A Health System with Miracles
In our column we discuss Miracle Workers:How can you tell when your nation's health care system has collapsed? One sure sign is the creation of a television program that offers access to health care to the desperately ill as a prize. The show has now materialized on American TV screens. Everything about it shows just how badly broken health care in America truly is."Miracle Workers," which appears Monday nights on ABC, offers the services of "miracle doctors" to people with horrible medical problems. The show's Web site says that the program is an example of the network's "tradition of developing reality programming that makes impossible dreams come true."
In a nutshell, the show finds people with serious medical problems who nonetheless have the right stuff to be appealing as well as suitably grateful to their television benefactors. The program matches them up with teams of doctors and nurses who have been selected for their buccaneering style, willingness to push the envelope and good looks.
So how exactly does a show that hooks up desperate patients with hospitals falling over one another for the free publicity their best and brightest docs can create square with our health care system? Watch the show and you will know that if you are lucky, comb your hair and are willing to dispense with any semblance of privacy, a TV producer and his medical advisers may show up at your house and direct you to a team of well-scrubbed young health care professionals with loads of time to spend with you.
These benefactors will smooth the way to your treatment and follow-up care by picking up whatever part of the tab you cannot pay. That is health care reality-TV style.
In reality, a quarter of us have either no health insurance or lousy coverage. No one has a doctor who isn't using much of the time once spent on patients talking to bureaucrats on the telephone to try and get approval for a prescription or a diagnostic test. A large number of us spend forever in emergency rooms to get basic care. There are many children who get no medical or dental care. The waiting times to see the doctor grow and grow.
We are bombarded with ads telling us to buy drugs because a man can throw a football through a tire in his backyard thereby arousing his mate or a butterfly will alight on our pillow if we swallow a capsule when we cannot sleep.
No one has any idea why anything costs what it does, but it would be dangerous to go to another country to get the same drug at a much lower price. The strategy of the payers hired to look out for our health is to routinely turn down requests for reimbursement in the hopes that we will simply give up.
Oh, almost forgot, the cost of this pathetic mishmash of a bloated, inefficient and sometimes dangerous health care system continues to grow right alongside the numbers of people losing insurance coverage or benefits. That is the harsh reality.What is really irritating about "Miracle Workers" is that the show makes health care seem a privilege, something you are lucky to get, rather than something you should have as a matter of right.
It suggests that what is most exciting about medicine occurs on the frontier, as if having your migraines treated, your alcoholism rehabilitated, your back pain relieved, your wheelchair properly sized or your congestive heart failure managed would not be miraculous if they happened today for everyone with these problems.
Worse still, the show sends out the message minute after phony minute that there is hope. Well, if you have a lot of money there is. If you don't, then this show is about as close as you are going to get to cutting-edge health care.
What "Miracle Workers" should make us do is shut off our televisions and sit down and write a letter or an e-mail to our congressional representatives and those who aspire to this office.
Point out that the rising cost of health care is crushing American business, leaving children in pain or disabled, forcing families to choose between eating and seeing a doctor, and creating a huge underclass of people who have a shrinking number of hospitals and doctors who will treat them.
Then note that if they want your vote, they had better be prepared with a plan to fix these problems. If they aren't, then in the real world of health care where you live, it will be a miracle if they get elected.
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Thanks for this beautifully written and all-too-right column. It is impossible not to be aghast at how shoddy our healthcare system is; that that fact is now grounds for entertainment sets the mind reeling.
- by Kevin T. Keith on Mar 23, 2006 at 2:13 PM | link
I'm not sure about health care being a right. Do adults have the right to have something that, if they can't provide it for themselves, someone else must? Do we have a right to have food? Clothes? Shelter? Books? TVs? By saying that health care is a "right" do you just mean that in a civilized society it seems that people ought to have it?
- by Laura(southernxyl) on Mar 23, 2006 at 10:10 PM | link
I don't see why a nation that has the technology, the expertise and the means should simply watch people die when they can adequately help those individuals. There is a perverse irony in considering the situation of someone terminally ill, who could be potentially treated if only they had the money and the situation that occured with the whole Shiavo fiasco. Thousands went out of their way to try and stop someone who was essentially a vegetable with no chance of recovery. Yet not many of these same individuals would spare a thought for patients like Alan ("Winace"), who have a good chance of recovery but never get that chance, because these patients simply cannot afford the costs of medical care.
