General Motors Makes More Health Care Than Cars

The consequences of terrifically bad low back pain management in the U.S. (drugs, pharma, & surgery) cause us to spend $85B per year in direct medical costs, now having surpassed total spend on cancer. LBP management is analogous to medical prostitution in the U.S. It’s a national crisis. I am not comparing the inequity in health care with slavery per se, but at some level, we should see outcry and marching in the streets not unlike the civil rights era when it comes to the disaster of LBP management in the U.S. Why don't we? Primarily because it's not as "sexy" as Katie Couric getting on national television and having a colonoscopy (I am not suggesting anything pleasant about a colonoscopy, but you get the point). In other words, you don't die from back pain, therefore any outcry is mitigated by all of the emotion associated with conditions you die from, many of them being far less of a burden on our health care system than back pain.

I don’t want to get overly political here, but both the Democrats and the Republicans have not even begun to touch on the solutions in my opinion (you continue to hear the mantra on both sides of the aisle about the U.S. still having the best health care system on the planet when nothing could be further from the truth). Neither a single payer nationalized health care system or an entirely market based system is the answer. Just like the current economic crisis where highly educated economists are giving us equations that no one outside of card carrying Mensa members (I am not one btw) can understand and that propose counterintuitive solutions like spending more $ to solve our spending $. My Depression thriving grandparents are rolling over in the their grave because they would in Nobel like (but uneducated) fashion suggest that the key to a spending problem is to spend less. We’re making the solution to the health care crisis overly complicated as well.

The issue is quite simple. We already have plenty of health care being delivered in sufficient quantities to cover everyone on the planet. The issue that the health care we have is being allocated terribly inefficiently due to servicing special interests, in particular physician specialists who control the setting of fee schedules. Never apologize for being a PT since we hold the biggest key to unlocking the nation’s health care crisis and invoking an avalanche of change, primarily in the form of getting patients to see a PT first. If we do nothing other than act like shepherds keeping our sheep (patients) inside the pen and out of harm’s way from the wolves (the problem is so bad that PTs playing a pure babysitting role is better than what we have now), we will have solved a huge part of the problem and be on our way to universal coverage (other high spend areas need similar reform to get us all the way there). Adding a dose of high level EBP care is icing on the cake and makes the solution even more compelling. In other words, the major problem is a structural one (the who, what, when, where, and why of how patients enter the health care system) even more so than actually what we do with the patient when we get them.

Remember this truism...despite what you hear on television, GM is officially out of the car making business. It’s an HMO (with a bad habit of making cars) because of the massive unfunded health care pension liabilities it has built up during the last 50 years of believing that doctors had halos over their heads. Large employers have been duped, and now we’re all about to pay for it.

What I really want to reiterate though and what is not debatable is that those of you who read this blog on a daily basis are the ones with the passion and power to tip the avalanche of change and turn the health care system on its head. As Victor Hugo once said, "An invasion of armies can be resisted, but not an idea whose time has come." Direct access in its truest and most comprehensive form is the preeminent idea for our health care system whose time has come. If for no other reason, advocate for the sake of your grandparents and great grandparents who, like mine, would be sorely disappointed in our nation's inability to solve simple problems with simple solutions. On behalf of EIM, thanks for all you do on behalf of the profession and the patients you serve.

John