The health care industrial complex is stronger than ever

The health care industrial complex is stronger than ever

Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by the size and scope of the facility and its cool, corporate look.

“Welcome,” I thought, “to the health care industrial complex.”  This meeting was, after all, designed for me and the other heart rhythm specialists from all over the world.

After picking up my badge I shuttled off to my first session and picked up the fresh flier published on the previous day’s events.  The publication was remarkably professional, processed with all the proper public relation jargon and complementary hyperbole.  The Heart Rhythm Society app that I downloaded on my iPhone, too,  looked eerily similar to the polished one at the ACC meeting earlier this year, just the sponsor page that blinked “Biotronik” instead of  “Amgen” as it had earlier this year.  Finally, as I turned by attention back to the flier, there on page two was a picture of Hugh Calkins, MD the current president of HRS and James Youngblood, the society’s “professional” CEO, honoring the “HRS Infinity Circle Supporters” from Medtronic.  Infinity Circle Gold members from Biosense Webster, Boehringer Ingelheim, Boston Scientific and Janssen and Silver member St. Jude Medical also were honored in the picture’s caption.

Of course they were.

Twenty-six years ago I entered the North American Society and Pacing and Electrophysiology (NASPE) as a young fellow in cardiac electrophysiology competing for the young investigator competition.  I was nervous as hell as I practiced and re-practiced by presentation.  I was competing against some of the best and brightest and was thrilled at the opportunity, the heady notoriety, and the opportunity to rub noses with the reviewers (international senior mentors) first hand.  Back then I did not have the perspective I have now with the interplay of forces that have come to define U.S. health care.  I had no concept of the powerful influence that the vast sums of money, lobbies, special interests, regulators, and oversight agencies have in medicine.

Since that time, NASPE has changed its name to the Heart Rhythm Society to reflect a more global mission.  Over the years I have seen the bureaucratic and political influence change the landscape of medicine as I never imagined as I struggle to cope with what it means to practice medicine today.  I suppose when one considers that for many communities in America, health care is their economy, I shouldn’t be surprised that the business and politics of medicine are now more important than ever.

Years ago near the start of the Vietnam War, President Dwight D. Eisenhower coined the phrase “military industrial complex” in his farewell speech to America.  He was describing the policy and monetary relationships that exist between legislators, our national armed forces, and the military industrial base that supports them.  These relationships include political contributions, political approval for military spending, lobbying to support bureaucracies and oversight of the industry.  The concept began with the concept of coordination between the government and the private sector to provide weaponry to government-run forces.

Now we have the private sector providing funding for our instruments of health care.  We see companies that supply medical devices, drugs, insurance, electronic medical records and companies that support lobbying efforts and data mining and richly-paid oversight entities.  Today, however, the budget is much, much larger for medicine than the military.  Our health care industrial complex has grown into the monster it is today with a supporting flotilla of corporate, special interest, regulators and oversight entities, with doctors and patient’s swept up by its wake.

Some have called this the iron triangle.  And just like it’s original reference for the military, we should recognize that it pertains to health care, too.  While this may be distasteful to many (including myself), I have also come to recognize that like the military, we need health care.  Unfortunately for all of us, this monstrous bureaucratically-wasteful system is what we’ve created.   For me, I find it helpful to understand this interplay, because it helps me focus on my role as a doctor today.

I can only hope that our younger medical students, residents, fellows, and younger doctors get taught this perspective.  Much too often I see them looking more like lambs being led to slaughter.  Hopefully, a little insight will help them cope with the seemingly endless bureaucratic and oversight “ideas” that keep surfacing as we struggle to care for our patients.  Hopefully this perspective will keep them engaged in pushing back when the onerous becomes intolerable.  Hopefully they’ll come to understand what they’re up against before they throw up their hands in disgust.

Perhaps bringing these concepts to consciousness will allow us to become coordinated advocates for our patients who are being affected by these very same forces.  Maybe then, we can continue to hold true to what we love about medicine, and beat back the iron triangle that is making it so difficult to do so.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • John Ballard

    It’s refreshing to see someone in a position to know using such clear language. You’re on to something. I have been complaining about something similar on blog comment threads for some time, but my take is somewhat different. After working in a post-retirement job in a healthcare system (my career in food service was totally for-profit, private-sector corporate environment, where we worked damn hard to get a nickle or a dime from every revenue dollar) I was shocked at the amount of resources, both human and financial, that I found in the so-called “not-for-profit” nucleus of most very much FOR profit healthcare settings.

