Today, I suppose I am going to sound like a preacher. But when the spirit is the problem, perhaps preaching is in order. I was reading Ezekiel the other day and a verse jumped out at me. Ezekiel is upset with Tyre, and ancient nation that is known to be wonderfully productive, but the explanation he gives for its downfall is very revealing. Ezekiel 28:18 says: You defiled your holiness with lust for gain; therefore I brought forth fire from your own actions and let it burn you to ashes upon the earth in the sight of all those watching you. This translation is from The Living Bible, but I could not think of a better way to explain exactly what is wrong with health care in America. It started out a holy and sacred duty to care for the weak and helpless, but the lust for gain that is extant in it now (often under the name of innovation) is actually burning up the system from the inside out. There is no new thing under the sun. If you depend on services to the weak to provide your wealth, it will backfire on you. The weak don't actually have wealth.
In the Fall 2010 health care news letter from a local hospital I found an excellent example of how what Ezekiel says happens. The article is about the recent practice of cooling a person to promote self healing after a major cardiac crisis. I will not name the devise, but the article indicated that instead of ice packs and water blankets this medical devise system allows precise body temperature control. In case you did not catch it, ice packs are cheap, and this brand name, probably patented system is available for who knows what cost from your local health supply salesman who gets a cut for his or her sale which comes with very bright advertisement brochures, and you can see how the cost gets higher and higher. Now you might counter that science needs precision, and the doctor deserves the tool that makes the practice most predictable. But where does this stop? As soon as the precision tool instead of the care taking practice (ice bags) becomes the standard, then the doctors who try to treat for less cost begin to be held liable for not actually maintaining a strict temperature when they could have, and even if no law suits are ever brought over body temperature, insurance companies will require higher standards for all. The simple availability of medical innovations is like a built in way to create new liability because the standard of care changes with what is possible in the market instead of what is possible for the patient. Health care is too expensive because we have demanded that only expensive health care be practiced. This demand is due to a delusion that only expensive care is real care, but delusional as it is, the most expensively controlled care (dependant on machines and data instead of human observation and care) is what is driving us over the cliff on health care. When I was in Jr. High I remember little story illustrations encouraging us to be content in life. These stories usually talked about a great struggle to get to the top and then once there the discovery that there was nothing up there. Our health care monetary practices are about the opposite. Everyone is reaching to this bottomless pit where they believe great wealth exists if they can just get down there, and when they do, there is nothing there. Or to put it Ezekiel's way, burned by your own actions.
Tuesday, November 23, 2010
Tuesday, October 26, 2010
Noble Values and Health Care
As I was visiting a friend at a hospital very close to my home, I found the following in a display of their history.
To the fifteen thousand citizens of Dayton and The Greater Miami Valley who subscribed one million dollars for the creation of a new institution of healing and mercy; and to the Sisters of Charity who, without thought of material reward, consecrate their lives to the sublime task of alleviating human suffering this Souvenir Edition of The Dayton Catholic Parishioner is dedicated. May 24 1931.
The official hospital history writes this on their web site.
In 1928, the city of Dayton partnered with the Sisters of Charity in Cincinnati to raise $1 million to finance the construction of GSH (Good Samaritan Hospital). The project took four years to complete, and when GSH opened in 1932, it was due to the efforts of the Sisters as well as the businesses and citizens of Dayton. Each had worked together to make their shared vision a reality, with the latest in health care technology now available to Dayton residents. The Sisters of Charity brought their health care expertise and experience to the new hospital, along with their noble values that are still the cornerstone of GSH today.
Looking at these two clips shows a necessary part of making health care work: noble values without thought of material reward.
But where are the people in America today who understand that being poor with noble values has a life strength that money cannot break? And even more importantly, who are the monetarily empowered people who can appreciate this strength and keep nobility in our values?
To the fifteen thousand citizens of Dayton and The Greater Miami Valley who subscribed one million dollars for the creation of a new institution of healing and mercy; and to the Sisters of Charity who, without thought of material reward, consecrate their lives to the sublime task of alleviating human suffering this Souvenir Edition of The Dayton Catholic Parishioner is dedicated. May 24 1931.
The official hospital history writes this on their web site.
In 1928, the city of Dayton partnered with the Sisters of Charity in Cincinnati to raise $1 million to finance the construction of GSH (Good Samaritan Hospital). The project took four years to complete, and when GSH opened in 1932, it was due to the efforts of the Sisters as well as the businesses and citizens of Dayton. Each had worked together to make their shared vision a reality, with the latest in health care technology now available to Dayton residents. The Sisters of Charity brought their health care expertise and experience to the new hospital, along with their noble values that are still the cornerstone of GSH today.
