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Health Care Should Be Driven by Mission, Not Money
As health care reform legislation enters a critical phase in Congress, it's important to keep our eye on the ball -- elements essential to the success of any reform effort. In order to define those elements, we must have a clear understanding of the nature of the pathology in our dysfunctional health care system.
Modern high tech health care is a right of the residents of most wealthy countries in the world -- except the United States. America is exceptional in this regard. It is also exceptional in being the only wealthy nation where health care is considered to be a business.
Prior to about the mid-1970s, American health care institutions like those in other developed countries were overwhelmingly non-profit locally controlled entities driven by their mission -- comforting the sick, curing illness, and promoting healing.
Most physicians practiced independently or in small groups, free to carry out their Hippocratic oath. Hospitals were community based non-profit institutions governed by local volunteer boards. Private insurance companies were also mostly non-profit, and rarely crossed state lines. Pharmaceutical companies were small, often family owned and mostly driven by George Merck's ethic: "If we develop medicines that cure disease, the money will take care of itself."
In the mid-1970s, leaders in American health care fell in love with business. They began to believe that management could be improved and costs controlled by a stiff dose of good old American business know-how. As a result, first MBAs and then full-fledged corporatism began to engulf and transform medical care. Hospital administrators became CEOs, services became product lines, patients became market share and so on.
Hospitals consolidated and became part of larger networks. Local control was weakened or lost. Insurance companies consolidated across state lines, and ownership was transferred from non-profit local corporations to for-profit multi-state and national corporations. As pharmaceuticals became a larger part of medical care pharmaceutical companies grew, became more profitable and merged, eventually creating huge multi-national conglomerates. Ownership was transferred from private (often family) hands to distant shareholders through lucrative public offerings. Health care products and services became just another commodity to be traded on the stock exchange -- their value judged only in terms of return on shareholder on investment.
The practice of medicine, the bedrock of any modern health care system, changed too. Doctors went from being independent professionals, bound only by their Hippocratic oath, to being employees of increasingly large corporate entities, many of them also for-profit. As a result, physicians have come under growing pressure to tailor their clinical decisions to the revenue and profit demands of their corporate employers. These demands often conflict with the profit driven demands of insurers, attempting to maximize their profits by minimizing their "medical losses." Revenue driven medical care was born. This profit-driven micromanagement of physicians' decisions about how to treat their patients exists nowhere else in the world. It too is uniquely American.
As a result of these structural changes, the mission of the American health care system changed. Increasing shareholder value became the driving force in the financing and provision of medical services. In the process, the healing mission of medical care has been diminished and sometimes lost altogether. This too is a uniquely American phenomenon.
In order to resuscitate the healing mission of medicine, a few very important changes must be made to drive the profit motive out of the financing and direct provision of health care. They must be a dominant part of any successful reform effort.
The first step must be the strengthening of our publicly controlled non-profit system of financing medical care. From a policy perspective, the simplest and most direct way to do that would be to gradually expand Medicare. Medicare is effective, efficient and popular. The eligibility age could initially be dropped to 55, and then gradually lowered to eventually encompass the entire population. Unfortunately this fair, simple and elegant solution is also the most politically difficult due to the enormous influence of the medical-industrial complex on our politicians.
The second step must be to remove the profit motive from the direct provision of health care services by changing the way doctors, hospitals and other providers are paid. We must eliminate the fee for service system, and move toward global budgets for hospitals, and salaries and bonuses for doctors. This would remove the influence of fees for individual services on clinical decisions and would eliminate the single largest driver of exploding costs in American health care. It would also allow the incomes of primary caregivers to be brought closer to those of specialists and stem the exodus of doctors out of primary care practice. Higher incomes for primary caregivers relative to specialists would be justified by their role in managing the use of specialists and expensive tests and procedures.
Third, we must greatly strengthen the ability of our public insurance system to control the prices of pharmaceuticals and medical devices to bring the US more in line with all other developed countries. These companies are entitled to a fair profit but not the windfalls they are currently receiving due to the market protection they enjoy from federal patents, protection from price negotiations by Medicare and the massive public investment in biomedical research that often forms the basis of pharmaceutical products.
Health care reform without these basic changes is probably not worth doing, as it would simply reinforce the existing dysfunctional system. If these changes are part of reform, we will be on the way to joining other civilized countries in making health care a right of all our people. If not, it will continue to be an increasingly expensive commodity that only the wealthy can afford.
