“You are right, Kerr, there’s a comma missing after “them” - good thing I’ve got another go ’round in the editing process still there. Clearer now?”

Yes… But not until I cut and pasted it here, put the comma in, and and poised my fingers over the keyboard to type out why it still wasn’t clear. I wasn’t after looking for typos, I was just having a moment of partial syntax-blindness in one eye or something of that sort. Thanks for the clarification.

This might be easier to read:
“That is, often when we worry about the dangers of losing modern medicine and society, we see clearly the costs of not having easy access to high-technology, high-energy medical care—but we don’t see, because we have assimilated into them, the high costs of the medicine and the society that makes it possible.”

For instance; if we had banned lead in gasoline and paint fifty years earlier, that’s two generations of kids with much lower rates of lead poisoning. Right now we’re fighting asthma as a neighborhood problem - we need particulates out of our air, diesel engines cleaned up or off our streets, and housing upgraded to make roaches easier to eradicate (incidentally often the same housing stock that’s full of lead paint). Oh, and no more garbage burners, though I have a bad feeling we’re losing on that one right now.

Worker safety laws can prevent tragic and expensive problems like mesothelioma and the hideous brain disease clump at a Minnesota meatpacking plant discovered last year that was caused by workers inhaling pig brain particles.

Enforcing traffic laws in my neighborhood would reduce the trauma care needs by close to half, and effective gun laws would take care of another 20-30%.

We have among the highest bike-commuter rates in the country despite having one of the least-bikeable climates, because of legislation giving cyclists equal road rights and investment in signage, lane planning, and offroad path development. That right there is part of the answer for diabetes, and we have groups working on the food side too - a neighborhood group spent years luring a grocery store into a neighborhood near me that only had bodegas and liquor stores, and the store is THRIVING because people wanted better food. Now there’s going to be a farmer’s market too, and a Native-organized group has been organizing food giveaways of healthy native foods (buffalo meat, wild rice, and various vegetables native and non-native) to elders and families with young children.

Political action non supposedly non-health-related fronts is a huge part of preventitive medicine.

This is actually an insanely easy problem to fix in any rational society (note, I do not claim to live in a rational society). Society serving education - agriculture, medical, educational through the graduate level could easily be made free. Malpractice could and should be capped - or handled through something like the national fund created to treat vaccine injuries.

I’m not, however, sure that doctor salaries are really the primary driver - I don’t know about in your country but in the US, the doctor’s fees will generally only be a comparatively small part of the care costs - large chunks of it are due to inadequate ability to distinguish between valuable and useless care - for example, most Americans at the end of their lives don’t use hospice for a host of reasons, one of them being that in order to qualify for hospice, they must give up all other treatments and have a formal diagnosis of only months to live. Doctors are reluctant to give such diagnoses (because they don’t want to cause a death) and patients are reluctant to “give up” on things like chemo. This also could be fairly easily changed - and since almost 30% of all hospital stays involve people in the last six months of their lives (some of this is obviously unavoidable, but a lot of it isn’t), that would save a huge amount of energy - I have had several dying, very elderly relatives subjected to surgeries and other treatments that simply didn’t do anything except cost a lot of money and cause a lot of suffering.

Birth is another place this would be easy to fix. I’ve written more on this, but I honestly could have gone much further with this, and perhaps will eventually.

Sharon

The average doctor in the US gets $165,000. Cuban doctors get about $3,000. That’s one reason Cuba can spend much less on healthcare but get better results than the US.

US doctors have to be paid so much because of the high cost of malpractice insurance. And of course, because people pay so much for healthcare if they don’t get the results they want they’re much more likely to sue the doctor for malpractice, which puts the doctors’ insurance premiums up, which makes them demand higher salaries, and…

High salaries also come from ensuring that not enough doctors are trained. For example, from 1997 to 2003 New York’s 41 teaching hospitals were paid $400 million to reduce the number of doctors they trained, according to the New York Times. When supply is low and demand is high, price goes up.

High salaries also come from the high cost of medical school. Because we the public begrudge contributing $100,000 over seven years for the cost of training a doctor, we end up paying $50,000 extra every year for that same doctor.

The second factor is profiteering by US and EU pharmaceutical companies. That heart pill did not actually cost them fifty bucks to make.

Take away large doctor’s salaries and pharmaceutical company profiteering, and healthcare becomes very cheap.