Looking at these two clips shows a necessary part of making health care work: noble values without thought of material reward.
But where are the people in America today who understand that being poor with noble values has a life strength that money cannot break? And even more importantly, who are the monetarily empowered people who can appreciate this strength and keep nobility in our values?
Tuesday, September 28, 2010
Why it is impossible to pay to have everyone live right
My blogging seems to have reduced itself to monthly rather than weekly. Maybe I have said about all I have to say, and maybe I'm hoping the Health Care Plan will go away. On September 4th a very well meaning Dr. with personal experience in both giving and receiving medical care wrote a piece with the following headline: Millions Die due to Withheld Medical treatment. His name is Mark Hyman, MD, and the article was sent to me from The Huffington Post. The withheld medical treatment was dietary and life style changes that no insurance company pays for. As thrilling as the article was about the revelation to people that self control rather than expensive procedures is the best answer to successful health care, the theme of his article poses an economic conundrum. Do we really think we can pay everyone to live right? If we are paying people to live right will they be motivated? If we refuse them care because they won't live right are we oppressive? I am not going to make any thematic propositions regarding these questions. I have tried to show the radical problem of reducing the health care system to numbers and figures because the individuality of care is a thing that does not fit on a spread sheet. Dr. Hyman's plea for "rational" insurance that actually pays for what people need just shows the economic impossibility of the task of universal health care in The United States of America.
Tuesday, August 31, 2010
Sort the Issues in Health Care
I am having horrible malaise about this health care issue. At this time it seems more reasonable to pray that November brings about a big change than to spend any more time trying to figure out what has happened. On the other hand, health care is broken with or without the political things that are going on, so today I will simply submit a test to determine whether you have the foundation to think rightly about health care needs, provisions, and economics. The goal of the test is to take the following twelve things and organize them into meaningful patterns. This is like a Sukudo, but with sorted concepts instead of number patterns.
Here are the twelve things:
Dialysis
Feed and Clean the weak
Health care: Care
Glucose imbalance in Diabetes
Hospital Days
Varicose Veins
Preventative Education
Health care: Purchases
Teach about illness
Infections
Health care: Corrections
Pain Relief
The imaginary "grid" is four boxes across and three rows down. The topics are pretty easy to spot, but even they must be ordered by a meaningful pattern.
Once the headings are placed, the goal is to have in remaining nine boxes ordered issues where the least expensive is at the top left and the most expensive at the bottom right. As in Sukudo, the items in the columns must relate up and down and left to right. The left to right is pretty easy as I gave you the topics, and I am not dealing with the angles.
I will put the answers at the bottom, but now I will lead a discussion in figuring out the answers, so stop reading and work it out for yourself on paper now if you don't want any clues.
First, locate the three headings. Since there are only three of them, not four, they obviously belong in the first column on the left. They are Health care: Care, Purchases and Corrections. It will be hard to order them until associated terms give some clues, but the goal is to have the one at the top that is most controllable by the person and family and thus least expensive, and the one at the bottom that is least controllable by the person and family and thus most expensive.
The next word on the list is Dialysis. Dialysis could be care, a lot of care is needed. It cannot be corrections because we know it does not fix the problem of kidney failure, and it certainly requires purchasing. No one can achieve dialysis without purchasing health care, not even the dialysis Dr. because the entire procedure requires a team of operatives from diagnosis to administration so it must be purchased by any person who is going to have it. Thus, we will put it with purchases.
Feed and Clean the weak. By this I mean any weak, the babies, the geriatric patients, the people with broken legs, those sick from disease, etc. etc. etc. This is that basic level of personal care that makes one human being dependant on another for health because without assistance they will not have nourishment or be clean. Hopefully by my examples you can see that it is not necessarily a correcting or purchased health care need. Most mothers take care of their own babies. Parents help out independent children when they end up with a cast, etc. etc. So this goes with Health care: Care.
O.K. We are up to glucose imbalance in diabetes. There is a fundamental difference between fixing glucose imbalance and doing dialysis. Dialysis does a function the body no longer can do, but it does not change body function. Fixing glucose imbalance whether by losing weight in type II diabetes or administering insulin in type I diabetes fixes (or prevents) much much worse medical issues from occurring. Is that enough to get you to see that this belongs in health care corrections?
Hospital Days. There was a time in the origin of hospitals where hospital days were not the biggest possible health care purchase a patient made. Those times are gone now. Just by reading the list you should know that the very last box on the bottom right is the place where Hospital Days goes - most expensive, least controllable by consumer.