    This is the copy and paste shtick I have left around several places:

    >>The footprint of most health care systems in America is often as big as an industrial park. There are so many clinics, labs, private practices, specialty centers, agencies, imaging centers, retail outlets selling durable equipment and disposables, pharmacies, the list is endless… And that doesn’t take in to account ancillary non-medical businesses from window-cleaning, landscaping and waste removal to uniform sales, food service outlets and parking garages. It takes your breath away to think of it. And every dollar supporting this is in one way or another the cost of health care in America. Every dime feeding this monster begins with a charge for someone’s medical bill.

    Healthcare systems should not be much bigger than a good-sized hospital. And they should be scattered far and wide, like grocery stores, in proximity to the places where health care is needed — NOT in the most affluent parts of the metroplexes where they are now concentrated. A more robust system of community health centers will be part of that picture. And that, too, is part of the vision of ACA.

    Complaining about stimulus spending is a smoke screen to distract from embedded toxic systems already in place. Ike’s military-industrial complex has not only grown, but has been amended by similar toxic tax-money-to-privatization schemes involving prisons, education, medical care and prescription drugs. This kind of argument is really tiresome. <<

    I think we have in many ways said the same thing.
    Keep up the good work.

  • http://www.drsocial.org brettmd

    I encourage everyone who reads this to support the @FTC to break down the monopoly and corruption that results from absolute immunity to abuse the law. If the medical board members had to be held even remotely accountable to the law, they would consider their actions, but I have numerous examples detailing that they do not.

    Support the @FTC . If SCOTUS rules that States can violate the anti-trust laws then there is no hope for patient advocacy and we can expect many more VA scenarios.

    From Doximity,
    Frank Proscia, MD Psychiatry

    @DoctorsCouncil: Warning to all hospitals- do not manipulate statistics! Severe Report Finds V.A. Hid Waiting Lists at Hospitals
    http://dox.im/8pm9tt

    Like Comment

    6:33 PM

    Brett Snodgrass, MD Preventive Medicine

    Dear Dr. Proscia,

    If you are actually trying to warn hospitals, then I respect that. Yet, psychiatrists are very clever, and ask questions they already know the answer to, etc… In case you are truly earnest in letting other hospitals know that they should not act unethically, here is how *a few* unscrupulous and personality disordered administrators and leaders may respond to your warning.

    “Warn them,” that is a
    1. Threat (per a pathology chair).
    2. Unprofessional
    3. Unethical
    4. You will likely be reprimanded by a State Medical Board for your unethical and unprofessional conduct that will lead to your dismissal from a hospital. Don’t worry, they don’t have to behave ethically or competently. They can decide whether you were ethical or not by the flip of a coin and they are completely immune from the consequences of their actions secondary to the
    Health Care Quality “Improvement,” Act of 1986.
    5. More here: http://www.houstonpress.com/2014-03-27/news/steven-hotze-texas-medical-board/full/
    6.http://www.nejm.org/doi/full/10.1056/NEJMp1401460#t=comments

    Kind regards doctor,

    I hope you are not serious. Warn someone who has authority over you in medicine. Don’t you know that physicians cannot speak up for their patients, for justice, or bring poor care and patient harm to the attention of others. The medical board in missouri continues to call my attorney telling her garbage such as I won’t be silent. Perhaps they should take off their prejudicial lenses, and if* they don’t, I hope that the FTC will win with SCOTUS and I will take the medical board members to court and sue them for harming patients through administrative negligence, and multiple acts of abuse of discretion.

  • http://www.drsocial.org brettmd

    In addition, I was reprimanded for this benign email, where I called myself a misfit. A reasonable physician would probably say “okay,” don’t do a stupid prank again. I appropriately received a letter of reprimand on 09 22 2010. However, abuse of discretion is common in the UMKC Pathology Department. The new UMKC Pathology Chair and Program Director decided to revoke her “written warning to me,” and upgraded her disciplinary actions to the Status of “underhanded activity,” and she setup a disciplinary proceeding on 09 24 2010 for “egregious,” activity.

  • LeoHolmMD

    The actual triple aim.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Priceless!!!

  • CPO_C_Ryback

    ” .. Years ago near the start of the Vietnam War, President Dwight D. Eisenhower coined the phrase “military industrial complex” in his farewell speech to America ..”

    .. after the 1960 election whereupon Ike was accused of a “missile gap” with the USSR by JFK. Whose VP, LBJ, sent 50,000 Americans to Vietnam, for the 1964 election.

    Ike was from rural Kansas, Abilene. He’s buried in an $80 soldier’s coffin and only three medals from D-Day. No $200,000 speaking fee from the National Trial Lawyers Association was required — how quaint.

  • JPedersenB

    I think you should call it the “Medical Industrial Complex” as there is very little about “health” in our current dysfunctional system.

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