Liberty, democracy, equity, and justice in healthcare: Leana Wen at TEDxUniversityofNevada

imagine a world a different world your eight-year-old daughter has diabetes she needs one shot of insulin a day but you can only afford one shot a week she has a seizure you bring her to the hospital but they turn her away because your five dollars short you've been coughing up blood and losing weight you're diagnosed with lung cancer it's early and surgery will cure you but the operation is three times what your family makes per year you go back to your village and prepare to die maybe you're a wealthier person your wife needs to have her gallbladder removed and you can afford it but everyone knows that you have to have additional funds ready because you need to pay the surgeon extra under-the-table if you have lots of money you can get just about anything you want an MRI or two no problem a kidney that can be managed two impartial advice is the only thing money can't buy your doctor says that you have to take a new medication but how do you know whether to believe him you know that he gets paid by drug companies everyone is skin in the game if you're a doctor this world isn't nirvana either primary care doctors get paid the same amount as garbage collectors so most of quit specialists are paid more but because they're paid more to do more the cost of health care is escalating out of control and because patients pay so much for health care they're angry when things don't go their way a patient upset about the results of a sinus procedure stabbed his doctor with a butcher knife 20 times until she bled to death family members have disease patients protest every day outside of hospitals the sad thing is most people can remember when things weren't like this just 30 years ago this country had one of the best primary care systems in the world doctors were trusted and revered it was virtually free and everyone had access to primary and preventive care so what is this world the cynics among us will say that this mess is healthcare in the US the idealist will say that such a dystopic society cannot exist actually this is China today and I'll argue that unless we change course this is what the u.s. is on a fast track to becoming I never thought that I'd be here to give a talk on China China is the land of my birth but it's not my country my parents were dissidents they were jailed and tortured during the court revolution and I grew up believing that the valleys that matter are liberty democracy equity and justice well I like to tell people that I became a doctor because I was ill as a child and I went to see so many doctors but that's not the whole truth actually when I was in second grade my teacher thought that my handwriting was so bad that she showed it to my entire class to see that's pretty embarrassing but then my principal found out and instead of feeling sorry for me she displayed my homework assignment to the entire school now this was China and that man 8,000 students saw my bad penmanship they really took Pema seriously in China and they saw my name on it so I was mortified and I thought I'm not going back to school ever and then my mother said to me well look on the bright side I mean everyone in China at the time wanted to be a doctor so this means that you're way on the fast track to becoming a doctor well I was eight when my parents and I left China and came to the US on political asylum we moved to this little town in the mountains of Utah and oh I wanted to do was to fit in I learn English but there were so many other cultural references that I didn't know a classmate told me that he went to the dentist and got kryptonite and I went around asking people what type of filling that was or where I could get some I was so gullible but I believed my friends when they told me that gullible is pronounced gullible or eventually I did become a doctor in my adopted country here in the US and I didn't think much about China actually I was team work in Africa and most of my work was based out of the US for African until I met a man in a bookstore in London see I was about to go to South Africa for medical work and I was browsing books in the Travel section when this man came up to me saying he's South African did I by any chance happen to be Chinese because he's about to go to China and I thought wow this is meant to be Wow it took me two years of asking him when's that China trip to figure out that he was and actually going to China after all I tell you that I'm gulel well I say to him now now that we're married that that he's lucky because what if I've been Korean or Japanese you know what what what what if I have been oh sorry all Asian people I just assumed they're Chinese or better yet all I even women look the same that's just not gonna fly well about two years ago I was given an opportunity to conduct research on the healthcare system in China I traveled to 15 cities from Beijing to Inner Mongolia to southern China and visit over 50 hospitals in the process I have unprecedented access to doctors nurses administrators government officials and patients given how much China's developed into this major world power I thought that I would find a better version of the healthcare system that I had growing up but instead of this utopia I found a dystopic world to start with not one of the hundreds of medical students but if spoke with could articulate a good reason for being a medicine it's what my parents said I should do and he said I guess it used to be a good career I studied it for so many years so I better learn to like it it's some nursing schools more than half the students dropped out and left health care altogether it's no wonder when nurses give answers like being doctors bad enough nobody wants to be a nurse and I don't like patients all I dream about is quitting to become a white-collar office worker everyone was deeply critical of the healthcare system people spoke about the 1980s when universal healthcare was dismantled and 900 million people three times the population of the u.s. lost health care coverage overnight everyone had a story of family or friends other loved ones who died literally waiting in front of hospitals because they couldn't afford to pay doctors to or unhappy imagine that you're a doctor you train all your life to diagnose and heal and listen and all of a sudden you're told overnight that you are now a businessman you have to work your patience for every last cent so someone comes to you with a copper runny nose if you diagnose him with a common cold talk to him about it and send him home you get paid 70 cents on the other hand if you order laboratory tests a chest x-ray and give IV antibiotics you're paid fifty