Health care reform part 2
Moving from illness care and disease management to healing and wellness
In part 1 of this 2 part series, I addressed the structural problems with the health care system in this country as it relates to financing. I asserted that the system is designed to benefit corporate stakeholders at the expense of the health of the general population — exactly the opposite of what a functional health care system should do. From my own personal experience as a physician, both inside and outside the insurance system, I have observed that people who pay more out of their own pocket tend to be more invested in their treatment than people who are fully “covered”. This is not a political argument: it is an empirical argument. It is simply human nature to take better care of what you paid a lot for than what you didn’t pay much or anything for.
Nonetheless, the financing system should be affordable to all, regardless of income. This is why the money should come from already available funds provided by the employer or the state. Even though money allotted to a health savings account is “free” it is not unlimited, so people would be motivated to spend their health savings account dollars carefully. and wisely (certainly no easy task, with the barraging of advertising we are all exposed to).
Part 2 addresses the need to create a health care system that promotes health (a health care system), not manages disease (an illness care system). As one who has straddled the path of allopathic and alternative medicine, I believe that the alternative medical range of therapeutic options has been vastly underutilized, as you will see from what follows, and needs to be routinized into health care as a regular and indeed primary form of treatment. It is on the whole safer, less expensive, more conducive to healing, and more effective than conventional medication in the treatment of chronic illnesses of nearly all types. The one area where conventional and pharmaceutical treatment is probably superior to all or nearly all alternative treatments is in emergency life-threatening acute illnesses. If people are healthier, these kinds of emergencies are likely to occur less often.
Components of Health Care Reform
Main Arguments:
The health care system should work for the people to make them healthier, rather than for the medical industry, the pharmaceutical industry and the health insurance industry, to make them wealthier.
We need to create an army of healers — health care practitioners who know how to improve people's health and keep people healthy.
We especially need to focus on the prevention and more effective treatment of chronic illness, which has exploded in prevalence over the past half century, and which modern medicine does a poor job of treating.
There needs to be a shift in focus away from disease management to cure, based on an understanding of the antecedents of and perpetuating factors behind chronic illness.
We need to reduce the number of pharmaceuticals people take by shifting the focus of practitioners from prescribing drugs to prescribing healing interventions.
We need to reduce the number of specialists, by improving the overall health of the community.
We need to reduce the number of hospitalizations, and shrink down hospital expenditures by making their services less necessary.
If people were in better health in general, there would be fewer hospitalizations.
We need to change the health insurance system so it is affordable to all, yet everyone has to pay (part 1). People don't value and use efficiently what they don't have to pay for. They tend to take it for granted and become less invested. Yet lack of money should not be a barrier to obtaining health care.
Health practitioners who are not specialists and in the past have treated a wide variety of chronic illnesses, should have certain basic competencies, which are taught to them in their training. Some of these are listed below:
Knowledge of nutrition, including the causes and remedies for weight problems, and how to properly counsel people about diet. Rationale: poor diet are is one of the largest contributors to ill health in our country today.
Included in nutrition should be an understanding of vitamins, minerals, and key supplements that can be deficient or may aid in healing. Rationale: Nutrient deficiency is an increasingly common cause of or contributor to chronic illness.
Knowledge of motivation and how to talk to people to get them invested in making behavioral changes that will improve their health. Rationale: Unless practitioners understand motivational interviewing, much or all their knowledge will not be effectively applied, as their patients simply won’t listen to them.
Knowledge of environmental medicine and how to advise people about avoiding poisoning themselves with the abundance of toxic products and poisonous foods that exist in today's toxic world. Rationale: Toxic exposure is one of the biggest contributors to disease in today's world.
Knowledge of how to assess toxicity and do detoxification. Rationale: Knowing how to detoxify people is an essential component of the treatment of many diseases and also of disease prevention.
Knowledge of the microbiome, including how to diagnose microbiome disturbances, and how to treat them. Rationale: microbiome disorders are becoming extremely common.
Thorough understanding of vaccine science among those offering vaccination, as it relates to safety and efficacy. As many of us have learned in the past three years, those administering vaccines have little or no understanding of the science behind vaccination. Such knowledge is essential to giving proper informed consent, for reasons we now are familiar with. Knowledge of how to treat vaccine injury is also a sine qua non. Vaccinators rarely have any knowledge of how to diagnose or treat vaccine injuries.
Competence in how to prevent chronic illness, including a thorough understanding of lifestyle factors in the genesis of chronic illness. Rationale: most diseases are now understood to be epigenetic, or highly modifiable by behavioral and environmental interventions that change the expression of certain genetic potentialities.
