Questions and Answers from the Dr. Fine presentation of January 18, 2021:

Question:
How can we generate the essential political will to make the necessary changes?   Perhaps the barriers are beliefs and emotional commitment rather than based on reason?  What role does dark money play? 
Answer:
The essential political will can only come from movement building, I fear.  (It's) a big project, one I devote lots of time to.
The barriers are all emotional.  My primary care colleagues, whose professional lives have been completely destroyed by the medical industrial complex, and also completely afraid of any change.  It's all dark money, really -- but very big dark money.  Remember Harry and Louise? They taught the liars in American politics that big lies work better than small ones.

Comment:
What we need to create a movement is a simple message that describes the difference between a health system and health insurance, and where the money is going that all people can understand.
Response:
(I) couldn't agree more.  The point is to stop admiring the problem and build the solution.

Question:
One thing people do not realize is that people without health insurance go to the emergency room when either sick or have an accident.  They can have surgery.  Premature babies receive care for months.  People can get chemo, radiation, and hospitals take it as a loss. How would the price of health care be any different if there was a health care center? 
Answer:
If we had a primary care center for all Americans, the cost of health care in the US as a whole would likely drop $500 billion, or by a seventh of what we are spending now, so by about $1500 per person.  We'd need other changes -- from regulation on the pharma industry to increasing public spending on education, housing, the environment and community development, to realize a 60 percent savings, which other countries have shown is achievable.

Question:
How does a country, acting through its elected politicians and health-conscious citizens change the mentality of a large percentage of fellow citizens who do not care about healthy lifestyles?  McDonald's and Kentucky Fried Chicken are highly successful businesses. Seems that the anti-smoking campaign worked well.  Cannot the same approach be used to educate about living healthy, along with access to medical care?
Answer:
YES!  If marketing campaigns can help companies sell bottled water (which is free!) and harmful food like goop, then the same approach can surely be used to persuade people to do what is better for them and save money.
Thanks for this question/idea.  The challenge isn't what.  The challenge is building the political and financial support to make these changes.


Comment:
Please speak of the Health Equity Zones
Response:
Health Equity Zones are attempts to organize communities around health behaviors and to address the social determinants of health, to get communities to work on improving education, housing, the environment and so forth.  I'm not a big fan of this approach.  From my perspective we need to corral the runaway cost of health care using the primary care for all approach, while we push government to work on the social determinants.  And we need to be careful not to medicalize social determinants, which is what is happening now.  Social determinants need social advocacy for their own sake, not because of their health impacts alone, and communities need agency, to work on what they need together.  Municipal governments exist to do this work if people with agency opus them.  That's what democracy is for.

Question:
Is it true that doctors in the US don't prescribe alternative/preventative medicine because they make less money than if they prescribe a pill?
Answer:
Thanks for the question.  I don't presume to speak for all or most doctors in the US.  That said, most of my colleagues don't actually know very much about alternative or complementary medicine.  The number of well-designed studies on these modalities are few.  On the other hand, pharma spends billions ($9.53 billion in 2020, but who is counting?) on marketing to my colleagues, which tends to grab attention.
All this is the end product of having a medical industrial complex that is for profit, instead of a health care system that is for people.  Doctors in the US don't make more or less money based on what they prescribe.  But money in health care tips the balance toward itself, with two feet instead of just a finger on the scale.

Question:
How much of the increased cost for the US is due to our paying more than other countries on prescription? 
Answer:
In the US in 2017 23.7 percent of all health care spending was on prescription medicine.  If they are over-priced by a factor of 2, then about 11.85 percent of the total US health care expenditure is because of profit driven prescription pricing.  That's about $330 billion dollars.  It could be more, depending on which countries we are comparing ourselves to.