Varicose Veins. Most of us get these, a certain number of us suffer pain because of them, and a lot of people buy services to get them fixed. Since they do fix, instead of require ongoing purchases to be effective, I have them in the correction category.
Preventative Education. If you don't know by now that this is the least expensive part of health care and the most controllable by the consumer then you haven't really listened to anything that anyone advocating government action in health care has said. As it is not correcting anything you are already sick with or requiring the purchase of something to deal with illness, it goes with the heading Care.
Skipping the heading, we go to Teach about Illness. Again, this is a Care issue. Information is available for free and the consumer has a lot of control over it.
Infections. This is clearly identifiable as health care that corrects a problem.
And the last non heading issue is pain relief. While pain relief seems like a basic care issue and can be fixed, pain is a symptom, not an underlying disease process alone, so anything exerted on pain has to be done over and over until the cause is changed. If you are anywhere in the health care market right now, you know that pain relief is one of the biggest sellers and you would easily place that in health care services that a consumer buys.
So lets take the three "Buy" issues, Pain Relief, Dialysis and Hospital Days. We know Hospital Days is the most expensive. Clearly Pain relief is the least expensive - although some pain relief can get very expensive.
Since we already pointed out that Hospital Days is the least controllable by the consumer and the most expensive, we know that this "Buy" category is going to be on the bottom row.
So the bottom row of the graph reads
Health care: Buy - Pain Relief - Dialysis - Hospital Days.
Which of the two remaining headings (Health care: Care) and (Health care: Corrections) is the least expensive. In spite of the current panic about nursing shortages and trying to pay salaries to do all the care that is needed right now for nursing homes, etc. Health care: Care is actually less expensive than Health care: Corrections. This is because personal care can actually be done without expending money. A high school graduate who is doing on line college classes can stay home with grandma so that nursing care is not needed. A parent can take FMLA to stay home with the sick kid for two days. Grandma can move in for a month when the next baby is born, and Grandpa can move in if he needs to rather than go to a home when his wife dies. These are simple, but non-monetary solutions that are under the control of the health care consumer. Of course choices have to be made, but all "fixes" also require some purchase where as the things under "care" have some totally non-monetary expenditure items.
So if Care is at the top, what order do they fall into on the expense scale. Obviously if you do preventative education and do not get any problem, that is the most frugal solution. If you have an illness and can learn what to do, you will also save a lot of money, or may not need any money. While Feeding and Cleaning the weak may not require monetary outlay, it will require reassignment of resources which can be costly in non-monetary ways ie: The on-line college student doesn't get to rub shoulders with peers and doesn't have quite the network for future growth, taking FMLA looks bad on the work record, Grandma will have disruptions to her routines, and depending on Grandpa's disposition, a family may decide that paying for a nursing home is less of a cost than putting up with him in the house.
So the top row looks like this:
Health care:Care - Preventative Education - Teaching about Illness - Feeding and Cleaning of the Weak
It should be fairly easy to assign the middle rows by looking at what is left. Start with the topic Health Care: Corrections on the left. Which of the three previously identified corrections fits with Preventative Education and Pain Relief? If you said Varicose Veins, you are right. While I admit that at times it is much correct infections than it is to correct varicose veins, to keep the theme we have to consider that good leg support, keeping the weight down, and adequate exercise all help decrease the possibility of varicose veins. If the veins are not fixed and cause pain then there will be no end of purchasing to try to buy pain relief, so fixing them is a less expensive solution than buying services to put up with them and the row works.
If you know anything about diabetes, you will identify that dialysis is required if diabetic problems end up destroying the kidneys, so correcting glucose imbalances is the corrective health care procedure that will save money by not requiring constant repurchasing of dialysis.
So the final thing I will explain is how Infections can be considered a costly correction when most of us very easily call a Dr. and for $4.00 at Walmart get our infections under control.
In the context of the column that starts with Feed and Clean the Weak, infections are one of the costliest health care items when people choose to pay for the Feeding and Cleaning of the Weak rather than do it themselves in the setting of family and friends. Think: children in daycare sharing colds, nursing home patients continually having urinary track infections, Rehab patients getting MRSA during two week post surgical hospitalization. And the infections get costlier and costlier as they get stronger and research can not keep up with keeping them under control.
So Here is the whole Graph.
CARE: preventative education, teaching about illness, Feeding and Cleaning the Weak
CORRECTION: Varicose Veins, Glucose imbalance in Diabetes, Infections
BUY: Pain Relief, Dialysis, Hospital Days
So lets look at the graph and make some generalizations about the benefit of spending money in these areas.