dollars how long would you keep on doing the right thing and counsel and talk about prevention and listen to your patients if that's not what pays and what do you do when drug company has come to you to offer you up to five times your salary if you prescribe their medication and patients come to you to thank you for your care by giving you additional funding now if you are impatient and you hear that poor people get denied access to services what do you want for yourself you want everything to be done because you can pay for it and because you have the money nobody's going to tell you about the risk of radiation of a CT scan or that the newest latest medication is actually untested or that the invasive procedure you're asking about is dangerous people got what they wanted but at what cost no doubt China has been very successful the government has lifted millions out of poverty it is a major world power my my father just went back to China to visit and he couldn't even recognize the street that he grew up on that's how much has developed but there's a fundamental problem a blind spot that's been missed in this rush towards economic reform that blind spot is our belief that being a consumer enables choice and that choice is power now I'm all for giving people information to have choices but turning patients into consumers need that healthcare is no longer a right it's a commodity disliked by a computer so your computer breaks down you go to the store if you don't have money nobody's going to give you a computer but if you have money someone's going to sell you the most expensive model the latest software the newest plugins and nobody will tell you that the $800 version is just as good as the 2000 dollar one apply this to health care and you can see how it becomes possible to deny people access to life-saving treatment and to sell them unnecessary even harmful interventions the doctor-patient relationship turns into a transaction between salesman and client I remember exactly where I was when I had this realization I was standing over the banks of the Huangpu River in my native Shanghai growing up is where my mother took me every day it's also where we sprinkled the last of her ashes several months before she died my mother had come back to China to see our relatives over the Whomper River my grandmother told me that that was only part of the story my mother had breast cancer breast cancer that spread from her breast her lungs she called a doctor in China supposedly her friend who said that he would recommend lung surgery to remove this mess now my mother's own doctor in the u.s. said absolutely not that chemotherapy is a standard of choice and that lung surgery would in fact reekin her immune system without adding benefit but my mother became so convinced that she needed everything to be done so she came back to China to get this procedure this operation to remove part of her lung that nobody would do in the US I stopped wondering then why it was that she died of pneumonia shortly after she returned my mother was a consumer she got what she wanted but at what cost that blind spot and the consequences are not unique to China I think of the u.s. where our health care costs are escalating out of control by 2020 we'll be spending a quarter out of every dollar on health care while millions of people are uninsured or underinsured 30% of all tests and treatments done are unnecessary it's far more profitable to peddle drugs and procedures than it is to talk about prevention one in three doctors in the US according to the New England Journal Medicine gets directly paid by drug companies or medical device companies and doctors here in the US are scared not a patient's killing us but a patient's suing us so I ask you then with this system of inequities inefficient sick care how far are we from the dystopia in China as we think about the future of China the US and beyond I urge us to keep three things in mind first as a society we must decide that there are some things that are not for sale health care is a right protecting the environment some things are not commodities and we have to safeguard these resources second we need to realign incentives to help people be their best selves in the US and in China in other places I've worked with many excellent doctors and nurses people who genuinely mean well who went into the profession for the right reasons to care and help people even a person who did my mother surgery I don't believe that he meant to do her harm people don't intend to be swayed by monetary incentives and we don't like to believe that weird that one person in psychology studies the one outlier who can resist temptation but why not just eliminate these pressures that make most people lose their way third start with our principles and hold on tight when I was visiting medical schools in China I attended the induction ceremonies where students receive the white coats and recite the Hippocratic oath and one of the school's the head professor professor Wu asked the students repeat after him the last line was I professor Wu hereby solemnly swear I watch this every single student repeated that line verbatim after him with his name professor Wu instead of hit instead of their own it's not enough to just know our lines we must all be mindful of our mission that's bigger than ourselves now by no means by romanticizing the communist state that's caused my family so much harm when my husband and I first met he asked me what I consider myself and I said without hesitation that I'm American because it's the American values of liberty democracy equity and justice that I feel so passionately about but capitalism doesn't have to equate consumerism and the beauty of a democracy is that all of us as citizens can decide what type of society we want to live in I also don't intend to perpetuate the stereotype of the on no American who's telling other countries how to do things in fact I like to end today by challenging you with one final thought could it be that China is in the position it is today because of the u.s. in the 1970s after the Revolution Chinese leaders were deliberating how to redesign their society they saw our decisions about how we design our health care system how we set our social priorities and followed us maybe it's partially our fault that China has the dystopia it does today to prevent further problems in our country and to stop the rest of the world from following us down this path we have to make a difficult decision we must decide if it's important for us to preserve our core tenets of Liberty democracy equity and justice if not we know what the future will hold if so we must commit now to our principles and our mission thank you