It's nonsensical.
- by Joseph O'Donnell on Mar 24, 2006 at 1:50 AM | link
As I have described repeatedly in my Bioethic Discussion Blog, part of the problem is the use of the word "miracle" which as broadcast by the media and inferred by pharmaceutical companies and others including as an example a multispecialty clinic who used the advertising tag line "Blurring the line between medicine and miracles.
This kind of expression fires the demand of the public and their expectation for physicians to prescribe more and more unnecessary and inappropriate medication and perform unnecessary procedures, all with the hope of a miracle as the result but leading to increased costs of medical care.
As I concluded my posting on the topic of the "Miracle Workers" The intent of the program is meritorious, the title of the program is misleading and sends a wrong message. "Physicians are not miracle workers.. period! As I have written previously, hope for a miracle cure is fine but dont expect miracles from your physician, they come from some other source." ..Maurice.
- by Maurice Bernstein, M.D. on Mar 24, 2006 at 3:13 AM | link
Joseph, I see a huge difference between saying "we should help these people" and "they have a right to our help". My problem is with the word "right". Nothing, you know, is free. If the government provides something it is paid for by taxpayers, many of whom have problems of their own.
You're free to help panhandlers who ask you for pocket change. Some of them really need your help. Some of them you really ought to help. They'll be hungry if you don't. Does this mean they have a right to the change in your pocket? The law should compel you to hand it over?
Besides, there are plenty of people who get help they cannot afford. I personally have known people who had surgery and were otherwise treated in hospitals, who had no insurance. In all cases the doctors and hospitals knew they would never get their money but they took care of the people anyway. Emergency rooms are forbidden to turn people away due to lack of insurance. It is a problem that people use them instead of primary-care physicians, the ones on TennCare have been begged not to but they do it anyway. There are also church-based medical clinics that charge people on an income-based sliding scale. No insurance does not equal no care, regardless of what you read in the newspapers.
The bit about kids really irritates me. I know there are kids in Tennessee who do not get medical care. It's because their parents do not take them to the doctor. Tenncare purports to cover all kids whose parents can't afford their insurance. As much money as it sucks out of the budget, it surely ought to. Pregnant women don't get prenatal care sometimes for reasons having nothing to do with insurance or money. Check out this abstract: Prenatal Care for Low-Income Women Enrolled in a Managed-Care Organization. "Conclusion: Even when affordable care was available, many low-income women did not avail themselves of it. Although women knew the importance of prenatal care, there was a gap between attitudes and actually seeking appropriate care. System and personal factors need to be addressed to overcome barriers to prenatal care."
It's a complex issue.
- by Laura(southernxyl) on Mar 24, 2006 at 10:40 AM | link
I am aghast that the entertainment industry would even attempt to create a reality based show about someones real life misery. I cant believe that people would even think of exploiting someone with a medical condition in attempt to make a buck. I find this outrageous and obsurd and will personally not be viewing. These are people who cannot afford the care they need and may possibly die if they do not receive adequate treatment. To make them audition for a chance in a million to get this care just about makes me sick. Lets find a way to help these people not exploit them.
- by Amy on Mar 24, 2006 at 3:43 PM | link
Although I can appreciate the criticism of the TV show and see the need for a better healthcare system, I do not see much harm in the show. If someone has the chance to do this show and gets the treatment that they need, I say go for it. I think it also will bring attention and maybe some education to some of the rarer birthdefects and diseases. It may even offer some hope to someone suffering from the same problems. They will see the TV patient go through a difficult operation and recover to have a better quality of life.
- by charlotte on Mar 24, 2006 at 6:32 PM | link
Charlotte, will we also get to see a patient go through a difficult operation and not recover to have a better life as is the result in many different operations? Will we see the surgeon afterward explain to the patient the possible reasons for the poor outcome and perhaps apologize if something went wrong? Will we see and be told that the results of operations might not turn out to be a miracle? Or are we going to see only the sucessful outcomes with the "miracle" being the takeaway description? ..Maurice.
