I happened to read something about nature the other day. The subject was how living things coexist in their spaces: it brought back memories of my college biology courses in ecology. (Perhaps it also offers an explanation for why the human species is going increasingly nuts inside the flying sardine cans the airlines have created).
Here are three terms.
Symbiosis: This comes from a Greek word simply meaning ‘living together’ and can be used to describe any association between two organisms.
Mutualism: This can be used to describe an association in which both organisms apparently benefit
Parasitism: In this association one organism [the parasite] benefits, and the other [the host] is adversely affected [weakened, sickened, damaged etc].
I draw these definitions to your attention, because I have a point to make here about our American healthcare system as compared with others. To do that, I look back to the last commentary I wrote about the UK travelogue of Dr Richard Young.
When you consider the health care systems in most industrialized nations, yes you see challenges just like we have here. But what distinguishes them and their challenges compared with us is that they produce better results at much lower costs. In the UK for example, Dr Young tells us that the British rationale is to spend on quality healthcare without frills, excesses and waste. The Canadians are the same way. Consequently, there are likely far fewer MRIs in these entire nations than there probably are in Chicago. There’s a stiff upper lip when it comes to waste, and there’s strong evidence that the British people are mindful of that as much as the British government is. They just don’t demand as much, and the common sense medicine practiced under the watchful eye of primary care physicians in the British NHS keeps their checkbook pretty well balanced. So the symbiosis of the British healthcare system and the people covered by it can perhaps be defined as a medical-economic mutualism. Each party derives benefits from its association with the other and they live peaceably and healthier in the same space.
Don’t get me wrong. There are many good things about the US health care system: it’s a medical-technological marvel. It’s just that we overdo so much of the good stuff – we do too much of it too soon, waste money on the excessive and unnecessary and push people into the healthcare meat-grinder far too fast. That explains why the term medical bankruptcy is so prevalent here, and nonexistent elsewhere. And we have overspecialized our healthcare system with physicians who are body parts specific, at the expense of the type of quality medicine that the Brits deliver from their general practitioners. We (meaning the AMA, the government, the insurance reimbursement system and spoiled American consumers)) have crippled the best delivery of healthcare we could ever hope to have. All we have to do is wake up and do the right thing by promoting and fostering strong primary care, family medicine as the required first step into the system. Got a headache, bellyache, sore knee? First stop – required – is your family physician, not a neurologist, gastroenterologist or orthopedic surgeon. And be glad you have a family doctor who knows you and all your parts. Raise a ruckus with your elected representatives to pay family doctors better, which will hopefully encourage new doctors to consider the challenges of family medicine. If you can do that, and we can get a hale and hearty primary care system running at peak efficiency – that’s going to create mutualism – good for patients and good for primary care docs. Good for the wallets of a nation, its employers and its people.
The stories come out regularly about surgeons doing too many unnecessary and/or questionable surgeries because they can and because it’s lucrative, e.g., heart procedures, spine procedures, knee replacements … the list goes on. Hospitals and highly profitable freestanding ERs are sprouting up everywhere, hospitals are on a spree buying up physician practices and jacking up office call costs, insurance companies only giving the best reimbursements to mega-groups and freezing out small practices until they can no longer survive. That folks is not a mutualistic healthcare environment. That is a parasitic relationship and look where it weakens and damages – US employers becoming less competitive in world markets, more and more of the nation’s GDP being eaten up by healthcare costs and not spent elsewhere, pharmaceutical companies charging obscene amounts for the latest drugs rolling out and people being wiped out financially.
Can anyone reasonably argue that we have a good thing going? When the broken system makes a lot of money for purveyors,costs a lot and does economic and health damage - that’s parasitism – good for one, bad for the other.