The Thursday Thesis - 12/12/2019
“You are all diseased” – George Carlin.
A couple of weeks ago I was reading about how much healthcare costs us here in the UK – it’s a lot of money, and it’s never enough. Just like churches appealing for more money (apparently God isn’t good with money and always needs more...) the NHS needs more money, despite the patently obvious fact that the health of our nation can’t be bought on our current budget – or any other budget, for that matter.
It occurs to me that we’ve got it all arse-about-face: completely arse-about-face.
We need to flip the model.
At the moment we pay doctors for treating sick patients – usually with expensive drugs which don’t treat the underlying causes of disease, but instead manage the symptoms. Of course, that’s what the drugs are designed to do – manage the condition, not treat the underlying problem.
It’s a good model – if you’re in the medical business.
Cure the condition – no more drug sales: it’s a transaction that happens just once. That’s Bad Business.
But manage the condition and you have a repeat business model that keeps the patient just sick enough to keep coming back for more of what doesn’t work.
I’ll say it again: The drugs don’t work because they’re not designed to cure.
And if you pause to think about the “payment-by-volume” medical model, you’d have to conclude that something is truly fucked-up.
Think about it – the more sick people you have in your practice, the more money you get paid...
Hmmm – is there a disincentive here?
Get to the root of the problem and treat it effectively and you’re going out of business...
A chronically sick patient is a long-term asset to a medical business, generating lots of repeat business for as long as they remain sick and in need of your attention and those all-important drugs.
Now, I’m usually an optimist when it comes to human nature, but a little bell rings in the back of my mind when I think about the Sickness Industry: how about you?
It’s obvious, isn’t it?
More sick people are good for business, whether you are a doctor or a drug company.
Just like any business, the job of a medical practice or drug company is to recruit, develop and retain a customer, maximising their Lifetime Value to the business.
As a pharmaceutical supplier you want to stimulate, grow and maintain demand for your products and services; pushing up prices and enhancing the perception of the worth of your offering.
The dream-ticket in the sickness business is to invent, and then profitably medicate, a condition. Do that and you’ve hit the jackpot: ADHD/ADD and Ritalin spring to mind here, though there are many, many more examples out there.
To whoever invented the diagnosis of “Stress”, I take my hat off to you. By making a person’s inability to deal with challenge into a medical condition (and inventing a drug which helps just a little) you’ve shown true genius and richly deserve the billions of dollars/pounds you’ve hoodwinked the foolish out of.
Those who profit from disease and sickness run the show. In a nutshell – the foxes are in charge of the henhouse. Naturally, the foxes will suggest that what we really need are more foxes to guard the hens...
And more money, of course, to buy more of what doesn’t work.
So here’s my Genius Masterplan to save the NHS, reform the Sickness Industry, slash the cost of real healthcare to all of us, and improve the health of more people.
Are you ready?
Here we go: It’s simple.
On Planet Neil, the doctors are paid only when the patient is well. Let’s all pay a small monthly subscription, something like your current National Insurance Contributions, but used for promoting real health instead of paying Government debt and drugs that fail to cure. Should you become sick, however, the doctor receives nothing from you but must treat you.
It’s a simple idea. Incentivising the whole healthcare sector to move away from management of disease and toward curing the root causes of disease, thus promoting long-term health, rather than incentivising the prescription of ineffective, expensive drugs to manage symptoms.
Now, if your illness is the product of your own stupidity, indolence or inability to manage yourself and take responsibility for your own life (obesity, alcoholism, drug abuse etc) you get three chances to man up and run your own life, each of which is time-limited and designed to treat underlying behaviour issues.
Three Strikes and you’re out.
Should you fail to mend your ways after your third strike-out you are released from the system to fend for yourself, out into an unregulated market for private medicine and healthcare where you can re-connect with the old model of healthcare.
Should you be ejected from Planet Neil’s Healthcare System, that’s YOUR problem, because your health and what you do to yourself is YOUR life, YOUR decision.
Naturally, those who cannot manage themselves and their own health will tend to remove themselves from the healthcare system and ultimately from the gene pool if left to their own desires and devices.
I know that softy Pinko liberals will hate this suggestion, but – let’s face it – they live in a world of fluffy clouds and pink unicorns, having little or no connection with reality. I think it is spectacularly foolish to squander vast quantities of scarce resources upon those individuals who are determined to destroy themselves.
So let those who wish to kill themselves with drugs, booze, smoking and other poisons get on with it. The State (well, you and I, actually) should not support such self-destructive behaviour at the expense of others who are taking responsibility for their lives, because that is so patently unjust and absurd.
To penalise those who do right in order to maintain those determined to do wrong and harm themselves is an insult to common sense: it is the ultimate insult to morality and human dignity.
For sure I believe fiercely in Equality of Opportunity and equal provision of healthcare – but I have no time for the not unworkable fantasy of Equality of Outcome, because people are fundamentally unequal and do not live in equal ways.
That’s reality – and we should never delude ourselves that it is otherwise.
© Neil Cowmeadow 2019
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