33 Comments so far
Show AllI like what Caper said but since he has been working as a Ted Kennedy staffer, I have one question that he must answer. Why didn't his boss ever push for single payer health care in all his years as senator of MA?
Jason Jordan
Sandpoint, Idaho
You've summed up the problem beautifully, Dr. Caper:
Health care reform without the basic changes you outline is probably not worth doing, as it would certainly only be a sham and simply reinforce the existing dysfunctional system.
The changes that you say are required will NOT be part of reform because the corporations who hold a tight grip on all of their congressional collaborators will see to that.
We "common people" can only dream of joining other civilized countries in making health care a right of all our people!
I have been waiting for a great summary like this, a clear and complete explanation of what real reform would have entailed from the health industry perspective, from the horses mouth as it were.
I hate to be blunt, but as this writer describes, much of the health care industry has become just like more pigs at the public and the private trough.
The situation in the health industry is very similar to that of two other bloated industries: the military industry and the financial industry. The stark fact is that the health, the military, and the financial industries (Wall Street / the huge banks) are essentially the only three large scale industries left in the United States not subject to the devastating impact of severe recession and depression forces. Most and probably all other large industries are left to implode and rot from more or less permanent severe recession and depression. While employment in the "Big Three" will stay roughly the same or even go up a little, employment in the far larger number of large, depression-impacted industries has gone down, will continue to go down, and will not be coming back under the kind of total right wing control of the economy that you have in the US.
Notice that it is, ironically given all the free market propaganda, taxpayer money and the Government that propels those Big Three industries and protects them from the ravages of economic depression. It is not market forces. There is a massive, unprecedented distortion and perversion of the market involved in the favoritism shown toward the Big Three. Specifically, tax payers and creditors such as China, Japan, and Saudi Arabia are paying or investing through the teeth to engineer a vast increase in the amount of goods and services that are produced and sold in the US by those three particular large industries. The health deform is to legally force some people who have been trying to avoid this perversion and distortion to join in it.
But this is the essence of what the health care deform is really, secretly all about. It allows the health care industry to join the other two as part of the Big Three that will be protected by the Government (and by extension by the people who fund that Government) from the depression that is indefinitely hitting and gradually imploding most other industries. Or to use the metaphor, it is these three industries that are getting on the lifeboats of the Titanic, so that they can then in effect be rescued by another ship. Meanwhile, everybody else gets no lifeboat, but merely the false comfort of rearranged deck chairs and a macabre entertainment while the ship goes down.
Oh, but you were not entertained by the Tiger Woods story nor by the story about the couple that attended Obama’s shindig uninvited? Too bad, you were supposed to be entertained, so that your mind could be taken off the fact that you are being economically abandoned and drowned by your government.
Since 1980 if not longer the US frequently goes from bad to worse under the cover of “reforms” and “commissions”. "Reforming" something is merely an excuse for the pigs to make sure that more and more feed comes into the trough for more gorging. What an irony, for example, that Medicare could be the keystone of a valid and successful reform, but in actual fact the crazed Democrats are CUTTING certain aspects of Medicare and not increasing eligibility for it at all.
For unification of non-right, for prior articles, and for prior commentary y'all are always invited:
http://www.unity-progress.blogspot.com
"The situation in the health industry is very similar to that of two other bloated industries: the military industry and the financial industry"
Surprise surprise for most leftists who, unfortunately, buy into the act first, think later, mentality prevailing in the good ol USA. Such a mentality stifles our ability to connect the dots and arrive at the real problem definition: It's the societal values. USan society values elitism, domination, submission, hierarchy, injustice. It affects all sectors of the economy and the society. Squish elitism under your boot heel. Stop beating around the bush.
Profit is the quintessential American value. At least, that's what the MSM and politicians have been telling the people for the past 30+ years. You know, "government is the problem" only free enterprise and individuals free to pursue their own self interests can solve all are problems.
Dr. Caper you've written a thoughtful and cogent piece. But I don't believe it will get Americas out their ideological stupor. The brilliance of the right has been to convince most Americans that they can be the wealthy - that all Americans can be above average, that there are endless vistas and resources. The American Left has been castrated and continues to act as such.
It's sad to admit this, but I am so over this charade they call health care reform. The longer it goes, the more I realize that there is no "there" there. We are not going to arrive at a point where any meaningful, long-lasting, or even groundwork for improvement is going to happen. The more they tinker, the less like reform it will be.
