In today’s NY Times columnist Paul Krugman wrote “Insurance and Freedom” about how Americans are enslaved buy their “need” for health insurance.

http://www.nytimes.com/2013/04/08/opinion/krugman-insurance-and-freedom.html?nl=todaysheadlines&emc=edit_th_20130408&_r=0

I would reply that Obama Care will not free Americans, just change the way they are enslaved.

Paul,

You question if Health Insurance has enslaved Americans. I might suggest that the American Medical system has enslaved Americans. In the past thirty or so years American Medicine has gone from curing ills to “Preventing” them. It is true that the biggest improvement in health has come not from our ability to cure illnesses but in preventing them in the first place. Yet, doctors myself included has made a good living convincing people that if you lower your blood pressure, cholesterol and exercise you can prevent a heart attack or stroke. We have data showing that. However, heart attacks and strokes are still the leading causes of death for Americans. They just happen at older ages. So why does American Medicine continue the promote prevention?

American Medicine promotes prevention because it sells. It is hard to watch the evening news without seeing an ad for some sort of medication. It is usually a new and more expensive version of a current medication.  The drug companies spend millions on studies designed to show that their new drug is more effective than the older one.  Doctors make a good living prescribing and monitoring those medications. So why to doctors persist in this charade?

Doctors persist for several reasons not just the economic. We are taught that these drugs prevent deaths, but not in how to find the cost of preventing one death with method a or b. When I started in medicine decades ago, we believed that preventing PVC’s saved lives. We prescribed drugs that made our patients feel ill and dependent. We enslaved them to our care lest they drop dead of a heart arrhythmia. Then patients took charge and stopped the offending drug and felt better. Finally doc tors had the nerve to study the drugs more carefully and found that the drugs were actually killing more than they helped.  The FDA banned one of these drugs completely.

Would medicine better serve America by teaching people how to weather the storms of illness?  In the past couple of decades a new approach to psychology, called Positive Psychology has found ways to do just that. Several books are now available that document this. Some of the books have even made the NY Times best seller list.  Doctors and others can now teach people how to successfully whether the storms of life, including illness. These techniques have other benefits besides just lowering the risk for heart attacks and strokes; they can help people weather divorce, job loss and other trauma. By promoting social and emotional health we can free America from the slavery of ill-health.

David Moseman, MD, MPH, FACP (disabled)