- by Maurice Bernstein, M.D. on Mar 25, 2006 at 3:35 AM | link
"Miracle Workers", I believe, is a misnomer in this circumstance. Reality per Webster's states "the quality of being true to life" Hm-m-m. The last time I was at the ER..agreed the staff was efficient and kind but I wasn't powdering my nose or freshening my perfume for the doctor! Good as he was, he was a little portly, older and myoptic! I believe that our 'profession', like others before...is going Hollywood. That is a condition of embellishment.Taking that, which is in its own place and time, good, helpful and actually not mundane and treating it to a make-over! Lets make it enticing beyond belief, a thrill each moment with tears of joy, or the fear of death brought to life! I guess for whomever benefits from it, it is a unique opportunity. No cost! (sorry, that I believe is a misnomer also!) Free publicity! Your neighbors/family/friends will idolize you! (No pun intended for another 'reality show'!) But why couldn't we have a show that educates or guides people to being self-sufficient, not dependent? How about empowerment? Isn't that a phrase coined by the medical profession as being the way to help the impoverished, the uneducated, the needy many? Show them how and they will follow? Oops! How exciting can that be? If the show encouraged people to be more proactive I would be all for it!! But reality in the Hollywood world teaches that luck and persistance (lets spend our time sending entrance applications to shows, instead of finding a job!)pay off...at least for those who are the 'chosen ones'! Of course, this does open up many other ideas for other 'reality shows..."Joe Idle (gets a job!), "Leave It To Beaver!"(and it will never get done) or "The Beverly Ill-billies" (and how they brought themselves out of the gutter with high ratings!). I see my future!
- by Barb B. on Mar 25, 2006 at 9:18 AM | link
Well,I almost agree with this "This kind of expression fires the demand of the public and their expectation for physicians to prescribe more and more unnecessary and inappropriate medication and perform unnecessary procedures, all with the hope of a miracle as the result but leading to increased costs of medical care." That's really true.
- by Dennis on Mar 25, 2006 at 9:48 AM | link
So Hollywood found someone else to exploit. This will not be an actual reality show because of many of the reasons you have all shared. The reality of healthcare in America is that it is rapidly approaching collapse. Each year millions of dollars of healthcare are spent without a hope of reimbursement to hospitals or phyicians. I don't agree that healthcare is a right because I happen to be a healthcare giver who sees first hand the abuse of emergency services by state covered patients daily. On average we see over 60% welfare or self-pay patients that get the same treatment as insured patients, we receive minimal reinbursement or none from these patients. The money is being sucked out fasted than it can be recovered. Now I am no financial wizard but I know that it can not go on forever.
I agree that doctors are not miracle workers but Hollywood has always been a little mixed up. They will do anything to make money if they think it will sell they will try it. I am embarrassed for these doctors and nurses that will take part in the exploitation of these patients.
- by Schref on Mar 25, 2006 at 6:38 PM | link
I think that it is sad that reality TV has exploited everything. The thing about reality TV is that there is nothing real about it. It is all set up and cut to show what attracts the viewers. As far as the right to healthcare and the cost of health care, I agree wholeheartedly that everyone deserves healthcare. I think that the cost of healthcare is fueled by the insurance companies. We complain about those who have no insurance, but maybe if there was no insurance and all of the billions of dollars that are spent on inadequate healthcare coverage was instead put back into our pockets healthcare costs could come down. Doctors are forced to charge higher rates just to recover whatever the insurance companies are willing to pay. As I see it, the only ones who profit are the insurance companies. Insurance has gotten out of hand taking with it healthcare costs. We keep paying more and getting less. Where will it end?
- by Judy Northrop on Mar 26, 2006 at 1:40 AM | link
Although I think the show does help people in need I also think it shows a very weak link in our health care system. These people who need help are not looking for elective procedures they are simply looking for a simple cure, as stated in an earlier message. They just aren't able to afford the treatment to survive on their own, either because they don't have health insurance or their health insurance won't pay for it. Health insurance doesn't pay for much these days and we are paying way to much for to little coverage.
- by Desiree on Mar 26, 2006 at 3:08 PM | link
I think Judy's right about insurance being a factor in health care costs being so high.
