Code Blue: Inside America's Medical Industrial Complex
by Mike Magee
As one who has luckily avoided the medical industrial complex for the most part, I still wonder how we got where we are with American health care, and why it's considered by many one of the worst systems in the world, while also being the most expensive.
Dr. Magee is an expert in his field, and he showcases his experience as a hospital administrator and as a senior executive at Pfizer during the Viagra gold rush. The author weaves a fascinating story of the system and its participants, pointing out both the good and the bad. He calls the system a tapeworm of economic competitiveness, and proposes plenty of thoughtful reforms.
The medical industrial complex, as Dr. Magee calls it, consists of medical professionals, insurance companies, hospitals, big pharma, government and universities, all of whom collude with each other to protect their turf and maximize profitability.
Medicine has made enormous strides since the 19th century, when doctors were clueless how to cure most diseases. We are living much longer than our ancestors, with a whole new collection of maladies. The American system is very much biased towards cures, always looking for the next magic pill, surgery or therapy that will save lives. The profit motive makes it that way. For the system to focus more on preventative medicine, such as nutrition, exercise, stress relief and lifestyle choices, it will have to move away from its transactional nature.
The book dives into some of the history of how we got here, and how groups like the American Medical Association, Food and Drug Administration, Medicare, and the employer based health insurance system got their starts. One thing I didn't know was that after World War II, when the American government was helping rebuild Germany and Japan, they helped both countries establish public health insurance, while at the same time squashing it here at home as "socialized medicine." Presidents as diverse as Harry Truman, Richard Nixon, Bill Clinton and Barack Obama all tried to establish some sort of government health insurance like has emerged in all other industrialized countries, only to be beaten back by the medical industrial complex every time.
What's always puzzled me is how what we now know as Obamacare was actually dreamed up by the Republican party decades earlier. Now that same party is trying to destroy the Affordable Care Act with no clear alternatives being discussed.
More points brought up in the book:
- Advocacy groups like the American Cancer Society are funded by industry and more geared to heroic cures than to prevention.
- The people who monitor and evaluate hospitals are not independent. Hospitals can be very secretive about their prices and their accidental death rate (which has been going up according to the book.)
- Drugs for ADHD (ritalin and adderal) and Pain (opioids) are recommended by doctors and commercials way too much for minor conditions, with the result that the profit motive trumps sound healthcare. Dr. Magee tells the tale of Purdue pharma and the Sackler family, and how their entrepreneurial zeal led to the current opioid epidemic. The author warns that all drug advertising and free samples to doctors should be stopped.
- Universities and researchers are beholden to the MIC, and have been known to stretch ethical boundaries with tests on human subjects and fudging their data to get the right result.
- Enormous amounts of health care dollars are spent on bureaucracy. For every physician there are 16 workers in the system, half of which add no clinical value at all.
- In order to pass health care reform, Obama had to agree not to negotiate drug prices or allow imports, leading to the scenario today where drugs in the US are often 10 times as expensive as the same drug in other countries.
The final chapter of the book lists reforms that the author thinks would help the health care system catch up to the rest of the world (where he claims we are number 50 of 55 comparable countries in overall health.) The big reform, which has been discussed by many, would be some kind of single payer, government based healthcare that would eliminate the middlemen and rein in the profiteers.
After watching this debate for most of my life, I'm not too hopeful because the current system is so entrenched, but I highly recommend this book to those in the healthcare field and those who use the system regularly.