July 25, 2009

Reform For Sustainable Health Care

There are at least two big elephants that too few of us are talking about in the rooms nationwide where the political discussion about health care reform are going on. One is named triage. The other one is for-profit.
Triage is the kind of prioritization required in effective emergency rooms. You treat the asthma attacks before the broken bones. Then you treat the broken bones before the poor person who has no other form of health care. And few would not admit that our health care system belongs in the emergency room. Reform is urgently needed.
For-profit is the kind of health care we can’t afford if we are serious about reform. Making money the ultimate purpose of any endeavor means you will get more money out of it, more than any official purpose of the endeavor. But money greases the skids in legislatures across the nation, as well as in the families of health industry employees. And since so many other jobs have already been off-shored, health care is one of the few domestic industries left that pension funds can invest in.
So far, the discussion I have heard about has been rather polarized. Too many people are talking past each other, rather than really listening to each other’s underlying needs. But to be sustainable, we have to live within our planetary means, and we have to share. Universal health care will also allow us to reduce the work week and create more jobs to do the same total amount of work. We can work to live, rather than living to work.
But I think there is a win-win solution, based on a two-tier concept. We should have a basic tier that covers things like tooth decay, broken bones, acute infections like pneumonia, asthma attacks, eye exams and glasses, diagnosis, and prenatal and pediatric care. All the really cost-effective procedures belong in this category, and should be covered by a single-payer system similar to (but not exactly like) Medicare.
Then in tier two, we call on the insurance companies to cover ailments that are expensive, elective, or the result of unhealthy lifestyle choices. And we regulate them to make sure they live up to their actuarial promises; if the for-profit corporations take your premiums they can’t cancel you in a crisis.
Also, there several topics that seem so far to have been missing in action. One is the role of complementary and alternative medicine, aka CAM. Another is the sliding scale. There is absolutely no reason for someone like my financially secure mother to be getting subsidized health care from Medicare. Any premiums or co-payments for a basic Tier One must be means-tested. We have to share. Sharing is not socialism, it’s Christianity. And it’s also good for us.
As for alternative medicine, we need to integrate those aspects which are effective and inexpensive into both tiers. Some herbal remedies work as well or better than some modern pharmaceuticals. Acupuncture can help in some situations. Healing touch like massage can easily replace drugs in certain cases; and, like healthy food and exercise, it helps maintain really good health, rather than merely fixing the symptoms of bad habits or misfortune.
Alternative medicine also calls on people to become their own doctors, as much as possible. We need to take responsibility for our own bodies, for getting acquainted with them, and taking care of them. One cost-cutting measure would be to make each adult responsible for their own medical record and file. If a doctor’s handwriting is illegible, write down what they say and ask them to initial it. This would be a lot cheaper than a nationwide computer system, although it would not make anyone much money.
Lastly, the public health perspective has apparently also been MIA. Some kinds of medical treatment are reasonably close to being a public good, the kind of investment or activity that benefits everyone. Timely treatment of infectious diseases like TB, syphilis, and malaria are examples of public medicine that protects the rest of us. Let’s consider expanding this existing function into some functions of a Tier One.
And of course, living a sustainable lifestyle would improve public health dramatically. If we used no fossil fuels, we would get plenty of exercise. And we would have to eat local food fresh from the garden, because we couldn’t afford to ship it across the planet or use a lot of energy to store it in a giant American fridge until it turns into a science experiment that you can't eat anyway.

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