Here Down Under we have the same sort of thing happen - public healthcare covers our whole body except for our teeth and eyes. So we get things like a young man with an abscessed tooth, he’s unemployed so he can’t afford the $190 for a consultation let alone $1,000 or more for the surgery, so instead he waits until half his head swells up, then goes to the public hospital - and wakes up in intensive care, the swelling was impacting his breathing and the infection threatened to get into his brain, his treatment cost $5,000 to the public. And again, high dentists’ salaries cause this false economy.

Not all countries pay their doctors so highly, but then they don’t have to. There are not many malpractice suits in Kerala or Cuba, and medical education is free for the doctor, and their salaries controlled and set by the government. And those countries also don’t have pharmaceutical companies profiteering - India doesn’t recognise patents on medicines, and Cuba gives theirs out free to their own people, selling them to foreigners for a profit.

Lastly, the largest improvements in health and health-related quality of life come from very simple and cheap things. Having clean drinking water and soap saves millions of lives, especially those of infants. Eating a good range of fruits and vegetables adds a decade or so of life. Doing crosswords and having an hour or more of conversation a day staves off the onset of Alzheimer’s. And so on.

Actual qualified medical care adds to all this, but in a relatively small way. As Sharon noted, we seem to be able to find $10,000 per pregnant woman for a Caesarean, but cannot find $50 per pregnant woman for nutrition advice, or $500 for some babysitting or subsidised prepared meals.

The last four times my family has gone to the hospital, they did a few pointless tests, told us what we had already told them, gave us treatment we could–and would– have done ourselves, and then charged us hundreds of dollars. Can we do better, even with less? God, I should think so. Do I want to make sure that when I really need the hospital, it’s still there and functioning? Yes! That means not wasting resources on xrays when you already know it’s nursemaid’s elbow, as a not-so-hypothetical example.

Kathy’s point about GD is that it is entirely preventable, and yet they won’t allocate the comparatively few dollars needed to prevent it, but will pay for the C sec, simply because the “wellness” model isn’t really considered part of health care.

Sharon

First of all, I do not believe that GD is responsible for the cesarean epidemic. Doctors start talking about a baby being “too big” for the mom’s pelvis when an ultrasound (accurate to +/- 25% for weight of a baby) indicates a weight somewhere around 8-8 1/2 pounds, and start talking about scheduling a cesarean. But a lot of babies who seem “too big” for a woman lying flat on her back in bed, tethered there by the fetal monitor, or an epidural, or an iv, all of which are very common interventions, in a position which closes down her pelvis, might easily be able to birth that baby if she were able, encouraged, and supported in moving and assuming positions that can create as much as 2 cm more diameter in the pelvic opening, such as squatting or hands and knees. GD might be responsible for the occasional truly huge baby that really can’t fit through the mother’s pelvis, but I know of many cases where a woman had a cesarean for a “too big” baby who went on to have babies a full pound or more bigger vaginally.

Many studies have been done, and I can get you the statistics if you want, that show that for a low risk pregnancy, birthing at home or in a birth center with a trained midwife is safer for both mother and baby than birthing in a hospital, particularly with an OB. (And lower energy and less expensive) If we are going to restructure the health care system to be lower energy and less expensive, we must take birth out of the hands of doctors, making midwives responsible for the vast majority of cases, and OBs only taking the high risk cases. This system is in place in several other industrialized countries — countries that rank significatnly higher than we do in terms of maternal mortality and morbitity and infant mortality. Some women really do need that high tech care and some cesareans truly do save lives — there is an appropriate time and place for every intervention — but they are all grossly overused in the current system. I don’t have numbers on this, but I suspect that childbirth is just about the most common reason for hospitaliization for women in this country, since something around only 10% of births occur anywhere else (again, I don’t have this number in front of me), so it would definitely make a huge difference. Part of the problem is the model of care in most hospitals is based on the premise that childbirth is a disaster waiting to happen, as well as incredibly inconvenient and time consuming, and must be managed so that it happens in a predictable way, as opposed to a model of care in which childbirth is a normal and natural life process which often needs time and patience. Yes, emergencies do happen, and I am in no was advocating unattended birth, but for the most part, if birth attendants sat back and watched, most babies would be born all on their own.

I could rant about the current system of maternity care for ages, but I won’t. I think I’ll leave it at that, for now.