’s initiatives, including the RightCare Alliance network of practitioners, patients, and advocates, Brownlee and Saini are deeply engaged in the intersection of patients’ rights, clinicians’ needs, appropriate care, and the road to a more functional healthcare system.
I spoke with Brownlee and Saini by phone while they were at their offices near Boston. Our conversation traversed matters medical, political, and personal; of an unnecessary medication that Brownlee’s father had received, she said, “It just about killed him.” In the interview that follows, Brownlee and Saini articulate the structural and cultural issues in the American healthcare system that enable the drug and device empire to do such harm.
—Grace Bello for Guernica
To read the interview, click here.