The term, Medical Industrial Complex, was first coined in 1980 by Arnold S. Relman M.D. who was, at that time, editor-in-chief of The New England Journal of Medicine. He adopted the concept from a farewell speech by President Dwight Eisenhower who warned about the dangers of a Military Industrial Complex. That ten minute speech can still be seen on the internet.

Much of what has changed medicine in the past forty years is due to the manipulation of the health care system by this Medical Industrial Complex. There are no innocent players when it comes to the constantly increasing cost of Health Care. The guilty parties include: physicians, health care executives, the public in general, hospitals, health insurance companies, HMOs, stockholders in public health care companies, the pharmaceutical companies, politicians, malpractice attorneys, and above all, lobbyists.

            There is so much money to be made in health care that it is frankly, shocking. We already spend $2.3 trillion a year (17 percent of our of our Gross Domestic Product) (1) for a system that makes billionaires of savvy businessmen while bankrupting ordinary citizens. Maggie Mahar has correctly labeled this issue "Money Driven Medicine" in her book of the same title. As long as investor owned health care insurance companies, hospitals, nursing homes, and the pharmaceutical industry, pay their CEOs millions of dollars in salaries and stock options, the cost of health care will never be brought under control. In 2004, a major health insurance company in Minneapolis paid their CEO $125,000,000.(2) Count the zeros. Companies that have to worry about their stock price will always do what is necessary keep it increasing in value. After all, their job is to make money. They are responsible for the value of their company and answer to their Board of Directors.

            Some non-profit health care entities do little better than their for-profit rivals. Chief Executive Officers in some instances make salaries in the millions. Some non-profit hospitals take advantage of their tax status but act like for-profit companies. In some instances, that means garnishing wages and foreclosing on patient's homes when they cannot pay their health care bill.

            If the current Medical Industrial Complex is to survive in this country, these cost issues will have to be dealt with. It would be far better if the industry did this themselves. Otherwise, there will be a ground swell of pressure from the general population and eventually the politicians to have government step in and do it for them.

            Fifty years ago this Medical Industrial Complex did not exist. It basically started in the mid-1960s with the development of the private hospital chains. These entities proved that it was possible to make money in health care. The Nixon administration pushed the concept of HMOs as a means of controlling cost but all that did was create a whole new Medical Industrial Complex. In many instances costs were not lowered.

            The problem is this: Those involved in health care should be looking after the best interest of sick patients and attempting to cure their illnesses. When you let dollars decide the best course of treatment, the patient suffers. In fact, we now have health care rationing based upon the ability to pay. Or, at least, to afford health insurance. According to most statistics, there are at least forty-six million Americans who have no health insurance. That figure was developed before the recent economic meltdown occurred and millions of individuals lost their jobs, homes, and health insurance. It seems ironic that one of the most prosperous nations in the world should allow some of its citizens to wander the streets as homeless schizophrenics and others to die because they simply cannot pay for cancer treatment.

            According to a December 2008 report by McKinsey and Company, we as a nation pay more for our health care than we do for food and more than China does for all goods and services.(3) The U.S. health care bill annually, adjusted for wealth, is greater than in other countries such as Austria, Canada, Germany, France, Denmark, Check Republic, Finland, Iceland, Poland, Portugal, South Korea, Spain, and Switzerland. This is not a good situation for the health of U.S. citizens.

            What role has the general public played in this crisis? Life style issues amongst the general public are a huge part of the problem. Chronic conditions such as obesity, diabetes, heart disease, arthritis, and asthma account for much of the cost of health care. Management of these chronic diseases would automatically lower the overall expenditures paid out each year. Obesity is an epidemic in this country accounting for hypertension, heart disease, arthritis, chronic join disease, cancer, and diabetes. Unfortunately, all of us pay a price for the indulgences of these individuals. Add in the people who smoke, consume too much alcohol, and illegal drugs, and you have a perfect storm that is actually preventable.

            Physicians are not innocent bystanders in this whole equation. In many instances they have abandoned the time honored Art of Medicine and have lost one of their most valuable healing methods, the doctor-patient relationship. Talk to one of them and they will give you a myriad of reasons for this. The first would be interference from third parties in the management of their patients. Not only do the insurance companies dictate how much a physician will receive in compensation, they try, in many cases, to micromanage the physician's patients. These entities decide who will and will not receive tests such as MRI or CT scans. They also deny certain treatments they consider to be too expensive. 

            This in turn, has made physicians look for other venues for income. Frankly, they see medicine much as their business counterparts. They advertise in magazines, newspapers, and on television. They own surgery and dialysis centers, imaging centers, and in some cases, hospitals. Does this create a conflict of interest? Some would certainly say that it does. Representative Pete Stark of California has been a persistent crusader on the issue of physician conflict of interest. For years the Stark Laws have been a thorn in the side of physician entrepreneurs and their business partners.