But as to everyone deserving healthcare: I read an article in the paper some time back about two women with breast cancer. One woman, in late middle age, hadn't been getting mammograms because her insurance didn't cover them. I paused for a moment thinking how awful it would be to be at that stage in your life and be unable to shake loose $100 or so once a year for such an important thing. It would have been hard for me in our early married life ... eating macaroni and cheese five nights a week as we did, and unable to replace shoes even when they got holes in the bottom. But then the article went on to say that when she found a lump, she waited until she and her husband got back from their weeklong vacation in the Bahamas before she went to the doctor. Did that woman "deserve" to get those yearly mammograms? Of course. So why didn't she get them? Why?
I think if people lost a little bit of that entitlement mindset - it's OK for me to spend my money on clothes or food but I shouldn't be paying anything for my own healthcare - some of the insanity would go away.
- by Laura(southernxyl) on Mar 26, 2006 at 3:37 PM | link
I've never seen the program but if people are being helped it can't be all bad. Maybe it can call attention to the sad state our healthcare system is currently in.
- by Cindy on Mar 26, 2006 at 5:01 PM | link
I think the show is just totally outrageous. Everyone one of us in healthcare would help whoever we could. Why not just donate the money to help a hospital? Where many people could benefit. The littlest things go unnoticed and are most appreciated.
- by Angie on Mar 27, 2006 at 7:03 PM | link
Frankly I will admit that I enjoy Extreme Home Makeover-but don't think less of me for that, however when I saw the commercial for this show it sickened me. I understand that health care isn't always available to everyone-but why publicize these peoples misery-then make everyone believe that they can miraculously be cured. And I also agree, what if the surgery/treatment does not provide benefit-does that clip go on the cutting room floor-this is along the lines of the shows of plastic surgeries that never show infections, embolus, death or any other complications-where is the reality in these reality TV shows.
- by Kasey O'Neil on Mar 27, 2006 at 11:32 PM | link
I think Laura and Maurice Bernstein MD have made some excellent points. I believe this is a well written article and the name of the show is a bit offensive to me. What is the real miracle? I did watch this show once and knew that it would be the last time. The people receiving the treatment aren't exclusive to the disease or problem that affects them. So why are they chosen? If there are 'miracle workers' out there why can't everyone with that problem be 'cured'? I also have mixed feelings over insurance for all - we have a welfare system in this country (and this country only) and it seems most people that are in the program have developed a sense of entitlement. Nothing is free - somebody always pays for other's free 'rights', most often you and me.
And right-on Maurice Bernstein, MD, "Physicians are not miracle workers.. period! As I have written previously, hope for a miracle cure is fine but dont expect miracles from your physician, they come from some other source."
- by Mary Jayne on Mar 28, 2006 at 3:38 PM | link
Hollywood meets hospital on reality TV? Unfortunately there are those in Hollywood that do not see the misleading commercialization of healthcare. What a shame to make free healthcare that is desperately needed into a freak reality show for ratings. Shame on the american public and industries that support such a disgusting mockery of our health system!
- by Karrah on Mar 28, 2006 at 7:03 PM | link
I've seen the show and I get a good feeling seeing these people with joy in their hearts and some hope for a brighter tomorrow. There are no guarantees and I think they know this. I would love to see follow up stories on some of the people that have truly touched our hearts but certainly complications are expected and not everyone gets that cure all miracle they were looking for, that's life. I don't see anything shameful about it. These people are getting their 15 minutes of fame, touching people's hearts and providing education to those of us who don't realize how good we have it. I know if I needed an expensive surgery that would improve my life or save my life, I would sign up for an all expense paid chance of a lifetime vs. bankruptcy. Who says these people are all poor? I've seen families on the show that look middle class or not poor anyway. I think the show emphasizes extraordinary conditions/diseases along with extaordinary stories. I agree that I don't like the title. It should be called Miracle Stories. Yes, American Healthcare is broken but this show is not centered on vagrants that America has turned it's back on, who have been the lucky ones to be chosen. If there is a will there is a way in America, no matter who you are. Extreme Home Makeover is the same concept. It is a feel good show!Lighten up!
- by CLE on Apr 4, 2006 at 6:28 AM | link