Friday, September 26, 2008

whose health is it anyway?

As soon as we became sentient beings we also became aware of our health. Before sentience the cold North Wind had no conceptual effect on our minds, after sentience the cold North Wind made us feel cold and even the thought of the North Wind brought goosebumps to our skin. Primitive humanoids had instinctive and intuitive ways to maintain and reestablish their health. An interesting documentary I watched on Public TV, showed a man living with wolfs within a confined area. The man submitted to the wolfs world. He did not exert human dominance, but let the wolfs manifest their ways of life as he adapted to them. On a rainy, cold day the man was shivering with the wet and cold, two wolfs came to him and laid across his body. In a short period of time the man was warmed. This display of health consciousness and health concern by the wolfs expresses an innate imperative living creatures have for health. All living organisms have a built in system to maintain and reestablish health balance and equilibrium, when and wherever health balance is disturbed, and intuitively it seems, to also aid others in establishing that health

As we historically move foreword from primitive humanoids to ancient, primitive humans and civilized human cultures we find that health care had become systematized. The aiding part of health had expanded to were individuals of the tribes or societies were sought out to care for health problems. These were individuals who had been handed down the knowledge or schooled in the aiding and curing of health problems. Usually these individuals were also spiritually developed and were called "Holy Men," Shaman," "Medicine Men," physicians, doctors, etc. Egyptian archaeological discoveries for instance, showed a highly sophisticated health care delivery system that ranged from medical procedures, herbal and pharmacological treatments, even surgeries and dental care.

Through out the evolutionary development of health care, the responsibility for health was shared. Each individual had a major share in his or her health: proper food, hygiene, rest, old wife's traditional remedies, and a knowledge of when to call a health aid practitioner. I remember my mother giving me a teaspoon of cod liver oil every day as a practical health measure. The remaining share came through schools and the General Practitioner Doctors, in the communities. Schools would require vaccination shots against certain diseases, and annually checked for hair lice. The Family Doctor was consulted when minor conditions occurred i.e. cold, fever, brakes, fractures, sprains, strains, etc. and when there were more difficult problems. My family doctor was Dr. Proby. He brought my sisters and I into the world, and had an intimate knowledge of the general health of our family. This good man would visit our house upon request with only a small black hand bag, would accurately diagnose (with out high tech machines), treat, and prescribe drugs if necessary. He also made himself available to individually council people on pregnancy, drug abuse, and a host of other health issues. He, like most family practitioners of that time were affiliated with local hospitals. That is were major and minor procedures were preformed, like extracting my tonsils. There too is where he could confer with specialists. The cost for his services was not prohibitive and sometimes there was bartering. The costs of surgery and other major procedures was not prohibitive. Your health was in your hands and in the hands of a trusted practitioner. With in the community, the Family Doctor was very highly regarded. There were even popular TV programs whose themes were about family doctors, like "Dr. Wellbe M.D."

From the middle 50s on, the idea and practice of health care was changing at brake-neck-speed. The community family doctors were falling off like Autumn leaves and with no Spring replacements. Most young, up coming doctors were choosing to specialize because "that was where the money is." As speciality grew in dominance, hospitals also began to specialize. Soon there was specialists in hospitals all over the place: heart, eye, ear, nose, and throat, brain, feet, disease specialists, orthopedic, you name it and there is a specialists. The burgeoning of specialization brought with it, innovations and refinements of diagnostic machines and testing equipment and procedures. The competitive need to be on par with other institutions that had incorporated the use of these expensive, new diagnostic and testing pieces of equipment and procedures begin to exponentially raise the cost of health care treatment, and because of the high demand for specialists brought higher doctors fees for visits and consultations. The high cost of health care brought in the insurance companies. They spread the cost and financial risk among millions of insured people. The employers and the insurance companies saw cooperative opportunities in using one another. Businesses could with incentives of health insurance, entice veteran employees to stay and prospective employees to join. The insurance companies extended their memberships and enjoyed greater profits. Of course, insurance was not a new product at that time, so there was a built in acceptance among people. There was in place at that time, auto, home, FDIC, life insurance, and of course there was Loyd's of London insuring just about anything.

The need to be affiliated with a cast of specialists for referrals, and the high cost of equipment made it cost prohibitive to maintain individual doctor's offices. Every doctor had to be employed by or contractually linked to a medical institution: hospital, clinic, emergency service or research and development, or teaching institution. The landscape of health care was changing from serving a patient to working with a client's insurance company. The main energy focus was now on the business side of health care: cost assessments, profit strategies, advertising, and because most accounts receivable were being payed by insurance companies additional office staff had to be employed for billing procedures with insurance companies. Some of the profit strategies or more accurately bilking insurance companies, were rife with creative interpretations of itemized statements: instead of 6oz. bottle of mouth wash, $1.50, it was billed as oral bacterial astringent, $15.00.

