What does a healthcare dystopia look like?
In my recent TED talk, I introduce you to a world where people die waiting for
healthcare, where corporate interests reign, and where doctors get paid to do
more rather than to the right thing.
I’m a Chinese-born, American-trained physician. A couple of
years ago, I was given an opportunity to conduct a research
project on China’s healthcare system. I traveled to 15 cities from Beijing
to Inner Mongolia, visited over 50 hospitals, and had unprecedented access to
doctors, medical students, nurses, administrators, and government officials. Given
how China’s developed into a major world power, I expected to find a fair,
functional system.
However, instead of this utopia, I found a dystopic world. People spoke about
the 1980s, when universal
healthcare was dismantled, and 900 million people lost coverage overnight. Everyone
had a story of friends and family who died in front of hospitals because they
couldn’t pay.
Doctors were unhappy too. Imagine you’re a doctor, and you
trained all your life to listen and heal; suddenly, overnight, you’re a
businessman and you have to work your patient to get every cent.
On the other hand, if you’re a well-off patient and you hear
that poor people get denied services, what do you want for yourself? You want
everything to be done. Because you have the money, nobody will tell you about
the risk of radiation of a CT scan. Same for expensive but untested
medications, or potentially dangerous procedures. People got what they wanted,
but at what cost?
No doubt, China has been very successful. The government has
lifted millions out of poverty. But there is a fundamental problem, a blind
spot that’s been missed in the rush towards economic reform.
This blind spot is our belief that being a consumer enables
choice, and that choice is power. I’m all for empowering people to have choices.
But turning patients into consumers means that healthcare is a commodity, not a
right. It becomes possible to deny life-saving treatment, and to sell
unnecessary, even harmful, interventions. The doctor-patient relationship
becomes a transaction between salesman and client.
That blind spot, and the consequences, are not unique to
China. Here in the U.S., costs of healthcare are escalating out of control. While
millions remain uninsured, 30%
of all tests and treatments are done are unnecessary. It’s far more
profitable to peddle drugs than prevent illnesses. According to the New England Journal of Medicine, 94% of doctors have some
affiliation with drug and medical device companies.
By no means am I romanticizing the pre-1980s Communist
state. My family left on political asylum, and I am very grateful for the opportunities
afforded to me by my adopted country. But capitalism doesn’t have to equate
consumerism, and the beauty of a democracy is that we as citizens can decide
what type of society we want to live in.
To prevent further problems in our country, and to stop the
rest of the world from following us down this path, we have to make a difficult
decision. We must decide if it’s important to us to preserve our core tenets of
liberty, democracy, equity, and justice. If not, we know what the dystopic
future will look like. If so, the time is now to decide that there are some
things that are not for sale, and that we must realign incentives to help
people be their best selves.