First, spending money on instructions for preventative health benefits everyone, but it does not control anything. Preventative health care is most under the power of the individual and the government can not control the individual (I'm pretty sure that is against the spirit of the Constitution). So when the government does things to promote prevention, it solves nothing, it only puts money into the hope that people will empower themselves with the knowledge.
On the other end of the scale, the government has always known that hospital days are expensive, and in no program have they ever been willing to pay the whole cost. Medicare comes closer than Medicaid to covering the cost of hospital days, but most hospitals run on a deficit. There is a sense that the government has been spoiled in having this privilege, and if they now dictate all assignments of money for hospital beds, they will have to stop undercutting, or they will simply ruin hospitals as the hospitals have to reduce costs to match payment received. One could theorize that the elimination of hospital beds as a plan for economizing health care is one option. It would set our society back about 200 years to the 1800's, but it is not as outlandish a potential as it seems. There are already many empty hospital buildings around the country and the potential that they all fail, or enough of them fail for them to stop being a significant part of the health care economy is possibly only a value added tax away.
The government has done a lot for the middle of the scale and has many programs to empower diabetics to care for themselves and keep their glucose balanced.
The malaise jumps up again. Every time I think about the issues that arise when the government tries to help (ie exerts control) on any part of the health care scene, I just get crazy. Hospitals come from hospitality. Healing comes from faith. Personal care comes from community. None of these are characteristics that our government was set up to have. But they are not things that flow gently out of the open market, either. I think I'll stick with praying for a change in November. At least if the market fails people are free to start over and reinvent the services they really want. If the government takes it over, it will become a bigger albatross than it already is.
Enough for today.
Here are the twelve things:
Dialysis
Feed and Clean the weak
Health care: Care
Glucose imbalance in Diabetes
Hospital Days
Varicose Veins
Preventative Education
Health care: Purchases
Teach about illness
Infections
Health care: Corrections
Pain Relief
The imaginary "grid" is four boxes across and three rows down. The topics are pretty easy to spot, but even they must be ordered by a meaningful pattern.
Once the headings are placed, the goal is to have in remaining nine boxes ordered issues where the least expensive is at the top left and the most expensive at the bottom right. As in Sukudo, the items in the columns must relate up and down and left to right. The left to right is pretty easy as I gave you the topics, and I am not dealing with the angles.
I will put the answers at the bottom, but now I will lead a discussion in figuring out the answers, so stop reading and work it out for yourself on paper now if you don't want any clues.
First, locate the three headings. Since there are only three of them, not four, they obviously belong in the first column on the left. They are Health care: Care, Purchases and Corrections. It will be hard to order them until associated terms give some clues, but the goal is to have the one at the top that is most controllable by the person and family and thus least expensive, and the one at the bottom that is least controllable by the person and family and thus most expensive.
The next word on the list is Dialysis. Dialysis could be care, a lot of care is needed. It cannot be corrections because we know it does not fix the problem of kidney failure, and it certainly requires purchasing. No one can achieve dialysis without purchasing health care, not even the dialysis Dr. because the entire procedure requires a team of operatives from diagnosis to administration so it must be purchased by any person who is going to have it. Thus, we will put it with purchases.
Feed and Clean the weak. By this I mean any weak, the babies, the geriatric patients, the people with broken legs, those sick from disease, etc. etc. etc. This is that basic level of personal care that makes one human being dependant on another for health because without assistance they will not have nourishment or be clean. Hopefully by my examples you can see that it is not necessarily a correcting or purchased health care need. Most mothers take care of their own babies. Parents help out independent children when they end up with a cast, etc. etc. So this goes with Health care: Care.
O.K. We are up to glucose imbalance in diabetes. There is a fundamental difference between fixing glucose imbalance and doing dialysis. Dialysis does a function the body no longer can do, but it does not change body function. Fixing glucose imbalance whether by losing weight in type II diabetes or administering insulin in type I diabetes fixes (or prevents) much much worse medical issues from occurring. Is that enough to get you to see that this belongs in health care corrections?
Hospital Days. There was a time in the origin of hospitals where hospital days were not the biggest possible health care purchase a patient made. Those times are gone now. Just by reading the list you should know that the very last box on the bottom right is the place where Hospital Days goes - most expensive, least controllable by consumer.
Varicose Veins. Most of us get these, a certain number of us suffer pain because of them, and a lot of people buy services to get them fixed. Since they do fix, instead of require ongoing purchases to be effective, I have them in the correction category.