25 thoughts on “Liberty, democracy, equity, and justice in healthcare: Leana Wen at TEDxUniversityofNevada

  • dr wen just because you have drop dead good looks does not mean all of us man will fall for your lies , i'm a man and dont fall for any beautful woman trying to sell me some thing , no way i use my mind , i dont think with my crouch

  • Her talk was confusing. She gives a good summary of the Chinese system as well as the US healthcare system. Greed, corruption is endemic within empire states. However note 'communist' Cuba takes a different approach with little corruption, 100% healthcare coverage, at a tenth the cost of the US, with the similar outcomes. The UK, Australia, Canada, New Zealand have 100% healthcare cover at well under half the cost.

  • you have to start where aristotle started: "who decides?" until you get democracy, the chatter of civilians doesn't matter. first get the hammer of citizenship, then begin looking at nails.

  • Very well presented view of a true professional with whom I proudly share the honor of serving our fellow men and women, as the medical profession largely did, before doctors became providers, and patients became consumers. Consumer capitalism and healthcare, professional healthcare, are immiscible. Laissez faire medicine is capitalism run amok, and right over the casualties of what once was the healthcare profession. Adam Smith's new science of economic philosophy was preceded by moral philosophy, and happiness is to be found not in the acquisition of wealth and property, but in the empathy and the esteem of our fellow men when we do what is right. Healthcare for all, in the 21st century, in America, should be a core value, acknowledged as it was more than two hundred years ago, when, in the Declaration of Independence, Thomas Jefferson and Benjamin Franklin insisted that the inalienable rights included, the pursuit of happiness, liberty and LIFE. Healthcare preserves life. A capitalistic society, with wealth based on specialization and efficiency can afford universal healthcare, if that society determines what is the purpose of the government, and foremost, even in a capitalist society, is a system of justice that places life ahead of greed.

  • I wonder what she meant when she said that primary care physicians make as much as garbage collectors. Does she mean per hour, without salary and bonuses? Does she mean how much they make from insurance? I'm confused with that comment.

  • Great and true speech Dr. Wen. Thank you. A Hero in Healthcare industry. A Great person indeed. True speech is bitter but is so true. Much humans had lost its conscience.