Competence in how to treat infectious diseases without antibiotics. There is an extensive literature on this subject, largely ignored by practitioners, who continue to prescribe antibiotics, causing the development of resistant strains of bacteria and the proliferation of microbiome disturbances (dysbiosis).
Knowledge, although not necessarily expertise in how to treat diabetes non-pharmacologically with diet, supplements and other non-pharmaceutical treatments. Rationale: diabetes is one of the most common and destructive chronic illnesses in today's world, which takes a heavy toll in death and disability on society. Modern medicine has improved its management, but not been able to cure it. It is in many cases, particularly in Type 2 diabetes, partly or completely reversible
Knowledge, although not necessarily expertise in how to treat cardiovascular disease non-pharmacologically, with diet, supplements and other non-pharmaceutical treatments. Rationale: cardiovascular disease is extremely prevalent and one of the most common causes of death in this country. Modern medicine has failed to reverse this trend, yet many effective cardioprotective and antihypertensive treatments exist which specialists almost are completely unaware of.
Knowledge, although not necessarily expertise in how to treat cancer non-pharmacologically with diet, supplements and other non-pharmaceutical treatments. Rationale: cancer treatment, while it has had some successes, often is brutally painful and frequently unsuccessful. Many alternative cancer treatments have been well established and may be useful to address side effects to chemotherapy and radiation, and in some cases may offer cures where conventional treatment has failed or proved to be intolerable.
Knowledge, although not necessarily expertise in how to treat neuropsychiatric problems non-pharmacologically with diet, supplements and other non-pharmaceutical treatments. Rationale: Modern medicine lacks effective curative or even safe and effective long term palliative treatments for most neurologic and neuropsychiatric conditions: many of these can be effectively treated safely and effectively with alternative treatments.
Basic familiarity with major alternative medical disciplines, including botanical medicine, functional medicine, homeopathy, oriental medicine, Ayurvedic medicine, mind-body medicine, bodywork, and possibly other alternative healing modalities. Rationale: practitioners need to understand when alternative treatments are appropriate and likely to be beneficial to the process of recovery from chronic illness, especially when safe and effective alternatives exist which they might otherwise have been unaware of. They should be able to make appropriate referrals to such practitioners when their own skills are lacking.
Disease management must give way to healing. Pharmaceutical and hospitalizations must be reduced. Root causes of illness must be addressed. Financial rewards must give way to therapeutics. The bounty of natural healing approaches must be brought to bear to work with the body, not against it. Prevention must be elevated in importance so treatment is needed less often. Let me know your thoughts.
I appreciate your thoughtful comment. My blueprint for healthcare reform is not meant to be practical. It is meant as a starting place. Browning said, "A man's reach should exceed his grasp, or what's a heaven for?" Without a vision of where we want to go, we can never get there. The essay was meant to imagine a good health care system. It may or may not be the best possible. Assuming it is a vision that more than a few can agree on, a way can always be found to make the dream a reality. Obviously, this will take a long long time.
You put forth plenty of good things that "should" happen, that we "need", that we "must" do. Trouble is, there is no mechanism that will cause these things to happen. In fact, most have the deck stacked against them, and they pretty much cannot happen. When I was a young teen in the 60's, I was leaving the clinic with my Mom and when we walked past the cashiers and never stopped, I asked why we weren't stopping to pay. She said, "Nobody pays for medical care, everyone has insurance to pay for it". I was horrified, instantly, because it couldn't have been clearer this was a system destined to be taken over by the very worst money-grubbing scum in society. Nobody cares what it costs, no incentive to limit demand, the providers will want more, more, more, and those paying benefit from higher prices and more demand, as it's obviously more lucrative to sell insurance for luxury yachts than john boats. Hmm, how's this gonna play out? The amazing thing was it didn't fall apart even faster, it was a few decades before it started getting totally out of hand. But, beyond that, even with market discipline intact, health care is a different animal for many obvious reasons. Unless it's government-funded, it will only work in a decent, moral society, where price-gouging is hated, not revered, and where the less fortunate are everybody's problem. So where are we? Lost. It can't be fixed. Even going to single-payer won't work, the countries where it functions reasonably well instituted single-payer before their medical establishment gobbled up 18% of GDP and climbing, with the power that goes along. I'm 72, and have finally had to admit the truth to myself - we're toast. The breakneck speed of the disintegration we have now is worse than I expected, but it was inevitable. Many have observed it's just the nature of men and societies - I've written too many words already, suffice to say there are many inexorable forces that cause a society to decay and finally collapse.