How the U.S. Health Care System Came to Be

Q. How so?

A. The ideal situation for all of us is to have a doctor who knows you, who takes care of you. Then if something happens and you have to be admitted to the hospital, he or she admits you, and is there when you arrive, says hi, coordinates your health care, and hopefully you get better. But we don’t have any of that; it doesn’t exist anymore.

Q. How do you help your own family navigate the system?

A. My mother fell down, she hurt her ankle. Mom is 86, so she went to a doctor with her swollen ankle. They wanted to do X-rays, and a CT scan, and the doctor wanted to see her every week for a while. It was ridiculous! The woman had a bruised ankle. There is nothing you can do about that. Just give it time.

Q. So how can laypeople keep an eye out for unnecessary expenses and tests?

A. I don’t think they can. That’s the pragmatic problem with American health care. Doctors do test upon test to both diagnose and then cover themselves in case there are lawsuits. For me it’s a very tough situation—as a physician I understand why the doctors do what they do. But I also understand the detrimental effects it can have on an individual, not only from a physical standpoint undergoing possibly unnecessary tests, but also from a financial standpoint.

Q. Are there any medical advocates who can do this for patients?

A. You have to have someone who knows the system. I’m sure that some entrepreneurial young man or woman is going to wake up someday and say, “You know, I can usher patients through their medical care.”

Q. Like a wedding planner.

A. Yeah, a health care planner. It’s just a matter of time.

Q. Where is medical research today on the chronic diseases we have not been able to conquer, such as heart disease and cancer?

A. We react to things; we don’t prevent things. American medicine is reactive for the obvious reason that it pays more to take care of a person who has lung cancer.

Q. How?

A. Just think of all the people who profit off of someone having lung cancer. It’s far beyond just the doctors—it’s the insurance companies and the entire medical industry. If you’re telling teenagers, “Don’t smoke,” and they don’t smoke, well, nothing happens. No one’s making any money, and they grow to adulthood, and no one dies from lung cancer, and everybody’s happy—but no one makes any money off of it.

Q. So modern research is creating more treatments than preventive measures?

A. Right. Reacting to problems is obviously not the way that you want to deliver health care, yet it is the only thing that we know how to do. Really, before the 1960s, the only individuals who were making money off of health care were the doctors. Medicine was 3 to 4 percent of our gross national product. Today we’re almost at 20 percent. When President Obama attempts to change the system, so many people are affected by the changes, it’s no longer just the doctors who are crying, “Hey, don’t do that, we aren’t going to get paid.” The book points out how we got to where we are, and it just connects these health care dots into a framework and makes it easier to understand.

Betsy Towner lives in California.