  • Whenever basic human needs become commodities the inevitable trend will always move out of a moral sphere and into a financial sphere. There is no incentive for corporate healthcare systems to promote preventative care and health education. In the capitalistic, corporate model, there is a push toward, and emphasis on research and development of cutting edge technologies and pharmaceuticals, that are oriented toward intervention of pathological conditions. The reason for this is obvious… This model provides maximum financial returns for investors across multiple corporate industries. Money for research and development in new pharmaceuticals is easy to come by through an abundance of grants and special interests. In short… there exists a feedback loop from government incentive, special interest groups, research and development, both in the private and educational sectors, health insurance providers and corporate healthcare facilities. This feedback loop circumnavigates the interest of the average consumer and competes in the market to maximize profit. The issue is that the healthcare industry, as a whole, is not dependent upon the consumers of these services; Rather it is dependent upon how efficiently competing companies can develop new medicines and technologies and sell them to the highest bidder. Corporate healthcare facilities and hospitals must possess the state of the art in medical technology and procedures in order to compete. Hospitals are usually known for certain specialized practices, which come at a premium price. Insurance programs dilute coverage for these procedures by requiring high deductibles and out of pocket expenses on top of co-pays and premiums. The average lower middle class worker, who is married and has children can expect to pay from 1/4 to 1/3 of their gross earnings just to maintain a health insurance policy… This does not include deductibles, and out of pocket expenses… It also does not cover more specialized treatments for serious conditions. The point being… Standard of care is highly dependent upon a patients financial solvency. Not so much as an overt denial of access to more comprehensive care; but in an implied threat of financial destitution should doctors and patients follow the best course of treatment/ The result…. A lower standard is applied and the patient is left to stop-gap measures. Pharmaceutical companies fill the void with a multitude of drugs, many of which are inadequately tested for harmful side-effects and efficacy. What's really suspicious is how an explosion of certain medical conditions seem to crop-up everywhere when a new "wonder drug" becomes available to market. For example…. Drugs for the treatment of bi-polar disorder. It seems everybody and their brother, mother, and sister is bi-polar these days. As long as privatized medicine exists, money… not health.. will be the #1 priority…. just as in any other entrepreneurial venture. We like to believe that unregulated free-market capitalism truly drives innovation and economic prosperity, even when we see, time and time again every evidence to the contrary, especially when it comes to the health and welfare of human beings. While free-market capitalism, with all it's flaws, does drive innovation and economic welfare, it can often be corrupted by individuals who use the lack of regulatory measures to their advantage. We cannot afford to discount the very real threat of a few greedy, ingratiated individuals. Human health and welfare should never suffer at the hands of economic greed that serves only those already endowed with economic advantage.We need a shift in perception and redefine what health is. We must grasp that economics has less to do with money and its' creation or its' exchange, but more to do with the efficient use and distribution of resources for the sole purpose of providing for the general welfare and prosperity of humankind. Economies will flourish in societies that provide for the equitable distribution of, and access to resources that promote the health of all constituents. Access to basic needs would include: 1) Adequate housing. 2) Adequate transportation. 3) Food & water. 4) Public utilities: electricity, natural gas, clean water, communications: internet and telephone services, roads and interstate highways. 5) Education: primary, secondary and advanced services. 6) Gainful, sustainable employment, as well as, a guaranteed basic income. 7) Healthcare: preventative, diagnostic and interventionist care. I know… this may sound socialist in tone; however, I think we can all agree that human beings, undoubtedly share in want of these basic needs. I also believe that we can accomplish the redefinition of economics through conventions of democracy and capitalism. In its' original form, corporations were required, by law, to enact a charter. The concept of the charter is much like a mission statement, which most, if not all, companies institute as a way to infuse a central definition or set of core values by which they conduct business. The idea of the charter; however, is a legal adherence to an ethical consideration and an extension of democratic values and principals to the practice of capitalism. What the charter requires is an affirmation of a corporations will to function in a way that maximizes positive influence and promotion of the Public interest. In short… corporations are tacitly required to adhere to ethical standards that promote Public welfare, inline with democratic ideals and values. Corporations were required to renew their charters every 5-10 years through an audit of prior conduct, proving the adherence to their charter under the law. These types of lawful expectations help to distinctly, define the difference between self-interest and self-service or selfishness. Conventions such-as the charter, require the application of multidimensional approaches to the conduction of business. The charter requirement forces ethics and democratic values into the otherwise unconstrained drive to maximize profit and financial gain at any cost, regardless of whether or not public interest, and welfare are served in the process. Here, the aforementioned, is just one small example of how we can start to redefine democratic and capitalistic economies, and reorient ourselves to the advantages afforded in societies that are truly healthy, prosperous, and free.