During the summer it began to dawn on me that I live in a state that already has better health care policies than Congress was contemplating. This fall, that fact was acknowledged with an amendment in the House bill that exempts my state from the bill. Folks, it is no reform bill working through Congress. It is another corporate giveaway with a misleading label. It is legislation that is more than 30 years behind what Hawaii already has (and Hawaii is so far from perfect - you don't want to get me started).
I am done. Only a few years from Medicare. It isn't going to happen in my lifetime. Plus ca change, plus ca meme chose.
For a detailed look at just how deep the rot goes in our current "system" check out Melody Peterson's recent book Our Daily Meds.
It shocked me. I thought I was pretty disillusioned and cynical but this book brought me to a new low in my estimate of my fellow man.
Nice summation of the basic problem. The evolution of healthcare into a major profit center has not brought the lower costs through increased competition that its proponents promised. Instead it has created another political hog at the trough, an Enron-like gaming of an ever-increasing pot of tax revenues.
Philip Caper would remind us of the non-profit basis of healthcare, but his voice does not have a big enough money megaphone to be heard. Here is a sample of the voices informing the debate:
“What’s becoming better understood is that our healthcare crisis is fundamentally a business problem,” writes Hammergren. “The system is overstrained and is breaking down due to outdated information technology; poor application of the basic principles of market economics; overall inefficiency in terms of work flow, care delivery, and the spreading of best practices; a lack of transparency around quality and cost; and blocked access to making informed consumer choices.”
That from John Hammergren, CEO of McKesson, a company who distributes one third of the drugs in the US and is "the Nation’s leading healthcare Information Technology (IT) company." I believe they are also a member of Novation or Global Healthcare Exchange (one of the two, if they haven't changed moved the pea under the shell again).
and
“This is the right time to reposition our healthcare business, given the changes and challenges in the industry,” GE Healthcare President and CEO John Dineen said in a statement. “Our customers are looking for productivity and solutions. We will focus on the products, the process excellence and the partnerships that broaden access to healthcare and reduce its cost.”
http://www.fastcompany.com/blog/christine-arena/case-point/big-biz-reforming-healthcare-where-it-hurts?#
(GE is also a member of the congress-created monopoly on group purchasing.)
See, a few more billion here and there, another initiative, some backroom tweaking, and voila, this growing pile of profits will turn into improved care to human beings. Stay the course, and keep the faith. There's will be no going back from the great business being done.
I can't say I'm reassured by the CBO scoring, either. They say the $849 Billion in increased subsidies will be offset by savings and increased taxes to net a savings of $30 Billion over 10 years. This in a report that uses a billion as a rounding unit in their calculations.
Would it be unseemly to also point out the scandal in 2003 surrounding the scoring of that monstrosity? Seems that Rick Foster, the chief actuary for Medicare was metaphorically duct-taped and thus unable to tell congress his estimate of $550 billion over 10 years for that bill. Congress voted on an assumption of $400 billion. If the truth had been told, the prescription drug bill probably would not have passed.
Let's hope Congress isn't telling themselves what they need to hear in order to chump the public into letting them deliver the corporate goods - again. This bill is heavy on increased subsidy, increased penalty on the "customers" (aka citizens and patients) and very light on real cost control. The taxes they propose on the Industry are, to the corporations, just expenses to be made up elsewhere.
Socialize necessities, privatize luxuries.
Concise, and the perfect mantra for the reform without which the US cannot survive.
So what it really comes down to is that we can either keep paying big business to kill us off or we can take the battle to THEIR front doors. WE are the ones with nothing left to lose. WE are the ones who are being treated like a forever bottomless pocket just waiting to be picked. WE are the ones who have been screwed for our very lives. WE are the ones who pay for decades at a time until we actually NEED the health care, only to be told that we aren't covered, it's a pre-existing condition, or the company just doesn't think that you NEED that life saving operation.
And now we're being told that even though we don't have enough money to take care of ourselves, we have to go nation building and continue a STUPID and INSANE war policy started by an idiot and a war profiteer. THAT they can somehow find the money for, or at least the will to borrow it from our grandchildren. Talk about priorities! We, the very ones who are paying for their stupidity, can't be helped in any way, or the country goes to hell. But any country that we invaded illegally and stupidly, THAT we have to continue.
