Making Sense of Health Care through Analogies

Another insightful post from Maggie Mahar of the HealthBeat.It is definitely reading in its entirety, especially the details re: point #3 below..

In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries.

But health care is complex, and numbers can sometimes be too abstract to make a lasting impression on people who aren’t health care wonks. Sometimes what really connects isn’t data, but analogies that put health care in terms that everyone can understand. Of course, there are good analogies that illuminate and bad analogies that mislead, so you always have to be careful. Here are a few of the best and worst analogies that I’ve come across:

(1) The Titanic and Inequality. As The Health Care Blog (THCB) noted recently, it’s hard to come up with a more clichéd analogy than the Titanic. It’s really the poster child for much ballyhooed behemoths that collapse because they’re not nearly as state-of-the-art or invulnerable as people assume. But really, that’s a perfect encapsulation of our health care system. We spend $2.4 trillion on health care annually—the equivalent of bailing out Wall Street twice every year.
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(2) Automakers and Prescription Drugs. One of the reasons why the upper crust has it so much better in health care is that the U.S. spends about 14 percent of its health care dollars on prescription drugs. These drugs are largely attainable only to folks with health insurance and generally don’t do much for the behavioral or environmental conditions that threaten the health of lower-earning Americans.

Actually, most prescription drugs don’t do much for anybody, let alone the poor. Last year, Marcia Angell, a Senior Lecturer at Harvard Medical School and the former editor-in-chief of the New England Journal of Medicine, observed that, “according to FDA classifications, fully 80 percent of drugs that entered the market during this decade are unlikely to be better than existing ones for the same condition.”
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(3) Consumer Goods and Medical Treatments. Thinking about how automakers would operate under the prescription drug model highlights the startling regulatory structures (or lack thereof) surrounding the pharmaceutical industry. But the car-as-medicine analogy only goes so far: it’s very helpful for understanding system-wide issues, but from the perspective of the patient, health care is unlike any other commodity.

This is a hard thing for some people to grasp, most of all the hardcore advocates of consumer-driven medicine—i.e. a health care framework in which people have high-deductible coverage and health savings accounts, and shop around for the cheapest care, the same way they would for a new car.
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(4) Handymen and Primary Care Physicians. Consumerism often directs us toward high-end, specialized goods—but in health care, this sort of innovation fetish can prove dangerous. In fact, one of the least sexy areas of health care is primary care, yet it’s also one of the most important.