  • Healthcare, like any other good or service is governed by economics and we can enjoy, not an infinite, but an ever increasingly opulent standard of living by the basic economic principles eloquently explicated in The Wealth of Nation. Just read it damn it. I know it's tough, and I have yet to meet an economics professor who has read it, but if you want to comment on economic matters, you are really speaking from ignorance if you haven't at least read Smith. It's like preaching on the Bible and you never bothered to read it, or commenting on physics without knowing even basic math…

  • I was both inspired and saddened by this speech. I remember having a conversation just a few weeks ago about pharmaceutical companies, learning how doctors are sponsored when they sell certain drugs. Initially I was disgusted. I was mad at the doctor for stooping so low and for allowing themselves to be bought by money and infuriated that the corporations that make up said pharmaceutical companies who made live saving drugs failed to truly care about the “little guy”. But then I remember that this is the U.S. and try as we might to do good, there is always going to be someone out there whose main objective is numero uno. In a perfect world, we would all find our calling and those destined to become health care workers would do so not for the money but for the joy of helping others. If somehow we could convince pharmaceutical companies to not push their drugs so fiercely without causing harm to the company itself, and make it to where a doctor sees a patient, gives them a diagnosis, and only prescribes a drug when absolutely necessary, the world would be a better place. Consumers would begin to trust their health care providers again and more importantly, trust in the system. You can’t walk across the street without hearing how someone somewhere in some sort of health setting was “wronged” by their healthcare provider. Of course the blame cannot be put solely on the healthcare system, part of it is the newfound entitlement consumers now seem to have, but there is an undeniable flaw in the system that needs remedied, and I believe that Dr. Wen does an excellent job of beginning to describe this flaw. The first step in solving a problem is acknowledging that there is a problem that needs solving, the next is figuring out what the contributing factors to that problem are. The inequity, injustice, lack of liberty, and lack of democracy in the healthcare system is tearing us apart. Like stated in the talk, this is a fairly new problem arising as some 30 years, the system we had in place was working, and I believe that corporate greed is a huge contributing factor among others.

  • I feel as though Dr. Leana Wen really brought like to a great subject that people are becoming more aware of each and every day. It is extremely sad that people who can not afford healthcare can not get help when they need it most, and one of her amazing examples was someone who needs medicine but can not afford it and they will basically end up dying in front of a hospital because healthcare has not been beneficial to them. Rich people get whatever they want and how is that fair? They can slip money under the table to a doctor and BOOM the doctor magically does exactly what they want. Now, if a poor person that had no money to spare but needed the same thing done the doctor would most likely snub them? Is this what America has come to? We make it seem as though healthcare is something you are not given the right to, but must purchase it to get what you want in your time of need. I am extremely angered by this because everyone should be treated equally when it comes to their life because not one person is more important than another, no matter how rich or poor they are. We were created equal and money should not have to buy you your importance to doctors and healthcare. Healthcare has become a like a salesmen and they are selling to their clients which is totally wrong in my point of view. It also saddened me that Chinese people being brought up in China have no interest to become doctors because they do not know what the benefits are. We do not want to be like China and make healthcare something that is bought, we want healthcare to be a right and something that is given to everyone. It astonishes me that doctors only get paid 70 cents if they do not prescribe a patient with medicine or some type of service, but when they assign a service or medicine to the patient they get paid extremely well. We are giving the incentive to these doctors that it is okay to give patients medicine or services because they get paid in the outcome, which is what they want which makes them want to give these services to the patients. If a patient does not need medicine the doctor should be honest and not assign them medicine, but we are now living in a world where we can not even trust someone who is talking about our health. We live in a sad world where our health has to be bought and I believe we need to stand together to make healthcare available to everyone, instead of only to the people who can afford it.

  • I don't like the speaker, you leave china after 8 years old. so, you don't know china healthcare today, you doesn't have any experience of china healthcare. a picture? a paper or someone told you …

  • I reblogged this excellent talk within my network

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