Funny how this serious love of greed and money over life took place under Reagan. I said back then that this would be a disaster waiting to happen, that the country would suffer and possibly die because of it, and I got called names, told I was full of shit and had my head up my own ass. Funny, looks like I was right all the time.
Until money stops being the only reason to live, this country has nothing, offers no one anything but indentured servitude, and has no reason to be happy about being here. Check out the Daily show from Monday. Seems that Americans are moving to Mexico so they can afford health care. Yeah, a GREAT country we got here, isn't it?
i could not have said it better, we have plenty of money for war, but fuck the american who works hard pays taxes and can't afford heath care so he loses everthing and die's
The object is now and always has been: Mandated giveaways direct to the HMO's with a pitiable public option handled as welfare (we all know what we do with 'welfare' in America) with NO regulation that the Big Pharma and the HMO's can't drive an 18 wheeler thru (with a bit of billion$$ fraud on the side to sweeten the books). Those that got get less for much more and those that got nothing get to die in a ditch (and maybe their relatives have the cumshaw to claim the body and maybe they don't have the money to bury them). Then comes the BIG COLLAPSE and all that "employer based health care" that big money preserved is now gone the way of the dodo and everybody's in court and threatened with jail for non-payment of health care mandates. Does anybody doubt this for a minute?
"In the mid-1970s, leaders in American health care fell in love with business"
Carefully note that our DEAR LEADERS led the slide. It's time to review our blind deference to leaders and hierarchy. Let the colossal series of mega-failures by "dear leaders" past nine years or so usher in a new era of grass-roots participation in public policy.
We have to build a lever of influence for the grass-roots. An organization without a hierarchy.
The local agenda is going to be the permanent national and global agenda. Localism is the only way. The alternatives destroyed themselves. They are not living. They are the undead. Wall Struck is undead. The MIC is undead. Chicago's Commodity Casino - undead. Health Maintenance Organizations - undead. Fossil energy - undead. Mass commute in private vehicles - undead. Intellectual property - undead. Privatization of everything - undead. Economic growth at all cost - undead. Corporate control of food supply, general industry, media, and public policy - undead.
rtdrury: I absolutely agree with everything you've said and then some.
I fear, however, that they would not go quietly and the transition would not be pretty. If Fear, definitely with a capital F, takes hold, all bets are off, except for the coming race war and/or fascist state. I'm hopeful that at least, in some places, strong local leadership would make a difference and mitigate the fear.
Humans will always respond to strong leadership, we just have to reverse the concentration of power at the top. It's also depressing to me that Obama had the chance of a lifetime to initiate this with a return to New Deal banking regulation and he blinked. Actually, he shut his eyes and turned away. He would have had 80% of us on his side.
The day O walked into the White House they let him know, in no uncertain terms, who was in charge - namely the 0.01% who have stolen the real wealth of the nation.
I'm afraid you are right, and if you are, there is no way for us to get our country back. It will continue to be run by and for corporations.
You're right.
I think the title of this essay is key. What drives people is ultimately what is going to drive our healthcare.
And as far as influencing what drives people, I think it's become increasingly clear that you need not only a reasoned argument--but maybe more importantly especially with regard to healthcare--a moral one too.
But it's tough to make a convincing moral argument that bartering people's health for profit is wrong while supporting a plan that allows for the continued existence of that bartering.
I would rate this article at the top of the healthcare reform debate. Cathy at California Nurses Association does a good job too.
Dear Dr Caper--You appear to mean well but you are wrong. Not about the changes toward business oriented health care, but about the solution.
If you had been on Senator Kennedy's staff last year you would have heard testimony from Dr Mark Hyman about what he terms functional medicine. Among other things, he claimed an 80% cost reduction in treating ADHD kids by using allergy testing, diet changes and nutritional supplements.
The first thing to do is stop the FDA from taking low cost, effective supplements off the market to prevent them from competing with expensive, patented pharmaceuticals. If you are unaware of this practice, you may wish to contact Dr Hyman or Dr Ron Paul or just search "FDA bans pyridoxamine"
And any physician who thinks it's OK to prescribe proton pump inhibitors without doing a gut pH challenge test is, unfortunately, a big part of the problem.
His first two steps of the solution sound reasonable and thorough. I think that the goal of those two is to eliminate the profit motive that controls the health care system negatively. I didn't understand his third step of the solution since I don't see how having all the insurance coverage will stop medical errors and drug price gouging.
