Senior Vice President and Community Health Investment Officer for Northwell Health, Dr. Ram Raju, spoke about the flaws in the United States’ health care system in a lecture at the Charles B. Wang Center Theater on Wednesday, Sept. 26.
Raju’s speech focused on the “two-tiered” nature of health whereby the nation provides care for the socioeconomically privileged and neglects the poor.
“After coming [to the United States] and performing surgery here for 30 years, I had a skewed view of health care,” Raju said. “I took care of every patient irrespective of their ability to pay but eventually I realized in this country, the richest country in the world the most powerful country in the world, there are people living in the outskirts of society. These people do not have health care access, and even when they have access, they cannot pay.”
He went on to tell the story of an illegal immigrant who was forced to choose between treating her cancer and maintaining her housing because she could not afford both. The woman’s fear of being evicted and potentially deported prevented her from getting the medical care she needed.
Raju told another anecdote about a cab driver who had access to the “world’s best health care,” but could not seek treatment for his hypertension because he works from 6 a.m. to 11 p.m.
The cab driver’s high blood pressure and paycheck-to-paycheck lifestyle both increased his risk of stroke, yet he could not abandon his job if he intended to maintain housing. In justifying his decision, he said, “My chances of getting stroke are much smaller than my chances of getting shot tonight.”
This example served to demonstrate how outside socioeconomic factors can impact your wellbeing even if you have access to a premium health care. “If you have to take two buses to see your doctor instead of working that day, you aren’t going to see your doctor… when the doctor tells you that you’re diabetic and need to eat well… and the nearest grocery store is 4 miles away from you, you aren’t going to walk there every week… when at McDonald’s you can get burgers, french fries, and a drink: cheaper, tastier, across the street. Your diet will never get better, but the health care industry never understood that.”
Raju argued that many doctors try to compensate for flaws in the system by prescribing more medication.
He proceeded to share research which found that only 20 percent of health outcomes are dependent upon the critical care that a patient receives. That is, the entire medical industry — doctors, pharmaceuticals, etc. — only controls roughly 20 percent of health outcomes. Another 40 percent is dependent on an individual’s healthy behaviors (or lack thereof) and the final 40 percent is attributable to socioeconomic factors.
“There is no doubt that we have the most expensive health care in the world, spending close to $3 trillion, and our outcomes are not as good as they could be because we are barking up the wrong tree,” Raju said. “We are constantly spending on this 20 percent, while the 80 percent goes unaddressed.”
Hospital readmissions are not usually due to medical malpractice, but due to the lingering social issues that patients face after treatment, Raju explained. As such, the United States health care system fails to address the root cause of its medical issues.
“We know how to rescue people from their deathbeds. We know how to pull people out of the river and we do it faster, better, with more technology,” Raju said. ”But if you walk 15 feet upstream and stop people from falling into the river in the first place, then you’d have a much better system.”
Making a pun out of the situation, he proposes, “The health care system requires you to fall into the river first. So, we shouldn’t even be calling it a health care system, we should actually call it a sick-care system.”
Raju closed his talk with a call to action.
“The two-tier system has got to be taken down,” he said. “We have to create a holistic patient care that treats everyone equally.” He encouraged the audience to join him in noting, “You are defined by your principles: what you are fighting for, what is most important to you. If you have that, then you could be the change-agent I’m talking about. If you have the passion for it, you will change the world.”
A.J. Nagaraj, assistant vice president for Campaign Operations and Fundraising Strategy at Stony Brook University, noted that he, “really appreciated Raju’s emphasis on ameliorating the disparities in health care.” Nagaraj said that the parallels between education and health care struck him. “Oftentimes, educational outcomes don’t have all that much to do with academic aptitude necessarily, but rather it’s these socioeconomic factors that ultimately have a disproportionate impact on life,” he said.
Sophomore biology major, Justin Goodridge, mentioned that he liked Raju’s “different perspective on who the health care system is tailored to,” adding that “the students in medical school here need to realize this.”