FW: WSJ.com - Marcus Welby Doesn't Live Here Anymore (Great Read forwarded by Dr. Durkin)

[CAL/AAEM News Service]

--0-1393127487-1043265849=:76939
Content-Type: text/plain; charset=us-ascii


WONDER LAND 

By DANIEL HENNINGER



Marcus Welby Doesn't Live Here Anymore

There was a time in the annals of medicine when the most famous doctor in America was Marcus Welby, M.D. But if you are under 30, you've likely never heard of Marcus Welby. If you are under 30, you've probably never encountered a doctor remotely like the beloved Marcus Welby.

Marcus Welby, of course, wasn't real. Played by actor Robert Young, Dr. Welby -- caring, wise, beloved, willing to move mountains for one patient -- was the central character in a very popular TV series from 1969 to 1976. Real doctors often chided Robert Young for creating a model of overtime compassion that no mortal doc could live up to.

Lyndon Johnson created Medicare four years before the series began, and by the time Marcus Welby retired in the mid-'70s, the American health-care system was in a cost crisis, driven by Medicare spending, inflation, subsidized hospital construction and a golden age of medical technology, such as the mysterious MRI machine. Richard Nixon officially birthed a new word everyone knows: HMO.

Today the "crisis" in health care continues without end, in large part because incumbent politicians are addicted to its continuance. This year the mess will be much in the news because many corporate providers of medical insurance will ask their employees to pay more for health care. Next week, unions at General Electric will strike for two days to protest G.E.'s $200 increase in co-payments. GE says that in 2001 it spent $1.4 billion on its workers' medical needs, which is indeed a lot of money.

Everyone's got a gripe about this subject, and this week the federal government poured its own can of gasoline into the cauldron with a report on 2001's spending Vesuvius. The average outlay on health care by every person in the U.S. was $5,035. Total outlays on doctors and their services: $313.6 billion. On hospitals: $451.2 billion. On drugs: $140.6 billion.

[welby]Marcus Welby, M.D.

Interestingly, the rise in total outlays was not mainly because costs rose but for the quantity of medical care used. There is no other explanation: For Americans, consuming medicine and health has become a major pastime.

When politicians and policy makers meet now to talk about health care in America, they discuss it almost wholly as an interplay of economics, money and insurance. Theirs is a world of utilization rates, first-dollar coverage, provider profiles, outcomes and other such arcana. But for all the effort, if you look at the way we pay for health care today, there has been little real innovation around the subject in more than 100 years.

We live amid an unimaginable cornucopia of medical opportunities, but our relationship to the medical industry hasn't changed in its essential features since Otto von Bismarck mandated health insurance for Germans in the 19th century. We don't light our homes with kerosene anymore, but we still consume medicine the old-fashioned way: We buy some medicine from a doctor or hospital, who sends us a bill, which we or they send to someone somewhere else, and this someone somehow pays for whatever medicine we "bought."

For a hundred years this is the only thing in life that's been paid for by the Tooth Fairy -- whether Medicare, Medicaid or private insurance companies. So how can it surprise anyone that the average American asks the Tooth Fairy to buy them, every year, more than $5,000 of medicine's wonderful products? Politicians may profess to be appalled, but surely no one is shocked that Medicare and Medicaid are crushing public budgets. Not a single consumer of medicine has the faintest clue what the "budget" for medicine is, and therefore no stake in using the system prudently.

Until the era of modern medicine, this system made some sense. Doc Welby knew pretty much everything medicine knew about disease and injury, which relative to today wasn't much. When you got sick, he administered what medical knowledge existed, and for most of this century the most potent thing in his black bag was penicillin. If what he knew didn't work, you gutted it out and either survived or died of myriad infections and ailments, mostly heart disease. Simple insurance paid simple bills because medicine, most of the time, wasn't complicated. The system worked.

There is no need to detail here the explosion in medical knowledge, pharmaceuticals and technology the past 40 years. It is one of the wonders of all history. Less noticed, I think, is what the suddenly marvelous world of medicine has done to create a culture of health. Before, we didn't think about it, until we got sick and went to see Doc Welby. Today we in the middle class think about our health all the time. It's still about life and death -- but it's also a "lifestyle issue."

Back then, you got old and sat home for 20 years bellyaching about sore joints. Now that WebMD has tutored you in osteoarthritis, you take Vioxx, consume Omega-3 via flaxseed oil and work out to be healthy enough to take this year's second vacation in -- how about Beijing? The Vitamin Shoppe and GNC are filled with the same people who pant in health clubs the way people once worshipped God in church pews. Staying well was fine in the old days, but now you've got to stay better than well if you want to keep cycling, jogging, rock-climbing, golfing or whatever it takes to be all that you can be. In this world, going to the doctor is a pit stop. And the data suggests we spend a lot of time asking doctors to give us valve jobs, new wheels and better lubricants so that we can, as we're told, "stay active." And why not? No one anymore says: "Gotta go sometime." There's too much to live for now.

This is not meant to belittle the deadly seriousness of extreme illness or its cost. But it is meant to belittle both Congress and corporations that think yet another variation of Count Bismarck's original Tooth Fairy system of medical insurance is appropriate for a society that has both mapped the human genome and discovered the benefits of St. John's wort.