I saw your response on yesterday's article on health care and I found what you wrote interesting and responded. I thought I was coming clean on health care but I'm afraid I'm still spoiled and have a long ways to go. I think that most of us who are lucky to have some decent insurance coverage from our employers will remain oblivious about the high costs of insurance. Another problem I see is that people will resign themselves into believing that things like marijuana and pyridoxamine are bad for one's health even if they know nothing about it but will happily fall for viagra, "happy meals", alcohol, cigarettes, etc... The government agencies and departments associated with health are also part of the problem. I have some friends who have and still work as government contractors to the DEA, FDA, HHS, etc... and they've shared with me all the lobbying and rampant business corruption talk that goes on. If someone tries to talk about natural supplements, then any lobbyist or paid hack associated with a big pharma company at the table will bully and interfere with the conservation so as to make that advocate of natural supplements concede with a "yup, it's too expensive and untested" defeatist admission. Dr. Caper would have to have run across such cutthroat and cutdown pharma bullies in all his years with TK.
I believe that the DEA and the FDA are mutually responsible for filtering out the good drugs and filtering in the artificial ones.
But how can you dispute the fact that Medicare for all would have
the greatest bargaining power to keep drug costs to a minimum?
And your argument that our butcher medical industry is more
honest and competent then government, when the root cause
of our disaster medicine is the medical industry having absolute
control of government, where is your logic?
For we the people are government, and we can effect change in
government. But not so with big business, as a dictator out of all
control are the rich who own big business.
Yes, the problem is gargantuan and I believe that every effort to "fix" it that gov't attempts will just make it worse.
That is why I advocate for people to start self-educating and to support efforts to clamp down on the FDA. The only way out of this is an end run. Ron Paul has 3 bills in the House to limit FDA powers. We also have to be vigilant about what they're putting in the Food Safety bill.
And yes, Alabama_John has a good point. All the supplements in the world (or actually all the medical care in the world) are useless if you don't eat whole, unprocessed foods.
Good point about the DEA.
A perfect article, surely and you are way off-topic with a cure
for illness that does more harm then good.
For the majority of illness is caused by a bad diet, with the
average American diet being 50% of calories fat. The perfect
solution being to eat nothing processed by man or animal,
and your idea of "nutritional supplements" takes us in the
reverse direction.
Forward direction being to eat only whole foods, as grown,
with none of the bulk, fiber, vitamins or minerals refined out.
Of course we should eat only naturally raised whole foods. But that does not negate the need for supplements. For example, if you have a need for thyroid medicine, natural thyroid is not only cheaper but more effective. That's why the FDA is trying to ban it as an "unapproved drug"
Many who have trashed their bodies with processed food and decide to make serious diet changes often have trouble digesting and if you don't digest and absorb what you eat it doesn't help. One should use digestive supplemnts that are appropriate, not antacids. Most therapeutic supplement plans have the goal of repair so your body no longer needs them to function well.
People live in toxic environments--air, water and food all contain toxins of some sort. Sometimes a supplement is the only way to counteract this unless one moves.
Additionally, since we are all biochemical individuals, nutrient needs vary considerably from person to person. It was recently noted that many women in the UK cannot easily convert beta-carotene to retinol and so they either need to consume animal source retinol or a supplement.
Your key word is "perfect" which no one is. There are many "medical problems" that are nothing more than simple vitamin or mineral insufficiencies or deficiencies. See the recent research on vitamin d. The reality is that it takes a long time for most people to change their diet. We don't have to treat people for all sorts of pseudo-diseases while we wait.
Finally, and sadly, Because of our screwy ag policies unprocessed food is often more expensive than canned and processed and that is a fact of life for many people.
Your goal of no processed food is an ideal to strive for and I assure you I am pretty much there and have been for over 30 years, but in the here and now we are wasting tens and hundreds of billions a year to treat problems that could be fixed for as little as $5/month or $20 for a UTI "cure".
Continued after a night's sleep.
I really want to pursue the question of use of supplements vs diet changes in health care. I don't believe it is a backward move, it is a move away from the standard allopathic medical model. Based on your comments about the medical butchers, you know that can only be a good move. Where it goes afterwards is anyone's guess.
There are millions of people over 50 with a diagnosis of congestive heart failure. Following the drug route they just keep getting worse. Using a nutrition support program, these problems can usually be fixed. Are you saying--don't help them, let them die if they can't change their diets? In my over 30 years of experience working with people to make diet changes, the process is very slow.