Preventative Education. If you don't know by now that this is the least expensive part of health care and the most controllable by the consumer then you haven't really listened to anything that anyone advocating government action in health care has said. As it is not correcting anything you are already sick with or requiring the purchase of something to deal with illness, it goes with the heading Care.
Skipping the heading, we go to Teach about Illness. Again, this is a Care issue. Information is available for free and the consumer has a lot of control over it.
Infections. This is clearly identifiable as health care that corrects a problem.
And the last non heading issue is pain relief. While pain relief seems like a basic care issue and can be fixed, pain is a symptom, not an underlying disease process alone, so anything exerted on pain has to be done over and over until the cause is changed. If you are anywhere in the health care market right now, you know that pain relief is one of the biggest sellers and you would easily place that in health care services that a consumer buys.
So lets take the three "Buy" issues, Pain Relief, Dialysis and Hospital Days. We know Hospital Days is the most expensive. Clearly Pain relief is the least expensive - although some pain relief can get very expensive.
Since we already pointed out that Hospital Days is the least controllable by the consumer and the most expensive, we know that this "Buy" category is going to be on the bottom row.
So the bottom row of the graph reads
Health care: Buy - Pain Relief - Dialysis - Hospital Days.
Which of the two remaining headings (Health care: Care) and (Health care: Corrections) is the least expensive. In spite of the current panic about nursing shortages and trying to pay salaries to do all the care that is needed right now for nursing homes, etc. Health care: Care is actually less expensive than Health care: Corrections. This is because personal care can actually be done without expending money. A high school graduate who is doing on line college classes can stay home with grandma so that nursing care is not needed. A parent can take FMLA to stay home with the sick kid for two days. Grandma can move in for a month when the next baby is born, and Grandpa can move in if he needs to rather than go to a home when his wife dies. These are simple, but non-monetary solutions that are under the control of the health care consumer. Of course choices have to be made, but all "fixes" also require some purchase where as the things under "care" have some totally non-monetary expenditure items.
So if Care is at the top, what order do they fall into on the expense scale. Obviously if you do preventative education and do not get any problem, that is the most frugal solution. If you have an illness and can learn what to do, you will also save a lot of money, or may not need any money. While Feeding and Cleaning the weak may not require monetary outlay, it will require reassignment of resources which can be costly in non-monetary ways ie: The on-line college student doesn't get to rub shoulders with peers and doesn't have quite the network for future growth, taking FMLA looks bad on the work record, Grandma will have disruptions to her routines, and depending on Grandpa's disposition, a family may decide that paying for a nursing home is less of a cost than putting up with him in the house.
So the top row looks like this:
Health care:Care - Preventative Education - Teaching about Illness - Feeding and Cleaning of the Weak
It should be fairly easy to assign the middle rows by looking at what is left. Start with the topic Health Care: Corrections on the left. Which of the three previously identified corrections fits with Preventative Education and Pain Relief? If you said Varicose Veins, you are right. While I admit that at times it is much correct infections than it is to correct varicose veins, to keep the theme we have to consider that good leg support, keeping the weight down, and adequate exercise all help decrease the possibility of varicose veins. If the veins are not fixed and cause pain then there will be no end of purchasing to try to buy pain relief, so fixing them is a less expensive solution than buying services to put up with them and the row works.
If you know anything about diabetes, you will identify that dialysis is required if diabetic problems end up destroying the kidneys, so correcting glucose imbalances is the corrective health care procedure that will save money by not requiring constant repurchasing of dialysis.
So the final thing I will explain is how Infections can be considered a costly correction when most of us very easily call a Dr. and for $4.00 at Walmart get our infections under control.
In the context of the column that starts with Feed and Clean the Weak, infections are one of the costliest health care items when people choose to pay for the Feeding and Cleaning of the Weak rather than do it themselves in the setting of family and friends. Think: children in daycare sharing colds, nursing home patients continually having urinary track infections, Rehab patients getting MRSA during two week post surgical hospitalization. And the infections get costlier and costlier as they get stronger and research can not keep up with keeping them under control.
So Here is the whole Graph.
CARE: preventative education, teaching about illness, Feeding and Cleaning the Weak
CORRECTION: Varicose Veins, Glucose imbalance in Diabetes, Infections
BUY: Pain Relief, Dialysis, Hospital Days
So lets look at the graph and make some generalizations about the benefit of spending money in these areas.
First, spending money on instructions for preventative health benefits everyone, but it does not control anything. Preventative health care is most under the power of the individual and the government can not control the individual (I'm pretty sure that is against the spirit of the Constitution). So when the government does things to promote prevention, it solves nothing, it only puts money into the hope that people will empower themselves with the knowledge.