Updated January 10, 2003


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
Do you Yahoo!?
Yahoo! Mail Plus - Powerful. Affordable. Sign up now
--0-1393127487-1043265849=:76939
Content-Type: text/html; charset=us-ascii

<FONT size=2>
<P>WONDER LAND </P>
<P>By DANIEL HENNINGER</P>
<P></P>
<P>Marcus Welby Doesn't Live Here Anymore</P>
<P>There was a time in the annals of medicine when the most famous doctor in America was Marcus Welby, M.D. But if you are under 30, you've likely never heard of Marcus Welby. If you are under 30, you've probably never encountered a doctor remotely like the beloved Marcus Welby.</P>
<P>Marcus Welby, of course, wasn't real. Played by actor Robert Young, Dr. Welby -- caring, wise, beloved, willing to move mountains for one patient -- was the central character in a very popular TV series from 1969 to 1976. Real doctors often chided Robert Young for creating a model of overtime compassion that no mortal doc could live up to.</P>
<P>Lyndon Johnson created Medicare four years before the series began, and by the time Marcus Welby retired in the mid-'70s, the American health-care system was in a cost crisis, driven by Medicare spending, inflation, subsidized hospital construction and a golden age of medical technology, such as the mysterious MRI machine. Richard Nixon officially birthed a new word everyone knows: HMO.</P>
<P>Today the "crisis" in health care continues without end, in large part because incumbent politicians are addicted to its continuance. This year the mess will be much in the news because many corporate providers of medical insurance will ask their employees to pay more for health care. Next week, unions at General Electric will strike for two days to protest G.E.'s $200 increase in co-payments. GE says that in 2001 it spent $1.4 billion on its workers' medical needs, which is indeed a lot of money.</P>
<P>Everyone's got a gripe about this subject, and this week the federal government poured its own can of gasoline into the cauldron with a report on 2001's spending Vesuvius. The average outlay on health care by every person in the U.S. was $5,035. Total outlays on doctors and their services: $313.6 billion. On hospitals: $451.2 billion. On drugs: $140.6 billion.</P>
<P>[welby]Marcus Welby, M.D.</P>
<P>Interestingly, the rise in total outlays was not mainly because costs rose but for the quantity of medical care used. There is no other explanation: For Americans, consuming medicine and health has become a major pastime.</P>
<P>When politicians and policy makers meet now to talk about health care in America, they discuss it almost wholly as an interplay of economics, money and insurance. Theirs is a world of utilization rates, first-dollar coverage, provider profiles, outcomes and other such arcana. But for all the effort, if you look at the way we pay for health care today, there has been little real innovation around the subject in more than 100 years.</P>
<P>We live amid an unimaginable cornucopia of medical opportunities, but our relationship to the medical industry hasn't changed in its essential features since Otto von Bismarck mandated health insurance for Germans in the 19th century. We don't light our homes with kerosene anymore, but we still consume medicine the old-fashioned way: We buy some medicine from a doctor or hospital, who sends us a bill, which we or they send to someone somewhere else, and this someone somehow pays for whatever medicine we "bought."</P>
<P>For a hundred years this is the only thing in life that's been paid for by the Tooth Fairy -- whether Medicare, Medicaid or private insurance companies. So how can it surprise anyone that the average American asks the Tooth Fairy to buy them, every year, more than $5,000 of medicine's wonderful products? Politicians may profess to be appalled, but surely no one is shocked that Medicare and Medicaid are crushing public budgets. Not a single consumer of medicine has the faintest clue what the "budget" for medicine is, and therefore no stake in using the system prudently.</P>
<P>Until the era of modern medicine, this system made some sense. Doc Welby knew pretty much everything medicine knew about disease and injury, which relative to today wasn't much. When you got sick, he administered what medical knowledge existed, and for most of this century the most potent thing in his black bag was penicillin. If what he knew didn't work, you gutted it out and either survived or died of myriad infections and ailments, mostly heart disease. Simple insurance paid simple bills because medicine, most of the time, wasn't complicated. The system worked.</P>
<P>There is no need to detail here the explosion in medical knowledge, pharmaceuticals and technology the past 40 years. It is one of the wonders of all history. Less noticed, I think, is what the suddenly marvelous world of medicine has done to create a culture of health. Before, we didn't think about it, until we got sick and went to see Doc Welby. Today we in the middle class think about our health all the time. It's still about life and death -- but it's also a "lifestyle issue."</P>
<P>Back then, you got old and sat home for 20 years bellyaching about sore joints. Now that WebMD has tutored you in osteoarthritis, you take Vioxx, consume Omega-3 via flaxseed oil and work out to be healthy enough to take this year's second vacation in -- how about Beijing? The Vitamin Shoppe and GNC are filled with the same people who pant in health clubs the way people once worshipped God in church pews. Staying well was fine in the old days, but now you've got to stay better than well if you want to keep cycling, jogging, rock-climbing, golfing or whatever it takes to be all that you can be. In this world, going to the doctor is a pit stop. And the data suggests we spend a lot of time asking doctors to give us valve jobs, new wheels and better lubricants so that we can, as we're told, "stay active." And why not? No one anymore says: "Gotta go sometime." There's too much to live for now.</P>
<P>This is not meant to belittle the deadly seriousness of extreme illness or its cost. But it is meant to belittle both Congress and corporations that think yet another variation of Count Bismarck's original Tooth Fairy system of medical insurance is appropriate for a society that has both mapped the human genome and discovered the benefits of St. John's wort.</P>
<P>Updated January 10, 2003</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
--0-1393127487-1043265849=:76939--