            What part in all of this do malpractice attorneys play? All doctors will admit that they order tests (i.e.: MRI, CT) as a defensive measure that occasionally has little to add to the patient's diagnosis. But, on the other hand, if something untoward happens which will not have been averted by the unnecessary MRI scan, there will still be a lawsuit. The plaintiff’s attorney can always find a highly paid witness to state that such a test should have been ordered. All the players, hospitals, ambulatory surgery centers, etc. are constantly faced with the possibility of legal action. Do malpractice suits and the threat of them add that much to the overall cost of health care? Defensive medicine in this country cost the health care system billions of dollars on an annual basis.

            End of life issues are difficult for everyone to face. Yet these add considerably to the overall cost of health care, particularly where Medicare is concerned. If someone is terminal, does it make sense to spend hundreds of thousands of dollars on expensive diagnostic studies such as MRI or weeks in the intensive care unit or ill conceived surgical procedures, when the outcome is not going to be changed? Everyone wants the best care for their dying relative. However, what is the best care in these situations? Doctors are trained to save lives. It is difficult for them to step back and let nature take its course. These are emotional and ethical issue that have to be dealt with.

            One fact is certain, health care lobbyist create havoc within the system. Due to political influence and lobbying by the powerful pharmaceutical industry, Medicare cannot negotiate the price it pays for prescription drugs.(4) The Medicare Prescription Drug Plan has and will continue to cost the government vast sums of money.

            This issue has been around since Teddy Roosevelt's day so it is not going to be easy to solve the problem due to the influence of the varied vested interest. The health care system in the U.S. is in a state of crisis and only a wise, radical restructuring will correct it. Some solution must be enacted soon A safety net is needed for those citizens who can't obtain private health insurance because of a pre-existing condition or because they can't afford the coverage.

            A government sponsored program must be established to cover these disenfranchised individuals under a single payer system paid for with a graduated federal health tax. This tax would be graduated in a similar manner as our current internal revenue code. It smacks of class warfare to lay the entire burden on the wealthy. Since everyone would benefit, everyone should pay the tax (including seniors) even if they had private health insurance. Under a graduated health tax code, those individuals with low incomes would pay something, but not as much as their wealthy counterparts.

            While not completely applicable, it would be a similar situation to the public school system. Everyone supports the schools through taxes whether they have children or if their children have left home. This has not prevented an expensive private school system to flourish as an alternative for those who can afford the cost.

            Cost containment is a separate issue. Bringing cost under control should be a priority for everyone. There are a number of ways to accomplish this goal. Private entities would be encouraged to lower their overhead. Private insurers must advertise and compete in an open market. Their overhead usually runs around 30% or more while Medicare comes in at around 8%. Currently, when an insurance company begins to see a drop in profits, premiums are simply raised. This practice must be changed or cost will never be kept under control. If everyone in the U. S. had health insurance, chronic illness could be managed effectively thereby keeping patients out of emergency rooms and hospital beds. This alone would greatly lower overall cost.

            For much of the last century and currently, physicians have worked as a "cottage industry" and compensated under a "fee for service" method of payment. By and large, physicians work individually or in small one to three person groups. It is difficult to control overhead without buying power. Therefore, physicians should be encouraged to form multispecialty groups much like the Mayo and Cleveland Clinics. These entities have proven that cost can be controlled. Physicians should be compensated with a base salary and given bonuses based on good outcomes. This will be a "key phrase" in the years to come. The encouragement of evidence based medicine would eliminate some methods of treatment that may be expensive, unproven, and dangerous.

            The way medicine is practiced today is after the fact. In other words, physicians wait until a patient is seriously ill before attempting to treat their problem. Instead, integrated medicine should be encouraged. This simply means that physicians would practice preventive medicine: Coaching the patient to stay well instead of ordering expensive tests after the fact. Again, managing chronic illness and teaching patients how to prevent obesity, control their hypertension, asthma etc. One thought would be to offer a health tax rebate for those individuals who practice a healthy life style. In other words, if a patient maintains a reasonable weight, exercises, does not smoke, and abuse alcohol they would receive a reduction in their health tax. If they did abuse their health, they would have to pay a higher health tax.

            While there are some privacy issues associated with integrated electronic medical records, these can surely be overcome. The cost benefit to e-records is substantial. And there is another important benefit that is seldom mentioned. Patients often come to a physician's office carrying a paper sack full of prescription medications that they have no idea why they are taking them. Often they don't even bring the medications in so the treating physician has no idea how the patient is being medicated. This leads to over prescribing and it can be dangerous. With an integrated e-record, the physician would be able to pull the patient's past history including prescriptions and be able to make an intelligent decision on how best to manage the patient's health problem. 

            As long as all citizens are covered with health insurance, the entity that pays the bill should not be an issue. No one could suggest that the public system described here would, in any way, be socialistic, the vested interests' code word for any government assisted program. What has been outlined in this discussion is reasonable and certainly not threatening to the private sector.

            Health care reform does not have to be a contentious issue. It is long overdue. It has to be accomplished.