On the other end of the scale, the government has always known that hospital days are expensive, and in no program have they ever been willing to pay the whole cost. Medicare comes closer than Medicaid to covering the cost of hospital days, but most hospitals run on a deficit. There is a sense that the government has been spoiled in having this privilege, and if they now dictate all assignments of money for hospital beds, they will have to stop undercutting, or they will simply ruin hospitals as the hospitals have to reduce costs to match payment received. One could theorize that the elimination of hospital beds as a plan for economizing health care is one option. It would set our society back about 200 years to the 1800's, but it is not as outlandish a potential as it seems. There are already many empty hospital buildings around the country and the potential that they all fail, or enough of them fail for them to stop being a significant part of the health care economy is possibly only a value added tax away.
The government has done a lot for the middle of the scale and has many programs to empower diabetics to care for themselves and keep their glucose balanced.
The malaise jumps up again. Every time I think about the issues that arise when the government tries to help (ie exerts control) on any part of the health care scene, I just get crazy. Hospitals come from hospitality. Healing comes from faith. Personal care comes from community. None of these are characteristics that our government was set up to have. But they are not things that flow gently out of the open market, either. I think I'll stick with praying for a change in November. At least if the market fails people are free to start over and reinvent the services they really want. If the government takes it over, it will become a bigger albatross than it already is.
Enough for today.
Tuesday, July 20, 2010
Trust is Healing
"Knowledge is Power" is a very well known American phrase, emblazoned all over our capitol city and possessed by our American existence beyond any other common belief. I remember a radio comedian in Cincinnati who had as an intro to one of his regular "secret microphone" sketches the line "Your right to know supersedes your right to exist." I loved the line for its funny truth because our culture screams if in real life even the most powerful potential move by the government is not 'transparent,' but adores TV characters who regularly look at people and deny them information until they 'need to know.'We are an unrealistic group of children who can neither take care of ourselves nor identify and appreciate the people who can take care of us. Or, to quote an ancient prophet "All we like sheep. . ."
So I would like to address today how our belief in our power through knowledge has affected our perceptions on health care. In the area of healthy diet, people can totally control their own intake if they desire and make many things change, such as pain in the case of gluten intolerant people. Others can adjust their weight, lower their blood pressure, or calm their nerves by adjusting to eating patterns that serve the needs of their own body. But when it comes to medication, the "client" is no longer in control. The FDA has chemicals that are available over the counter and chemicals that require a professional assessment and recommendation. So now, our desire to have one thing or another for our health comes into conflict with our need to get professional judgment about whether the drug is needed. As a mental health nurse, I see daily the struggle between self reliance and professional service as people regularly medicate themselves by purchasing street drugs, either illegal or prescription, to avoid depending on the services of a professional to treat their mental anguish. The expanded "knowledge" about drugs through required ads and warning data has changed our perception of chemical medicine treatment. Patients regularly order up prescriptions, sometimes motivated by TV ads, rather than wait for an expert opinion from their doctor. Now I am not disagreeing with the idea that knowledge is power, but like every other market motivated equalizer, it does not function purely when applied to the setting of illness and health care. Some people are quite capable of understanding their own chemical needs, and some doctors, raised and educated in the age of unlimited knowledge have given up trying to know the special facets of chemical treatment because there is just too much to deal with. But the thing that keeps faith in medical care is not some type of supply and demand smorgasbord of options that smart patients chose well and oblivious patients choose poorly. The thing that keeps faith in medical care is trust. Whether the patient is asking his doctor to let him try something or asking the doctor what on earth is wrong with him, the facts that are needed to solve medical issues do not present themselves without trust. Most of America is crying over health care now because they do not trust it. Without being able to express the facts, they feel that the services rendered are more about getting money out of them than healing them, and they do not trust it anymore. When I really see it for what it has become, it is hard to care whether it fails or not. This has nothing to do with the current governmental health care reform. That is just another wave of the same thing we have now with different people in control. It will change nothing substantial about the fact that health care offerings in America are really a way to gather money instead of a way to heal the people. But the worst part about this is that a very small percentage of the care that gathers money even offers healing. That is because, as I am sure I have said somewhere along the path of this blog, you can't buy health. You can discipline yourself, change your life, repent of your body wrecking life style and do the things that improve health, but you can't buy health. And you especially cannot demand that others buy you health in whatever way your knowledge has concluded works for your own power. As the wonder of modern medicine melts away like a wet witch because the patient is trying to get out of it's control, look for those you can genuinely trust to build it back up. It is not the ones with things to sell or buy who can be counted on for healing but the ones you know you can trust.
