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Dr. Walter Bortz -- health care visionary or a Dr. Quixote?

Original post made by Jay Thorwaldson, editor emeritus, on Feb 11, 2011

On a spring day in early 1982, I bumped into Dr. Walter M. Bortz, II, a longtime Palo Alto area geriatrician, outside the former Palo Alto Medical Foundation/Clinic building at 300 Homer Ave.

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."

==BI Jay Thorwaldson is the former editor of the Weekly. He can be e-mailed at

Comments (5)

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Posted by Sean
a resident of Midtown
on Feb 11, 2011 at 6:58 pm

I want to booze, screw and dissipate to my heart's content. It is my personal freedom to do so. I also want to be able to check out (commit suicide) when I want to. If the medical profession would agree to doctor-assisted suicide, we could get beyond all this hugely expensive, end-of-life nonsense.

When will Dr. Bortz finally get aboard with the true economics of health care? It really doesn't matter that he is healthy, for longer than most, because, he will still have end-of-life, economy-destroying expenses, if he, or his family, cannot have the ability to end his life with an injection. It is a complete fantasy that healthy people cost the medical system less than unhealthy people. A type-II diabetic, or an obese person, or a heavy smoker costs less than a a healthy person who lives long enough to develop Altzheimer's disease, assuming that the former group dies at an earlier age.

There is no way that our health system can survive, unless we have doctor-assisted suicide.

Like this comment
Posted by Bill
a resident of Another Palo Alto neighborhood
on Feb 12, 2011 at 4:17 pm

A lot of words here .. but not much substance.

Like this comment
Posted by Anon.
a resident of Crescent Park
on Feb 13, 2011 at 3:04 pm

I support Sean's right to commit suicide. ;-)

Whatever we (Americans) are doing, we are so superior and self-righeous and always trying to push it on others, talking about how rich, great and powerful we are ... yet we don;t bother to carefully examine the stats in public comparing us NEGATIVELY with ALL the other developed countries.

Health care is like most things in the US, it is a status symbol of a clique, a class, and elite, and this is our game that we think is so wonderful ... it's just might makes right or in this case money and guns.

Like this comment
Posted by Sean
a resident of Midtown
on Feb 13, 2011 at 3:20 pm


You say you support my right to suicide, but it just isn't so! If I want to ask a doctor to give me an injection, as if I am on the operating table, then I should be able to do so.

Comparisons to other countries can be useful, on specific issues, but not others. For example, Sweden has almost twice the murder/attempted murder rate of the U.S. Each country is different, according to its own culture, but I just want a very decent thing: Doctor-assisted suicide. If it is not allowed on a voluntary basis, it will come down to a rationing model (death panels).

Like this comment
Posted by More choice, not less.
a resident of Greenmeadow
on Feb 14, 2011 at 11:15 am

We have "pre-paid health care" not fee for service already.

It is called "Managed Care" insurance, ie: HMOs.

We are heading toward one huge national HMO with no other choices available to us.

I prefer fee for I get the service I want, not the service someone else has decided I need ( or don't).

So, with apologies for not reading the book and just commenting on this thread based on what Mr. Thorwaldson has written, I can see why there is no take-off on this book. Right now we have the choice to choose HMO or not, and there are many working hard to remove even that much choice from us..hard to support buying a book which pushes me into even less choice.

Sorry, but further commenting on this topic has been closed.

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