Healthcare Crisis - The Best analysis I have found

Here is an extract from a recent letter to the Times in the UK. It refers to the NHS but as you will see, nails the issue for us in Canada as well.

From THE WEEK Magazine 30 April 2005

Let’s Rethink the National Health Service

Letter to the Times from J.D. Manson, London W1

Anatole Kaletsky is being realistic when he says “Britain will have to re-examine the concept of a healthcare service funded through taxes”. The concept that healthcare would be available to all free at the point of use was a product of our understanding of disease 60 years ago. Then so much disease was the product of poverty, malnutrition and bad housing, which caused TB, rickets and low resistance to infections. The Labour Government of 1945 believed that providing work, adequate nutrition and decent housing would not only reduce disease prevalence but actually reduce the demand for healthcare.

Today, with antibiotics and huge advances in knowledge and treatment techniques, this now totemic concept not only imposes and insupportable economic burden but has resulted in many people’s abdication of responsibility for their own wellbeing.

The issue for us, as we see costs climb and crowd out everything else, is that we miss the point that 30% of the population drive 80% of the costs and their treatment is only palliative and is not a cure. The drug companies have of course no interest in a cure. They want us to have type 2 diabetes, hypertension, high cholesterol etc.

We also don't want to change - so we continue to smoke, take no exercise, eat crap etc. We then demand that society pay to keep us ticking over.

Here is a dramatic supporting comment from the article Change or Die:

Dr. Raphael "Ray" Levey, founder of the Global Medical Forum, an annual summit meeting of leaders from every constituency in the health system, told the audience, "A relatively small percentage of the population consumes the vast majority of the health-care budget for diseases that are very well known and by and large behavioral." That is, they're sick because of how they choose to live their lives, not because of environmental or genetic factors beyond their control. Continued Levey: "Even as far back as when I was in medical school" -- he enrolled at Harvard in 1955 -- "many articles demonstrated that 80% of the health-care budget was consumed by five behavioral issues." Levey didn't bother to name them, but you don't need an MD to guess what he was talking about: too much smoking, drinking, eating, and stress, and not enough exercise.
Then the knockout blow was delivered by Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University. He turned the discussion to patients whose heart disease is so severe that they undergo bypass surgery, a traumatic and expensive procedure that can cost more than $100,000 if complications arise. About 600,000 people have bypasses every year in the United States, and 1.3 million heart patients have angioplasties -- all at a total cost of around $30 billion. The procedures temporarily relieve chest pains but rarely prevent heart attacks or prolong lives. Around half of the time, the bypass grafts clog up in a few years; the angioplasties, in a few months. The causes of this so-called restenosis are complex. It's sometimes a reaction to the trauma of the surgery itself. But many patients could avoid the return of pain and the need to repeat the surgery -- not to mention arrest the course of their disease before it kills them -- by switching to healthier lifestyles. Yet very few do. "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle," Miller said. "And that's been studied over and over and over again. And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."
Why can't we change the dialogue from needing more doctors and more drugs to making behaviour the key?