So I would like to address today how our belief in our power through knowledge has affected our perceptions on health care. In the area of healthy diet, people can totally control their own intake if they desire and make many things change, such as pain in the case of gluten intolerant people. Others can adjust their weight, lower their blood pressure, or calm their nerves by adjusting to eating patterns that serve the needs of their own body. But when it comes to medication, the "client" is no longer in control. The FDA has chemicals that are available over the counter and chemicals that require a professional assessment and recommendation. So now, our desire to have one thing or another for our health comes into conflict with our need to get professional judgment about whether the drug is needed. As a mental health nurse, I see daily the struggle between self reliance and professional service as people regularly medicate themselves by purchasing street drugs, either illegal or prescription, to avoid depending on the services of a professional to treat their mental anguish. The expanded "knowledge" about drugs through required ads and warning data has changed our perception of chemical medicine treatment. Patients regularly order up prescriptions, sometimes motivated by TV ads, rather than wait for an expert opinion from their doctor. Now I am not disagreeing with the idea that knowledge is power, but like every other market motivated equalizer, it does not function purely when applied to the setting of illness and health care. Some people are quite capable of understanding their own chemical needs, and some doctors, raised and educated in the age of unlimited knowledge have given up trying to know the special facets of chemical treatment because there is just too much to deal with. But the thing that keeps faith in medical care is not some type of supply and demand smorgasbord of options that smart patients chose well and oblivious patients choose poorly. The thing that keeps faith in medical care is trust. Whether the patient is asking his doctor to let him try something or asking the doctor what on earth is wrong with him, the facts that are needed to solve medical issues do not present themselves without trust. Most of America is crying over health care now because they do not trust it. Without being able to express the facts, they feel that the services rendered are more about getting money out of them than healing them, and they do not trust it anymore. When I really see it for what it has become, it is hard to care whether it fails or not. This has nothing to do with the current governmental health care reform. That is just another wave of the same thing we have now with different people in control. It will change nothing substantial about the fact that health care offerings in America are really a way to gather money instead of a way to heal the people. But the worst part about this is that a very small percentage of the care that gathers money even offers healing. That is because, as I am sure I have said somewhere along the path of this blog, you can't buy health. You can discipline yourself, change your life, repent of your body wrecking life style and do the things that improve health, but you can't buy health. And you especially cannot demand that others buy you health in whatever way your knowledge has concluded works for your own power. As the wonder of modern medicine melts away like a wet witch because the patient is trying to get out of it's control, look for those you can genuinely trust to build it back up. It is not the ones with things to sell or buy who can be counted on for healing but the ones you know you can trust.
Tuesday, July 13, 2010
Keeping it Real
So, I have passed another week unable to look at that crazy health bill again. I know I am not keeping my promise here to evaluate it, but it is phenomenally vague, causing the law itself to look like it is meaningless until the rules come out that fulfil it. And of course, that is how the government actually takes things over. Administrative law can be incredibly oppressive for the sake of accomplishing the overall goal, but at that level, comprehending how the rules affect freedom and rights is so difficult the oppressiveness gets by without question. Here is a lovely example. The quote of the week on conservative talk shows is the one where the newly appointed director of Medicaid, Donald Berwick indicates that our health care will be superior to that in Europe or wherever else because we will "ration services with our eyes open." Of course this has every talk show person bouncing with "I told you sos" but truly, those of us who are in health care know that there are not enough resources for every single person to be serviced without limitation by any program. The man is saying a truth (that services must be rationed) and is stepping up to be "open" by saying we will ration them with good judgment and fairness (our eyes open). And here, America, is your opportunity to see what is really happening. The past ten years of medical market advertising that has caused you to somewhat magically think that health services are unlimited for everyone at all times has finally been washed away, and you can look at the real issue. At all points in time medical services have been rationed and limited and only given when very specific benefits were in place (whether economic or charitable) and the real thing that is happening is who is going to decide how they are rationed. No one has been thinking clearly about this because everyone has been drinking the kool-aid of advertisements and acting like unlimited health is a right of nature. It isn't. Health is a personal responsibility and medical services are a limited commodity. Now, open your eyes and get your right to services back not by trusting the government, but by demanding that the government get out of it. When health care is a private and personal endeavor, irresponsible people are kept under control. The government is totally unable to keep irresponsible people under control. As a crisis worker I have heard plenty of stories from people about how the local doctor gave free care to them when they couldn't afford it. But you can be sure that that free care was exactly the care the person needed, and not every piddly thing the person wanted because the whole dynamic of thankfulness and dependence when there is no obligation lets the doctor call the shots. Now