The syncretistic method of adding a strict business, profit model, specialization, payment via insurance companies, reliance on high-tech diagnostic equipment, and the need for liability insurance and litigators, separated the patient-doctor relationship from mutual health responsibility to a client purchasing health care through an insurance agent, who sells a health care contract and determines the financial limits of treatment. All this expressed through esoteric and convoluted legalize and medical nomenclature, which caused further disenfranchisement of the patient from the health care process. Now days a person's health care is in the "hands" or to quote the advertisement, "the good hands" of an insurance company, of the medical aggregate system, the H.M.O.s. Michael Moore's, documentary, Sicko, showed in a disturbing way the dysfunction of our health care delivery system. The documentary shows a scene where a man who had an accident-two fingers were cut off. After an examination by his health provider the man was told of the cost of attaching both finger. The cost was $90,000; $30.000 for one finger and $60,000 for the other finger. The man, considering his insurance deductible and co-pay, opted for the cheaper surgery and consequently was left with one digit short. A contrasting situation was shown, I cannot remember which European country, France or England, a man who had four fingers cut off in an accident; went to his universal health care provider, and upon examination had his four fingers attached with no discussion of cost. The practitioners had no cost or insurance limitations for treating their patient. He was given full care for the condition he had and left the health care establishment with a voucher for transportation to his home.

Here in the U.S. we spend the the greatest amount of money on health care in the world (mostly in insurance premiums), and in return we get a health system that is out of phase, with even adequate health care treatment. For example, my wife goes to the drug store to pick up her prescription. The cost of the prescription is $15.00 with her insurance requirement of 50% co-pay. She asks the counter person, how much would her prescription cost if she (the counter person) made it generically, with similar weight and number of pills? The answer was $5.00. So my wife, being of sound economic mind, makes the store take the prescription drug back and demands the generic drug. Say however, I did not have insurance and was given the same prescription as my wife, and say I had no idea about generic drugs. My cost would be $30.00. I am certain many of you have dealt with similar situations, so you need no explanation. But! here are some simple questions to ask yourself. What genius created such a payment system? What was his or her's motivation? Who does it really benefit? Here is another situation that demonstrates the dysfunction within the health care, aggregate system. This time it does not come from the private sector. It emanates from the Federal Gov., namely Social Security- Medicare. This shows equal opportunity dysfunction and belays the notion that government health care systems are run better. Both operate on the rails of their own motivations: private companies run on profit and power, government runs on personal aggrandizement, unretractable ideas, and power. Where sits the public, the customers and citizens that are suppose to be served? Another good question. During the Bush Jr. Administration, an additional part for Medicare, Part D, was created and was aimed at lowering the high cost of prescription drugs for Seniors. I am not certain of the exact details of Part D, but in general the forthcoming facts are expressed accurately. First, Part D costs approximately $100.00 plus, per/month, depending on which insurance company one uses. Second, it does pay for drugs, up to $2600.00, then the payout goes to zero, this procedure is termed the "doughnut whole," and all payments from that point on were out of pocket, until an expenditure of $2600.00 was reached. Then the insurance would kick in again. This doughnut whole was not clearly explained to the Seniors, the originators pushed seniors into signing up for Part D by putting a time limit for application and added to the pressure by disqualifying seniors for not applying in time. Can you imagine, the surprise, disbelief, and anger the seniors had when they reached the doughnut whole?

So what are the principle ideas operating our twenty-first century health care system. It operates on a single pay idea where individuals pay for their own health care, or co-operative pay where individuals co-operate with business, federal, state, county, local governments.
All of the direct, assisting, and auxiliary components of health care are centered around the individual's health care. These facilitators however, even though they cover themselves under the cloak of selfless service, are either motivated by maximum profit, self-aggrandizement, politics, or power, and as such their delivery becomes striated, diverting the whole health system into acute dysfunction. Its these repulsive ideas, these cancerous ideas, that have been allowed to thread our current health care system. It is within this realm that bonuses are a reward for finding loopholes for not paying for treatment or disallowing coverage for preconditions or for pricing 45,000,000 people out of health care coverage.

So what can be done to revamp health care according to the very best ideas commensurate with the essence of health care. First and foremost there should be a consensus and then a mandate that health care should be a privilege granted to all, from gestation to death. Just as England did after WWII, mandating that all its citizens would have health care from cradle to grave. Authorize a Board or Commission of Health Care, presided over by a body of not more then nine people. The composition of which would be 4 ordinary people who do not work in the health care field, 1 business person, 1 doctor, 1 philosopher, 1 American Indian Healer, 1 historian or any combination that would be innovative and relevant. Businesses and governments would be resources and sources for funding, but the Board would be creators of the operating principles and management concepts. A revamped health care system should not be created and guided by the profit motive or a political motive. A good place for such a board to start developing guiding principles would be the Hippocratic Oath. They could develop a contemporary interpretation of the original oath, and use it as a mantra for all involved with health care. Then bonuses could be given for positive results for treatment.

Now we come to the answer to the question that initiated this blog: Who's health is it anyway? It is your health. It is may health. It is ironic that we need to reestablish our responsibility for our own heath. We have relinquished this responsibility to the health care system and have allowed it to muck it up beyond our control. It is us that must suffer at the hands of incompetence. There is a small percentage of citizens that have not been rolled over by the wheels of our health care system, who have opened their windows shouting "I am mad as hell" and have taken their health care back. These citizens, shop at 'whole food stores,' they see Chinese doctors, chiropractors, they excercise using tai chi, chi gong, yoga, value quite and meditation, and bring back their soul and responsibility for their own health. This is the wave of the future, and as the American poet Emerson said, when the time has come for an idea to manifest, ..."It is impossible to tilt the beam. All the tyrants and proprietors and monpolists of the world in vain set their shoulders to heave the bar. Settles forevermore the ponderous equator to its line, and man, and mote, and star, and sun, must range to it or be pulverized by the recoil."

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