But, when something positive happens it serves as an incentive to pursue further changes. A young woman told me her boss (an RN who owned her own small home health agency) was very interested in alternatives. The young woman listened to her boss, after 3-4 years of medical "treatment" for recurrent UTI's. She purchased the product recommended and $20 and 3 days later she was "cured". Then, she said maybe she should start paying attention to other things her boss told her, so she stopped eating donuts. To her amazement, all her stomach pains stopped. Then she started looking at other things to change. This is how most changes take place, and altho I have also seen success with the cold turkey approach, the tortoise usually beats the hare.
To repeat myself, wasting hundreds of billions of dollars because people can't/won't change their diets is absurd. Judicious use of nutritional supplements is an incredibly huge cost saving effort and will result in healthier people who become more interested in diet change and health maintenance as they start feeling better.
Some really good points here by the author about the evolution of hospital administrators to CEO's.
Administrators used to be in deference to physicians, but that has made a 180 degree turn.
However, I think it is off base to say that health care follows a standard business model.
Can you think of another profession where a "customer' can pay absolutely nothing but sue for millions if they don't like the outcome?
There are certainly gaps in insurance coverage but many health care services are provided free of charge.
Fear of malpractice continues to cause unnecessary and harmful diagnostic studies to be performed on those who will pay nothing as well as those who will provide complete reimbursement.
Finally, I don't think equalizing the pay of general practitioners and specialists is a lofty goal.
Specialists, almost by definition have years more training. The discrepancy in pay is not entirely out of line.
Also, who wants to go to a general practitioner for say heart disease?
Who is more qualified? The doctor who did a 3-4 year residency covering everything from obstetrics to pediatrics to geriatrics. Or the doctor who did a 6 year residency specifically on heart disease?
FACTS
(1) Many studies show that lawsuits in medicine add only 1.5% to
the cost of healthcare in the U.S. And states have tried but
failed to reduce this 1.5% figure.
(2) Your friendly family doctor makes most of his income referring
customers to a specialist, as a universal referral fee gives him a
40% kickback, a full 40% of all money given to the specialist.
No need for a doctor to expand his training or skills as it would
just reduce profit.
(3) Virtually all doctors and medical specialists retire millionaires.
(4) To make a profit off the mísery of the sìck, this would corrųpt
the morals of the most honest doctor on earth.
In response to Jason Jordan -
When I joined Senator Kennedy's staff in 1971, his top legislative priority was passage of "The Health Security Act", a single payer "Medicare for All" style national health insurance program that also would have restructured the delivery system and constrained future health care costs in order assure that the program was sustainable. As recently as 2007, Senator Kennedy introduced "Medicare for All" legislation into the Senate. Congressman John DIngell introduced a companion bill into the House. In April of 2007 Senator Kennedy gave a speech at the National Press Club calling for "Medicare for All". Even as Chairman of the Senate HELP committee, he was unable to attract any significant co-sponsorship in the Senate.
It is up to the public to create a climate that makes such legislative efforts successful. The first step is education of an increasingly uneducated public. We have a great deal to learn from other countries (see T.R. Reid's latest book "The Healing of America"). Most American do not yet understand that.
Until the day he died, Senator Kennedy believed that "Medicare for All" was the best program for Americans. He also believed that goal to be unachievable in today's political climate. But he never stopped trying.
Surely Ted had the same problem as we here face today.
The most intelligent half of society has all the wealth,
they decide which politicians get selected and campaign
funded and "Money is the root of all evil."
Actually pride is the root of it all, as we the slow
thinking laboring class reject any notion that those
more intelligent can deceive us, by a pretense of
good hide an intent to enrich themselves upon the
misery of us.
DOCTORS ---- THE BOTTLENECK
(1) Virtually all doctors and medical specialists retire millionaires.
(2) Major cause of illness is diet, average American diet being 50% fats.
still no doctor is required to take one course in nutrition, and hardly a
doctor ever brings up the subject of diet with a patient.
(3) Your friendly family doctor makes most of his income referring customers
to a specialist, as a universal referral fee gives him a 40% kickback, a full 40%
of all money given to the specialist. No need for a doctor to expand his training
or skills as it would just reduce profit.
(4) Now a black-out on any discussion about doctors. Only 25% of doctors
belong to AMA, only a very small number go public or take any position on
healthcare reform.