Time Spent with Patients a Critical Factor in the National Health Crisis*

Bernard Lown, MD 

That we have a dysfunctional health care system is now widely acknowledged. No longer does one hear that Americans receive the best medical care in the world. Moreover, the US crisis in health is noteworthy for a blatant contradiction. Despite our investing a king’s ransom on health care, one-third of the population is inadequately protected against the unpredictability of illness. The number of uninsured people has reached a staggering 47 million, with an additional 30 million covered merely for catastrophic illness. No other industrial nation comes close to the approximately US$7000 spent by each American annually for medical care.  

Mounting health expenditures preoccupy economists and politicians. The escalation is ascribed to an ever-aging population with greater health demands as well as to costly scientific and technological advances. What is largely ignored is the commodification of illness that America’s market-oriented health care system fosters. As is true in business, the underlying intent is maximizing profitability rather than promoting patient well-being. Unnecessary tests and procedures are encouraged. A market-based health system also has significant upfront costs and unavoidable systemic inefficiencies.  

Another consequence of the system contributes to its rising costs and malfunction: Market values are the invisible elephant in the doctor’s office. They quench the human dimension in health care and corrupt the doctor-patient relationship. The first casualty is listening. Since listening to a patient consumes much time and is minimally reimbursed, it is most often done in a cursory, hasty manner, leaving the patient frustrated and the doctor uninformed.  

Antecedents to the Financial Meltdown

Bernard Lown, MD

The irony would be delicious if only the victims were other than multitudes of innocent bystanders. The surge in Iraq was meant to tamp down violence and reduce American casualties before Republicans faced a potentially disastrous national election. But unexpectedly a new, even more destabilizing home front has been opened. Nothing is as likely to roil the masses as a loss of jobs, the foreclosure of homes, skyrocketing food prices, unaffordable fuel and heating oil, bankrupting medical costs, and a loss of equity in dealing with mountains of personal debt.

The Bush-Cheney gang may be muttering “et tu, Brute.” After all, the financial crisis is the handiwork of their staunchest allies. The attack on Wall Street’s financial institutions was an inside job. The bankers, the hedge fund managers, the CEOs of financial houses, were recipients of inordinate largesse from the Bush White House. This very administration shed every vestige of regulation and oversight. It enabled a massive transfer of wealth to the upper 1 percent of the population through the sale of subprime mortgages and fraudulent derivatives. Such an orgy of whoopee, greed, and corruption has not been witnessed since the Gilded Age.

Instead of subsidizing the victims, Congress hastened to bailout the very perpetrators of the financial debacle. The mammoth sum of $700 billion was entrusted to the secretary of the treasury, Henry Paulson, though he had been one of the very architects of the financial crisis. Paulson is now anointed as some sort of economic czar to extricate Wall Street from the mire of its own misdeeds. Essentially, the large bailout is an enormous shift of wealth upward. It is to be disbursed by one of Wall Street’s leading speculators to his cronies, while Congress is assuaged with a promise that a few crumbs will trickle down to Main Street.