We paused in the warming sun and chatted. Then he made a comment: "You know, Jay, most physicians don't have any idea what's about to happen to them economically."
He had been studying more than the health of older people, of which we have many in the Palo Alto area (which once rivaled Dade County, Fla., as the fastest-aging population in America). He had been reading up on medical economics, the emergence of large for-profit systems and the growth of the health-insurance industry.
I was doing public-affairs work for the brand-new foundation and looking for a way to let people know that the non-profit foundation now was more than just a group practice.
From those prophetic words emerged a series of biennial national conferences on health care economics and policy, which drew hundreds of physicians, administrators, insurance people and even some government leaders and legislators — and a bevy of journalists. Throughout the 1980s the conferences tracked economic trends in medicine into the world of "managed care" and "for-profit medicine." Critics of the trends assailed the profit-motive thinking. It is a debate that still rages across America.
Dr. Bortz has been far more than a cerebral thinker about how to encourage healthier lifestyles for American families, promoting physical activity, healthful diets and challenging mental activity as a way to slow aging and prolong a good quality of life.
He became nationally known in the early 1990s for a provocative book, "We Live Too Short and Die Too Long" — detailing the heroic (and hugely expensive) efforts to prolong the lives of people who have spent decades clogging their arteries and stressing their bodies by doing nothing, or too little. Somehow the TV generation has morphed into the computer-keyboard generation.
His second book created an even bigger stir: "Dare to be 100." That, Bortz maintains, is the natural lifespan of humans. Instead, our diets and sedentary patterns have resulted in overweight children, a huge percentage of whom will develop diabetes, and adults who will become ill and require expensive treatment.
Now at 80, Dr. Bortz and his wife are both known for putting their feet where their opinions are. He is getting in shape for the Boston Marathon and she is planning a competitive run, although against fewer competitors her age these days. They have provided much of the energy behind the "50-Plus Fitness Association," a locally based organization with chapters scattered across the nation. I served on the board for a time in the 1990s — I was their bad-example mascot, I quipped.
Now Dr. Bortz has a new book out, his seventh, in which he digs deeper into the fabric of medical care and emerges with deeply disturbing conclusions. He describes today's medical care as "disease-based medicine" as opposed to "health care."
The book is called simply, "Next Medicine: The Science and Civics of Health." The cover shows a calm prairie-like field of grassland under a blue, cloud-studded sky.
But it is too calm, too pretty. The title and cover fail to convey the conflict he outlines within its pages. It leaves the Bortzes wondering and puzzled about why the book's sales haven't taken off, well, like a prairie fire. Dr. Bortz spoke Wednesday night (Feb. 8) at Kepler's bookstore in Menlo Park and is scheduled to speak Feb. 22 at the Commonwealth Club. In January, he spoke on what he feels is the "corruption" of the profession by the economic interests — a brief recording is on the Commonwealth Club's website.
His Feb. 22 talk is entitled: "Wealth Before Health: Is American Health Care Threatening the Stability of the Nation?"
In the book, he goes deeply into what he considers the malaise of medicine, which is dominated by special economic interests and the old fee-for-service pattern of medical care, too often misnamed "health care." The economics reach down in many cases to individual physicians and medical school researchers/professors who have investments or interests in genetic research, the hot-ticket item today after a century and a half of "germ medicine."
The core message of the richly detailed book is that the payment mechanism is tied directly to medical practice, and actually gets in the way of doing it right. This is not a new message, and seems deceptively simple, even simplistic. Much lip service has been done on health promotion and disease prevention. Dr. Jack Farquhar and his team at Stanford University School of Medicine did groundbreaking work in the 1970s and 1980s on how to promote healthier lifestyles, using "refrigerator magnets" to convey easy-to-understand messages. Yet their careful research failed to penetrate the profession, the insurance industry, big pharmaceutical firms or our political system.
Only when (or if) American medical professionals can develop a new funding mechanism, such as pre-paid health care to replace fee-for-service, will real "preventive care" be achievable, Dr. Bortz believes.
"The recent meltdown in our financial system is a painful reminder of the heavy price we pay when we fail to keep a close eye on the events occurring on the commons," he wraps up in the book. "Vigilance requires that the medical system be exposed to strict review. We need capitalism to reconfigure its product for our health benefit rather than for our pain.
"Feeling worse and paying more is not a healthy prescription. ..."
Only when "people realize that one of their most important institutions has veered from its mission and become a hazard, not only to its own integrity of purpose but to the overall Commonhealth, then a moral imperative arises, and absolute individual and collective responsibility to fix what has gone wrong," he concludes.
"Of all the thousands of prescriptions that I have written, of the thousands of patients I have tended, this is the most important prescription, for the most important patient, all of us."