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AN ECONOMY OF CARE
MAY NOT BE SO CARING
Journal of Healing – Jan. 31, 2007
By Mary Koch

I miss skiing.

We both gave it up 13 years ago after my husband’s paralyzing stroke. For me to go skiing without him seemed like a betrayal. Besides, as a caregiver I didn’t dare risk a broken leg.

Now as we slog through this eighteenth week of January, I understand how skiing kept our spirits up in winter. I miss not only the fun of gliding, sometimes tumbling, down a mountain. I miss the ski culture – the conviviality of the lodge, the pauses to drink in mountain-top scenery while catching your breath, the three-minute conversations with strangers while riding a chair lift.

I recalled one of those conversations this week. We were skiing in Canada and riding the lift with a rancher from Alberta. He was describing the province’s economic woes and concluded that in the end, Albertans’ economic survival would amount to “taking in each other’s laundry.”

* * *

I WAS reminded of his comment as I read an article that my brother had clipped from BusinessWeek. The magazine reported at length that America’s $2 trillion health care industry (including insurance and pharmaceuticals) is propping up our economy. Health care added 1.7 million new jobs in the past five years while employment in the rest of the private sector remained flat.

The article was written a few months ago, before pharmaceutical giant Pfizer announced its recent cut of 10,000 jobs – but Pfizer is a blip on the radar. In one month alone last year, 35,000 new health care jobs were created. Without the health care system, BusinessWeek reported, unemployment in the U.S. would be 1 to 2 percent higher.

If the current trend continues, some 30 to 40 percent of all new jobs will be in health care. So instead of taking in each other’s laundry, we’ll all be taking care of each other. What could be wrong with that?

It’s not good, says the magazine, because “a well-balanced economy needs to provide a wide variety of jobs, not just positions for doctors, nurses and medical technicians.”

Not to mention the well-balanced patient.

BusinessWeek interviewed a 46-year-old nursing student who quit her job as a traveling insurance saleswoman because nursing will pay more and she won’t have to travel. You bet I want to see nurses paid well; but I’d hope that wouldn’t be their primary motivation.

* * *

WHAT’S GOOD for business may not be so hot for the patient. We spend more on health care per person than any other nation in the world and rank around 25th in life span.

An interview with Dr. Arthur Agatston in the Jan. 24 New York Times spotlights one reason why. The famous “South Beach Diet” doctor runs a private cardiology practice with 2,800 patients. His staff of nurses and nutritionists works closely with patients on diet, exercise, smoking cessation, etc. Only three of his patients had a heart attack last year, he told the Times.

But here’s the catch: His medical practice is losing money. It’s his “outside income,” says the doctor, who has sold some 20 million books, that allows him to practice medicine the way he believes.

American health care, concludes the Times, is a “perverse system of incentives that nudges doctors and patients toward expensive tests and procedures when cheaper preventive measures might actually produce better results.” Hey, it creates jobs, doesn’t it?

The other big health care issue is, of course, access. Gov. Arnold Schwarzenegger recently outlined a plan for covering the uninsured in California. I’m sure it was only a coincidence, but did you notice? He was on crutches, recovering from a skiing accident.

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