try to apply that to a free governmental clinic. All of a sudden the person who can't afford care is no longer obligated to a professional who can properly limit the complaints that will be addressed. Every service is now something the Dr. is being paid for, so the client no longer appreciates getting free service and wants to control the decision making instead of going to the doctor requesting help. But these problems are not just about money. When it comes down to it, personal care is exactly that: personal. If a proper relationship does not exist, care does not happen. So in every clinic, when the professional begins to feel that the client is not grateful, is not respectful, and basically does not want help, only wants to demand things, care will stop. Treatment won't. There will still be lots of orders, tests, prescriptions,etc. But the process will lose that extra value called care, and the over treated patient is as likely to die from neglect as the untreated patient because no real issues are being addressed because no one is really talking to anyone anymore because no one cares. This situation already exists so extensively it is hard to believe anyone is pushing for more of it by wanting government intervention. And if you imagine that non-caring over treatment is less expensive than no care, you are wrong and you can open the books of every medical system in Europe for proof of that. In his science fiction allegory The Great Divorce, C.S. Lewis sets up a Hell where no one has needs because everyone gets what they want just by imagining it. Of course nothing is actually real, so even though you have everything you want, no one is satisfied. Our health care is on its way to being exactly such a hell. By trying to provide things everyone wants without any knowledge of what it takes to meet needs, the government is creating a service that will not be real health care. No doubt Dr. Berwick is hoping to counter this, and believes his knowledge will be the thing that makes the system right. But the nation as a whole has too many conflicting needs to be figured out from the top. Smaller groups are the parties that have the capacity to care. Even beyond that, individuals are often the only ones gifted enough to know and enforce what is needed. Even if Berwick can bring miraculous wisdom to Medicaid, there is a very long train of workers who will be pegged into that system who will not have the talent to carry on the miracle. When health care is no longer an individual endeavor but is a process and procedure that citizens go through as a part of civic responsibility instead of private life, it will no longer be health care, it will be oppression. The road to hell is paved with good intentions.
Tuesday, July 6, 2010
Immigration problems shed light on why health care won't work
I'm sure people realize that the health care law is long, boring and almost meaningless when it comes to telling you what is actually going to happen to you. So to take a break from that law and address the newest issue on the government's plate, I'm going to tell you a little something I know about Immigration reform. I had been a law student for four weeks when the terrorists flew planes into the World Trade Center, Pentagon, and then passengers downed the fourth plane in a field in Pennsylvania. And I took Immigration Law in the fall of 2002 when the Department of Homeland Security was being formed. So I did a long research paper on what was wrong with US Immigration and whether or not the creation of Homeland Security was going to change anything. What was wrong with Immigration was really very simple. No one in charge of it really cared about it.
Now that may seem like a horrible thing to say, but by 1998 advise was on the table that stated the primary problem with US immigration is that the task of legally getting people into America was not a priority and even though ignoring the need for good service in that area had increased illegal entry exponentially, the government still had not changed anything.
All the priority and power was given to enforcement of those trying to go "outside" the gate, and no one was addressing the fact that smoother direction to the appropriate gate and better facility of legal entry would help the illegal problem. So for decades, governmental advisers had been asking that a separate entity be created, like the EPA for just the supervision of people coming properly to the country. To make a long story short, since The Department of Homeland Security was set up for the sake of security, it hardly made a priority out of making legal immigration function well, and of course the border issue is even worse than before.
So why should I mention this on a blog about health care? Because the issue really is government, not health care. My research says that for almost two decades advisers had been trying to get the government to change and get someone who cared about the art of service to the immigrant to make the flow better so that we would be seen as a peaceable neighbor and not a walled city that had to be overcome. And yet, no change had happened, and after catastrophe occurred, no good change was possible. And now look at our mess.
My personal opinion is that if the government did that to itself, it did it to itself, and since who comes and goes in this country really is the government's right to decide, a twenty year negligence of their own administrative responsibility probably explains why they have the trouble they have now, and they probably deserve it, though I feel very sorry for the people caught in the middle.
But what is going to be the situation when that kind of negligence works its way into the health care of citizens.
Sometime in the past month I had to commit a patient to a State facility. No less than 10 professionals were involved over two days to jump through all the hoops to get the permission for this to happen. By the time I was able to connect with the professional who could receive the patient, eight of those professionals were eating dinner and two of us were working overtime to actually get the care to happen. Both of us were cursing the system that took two days and 10 approvals to function and was still so dysfunctional that it burdened off shift workers with extra work. But ask anyone you know who works in government and they will tell you that the only way things actually get done is the occasional person who is motivated handles it. Otherwise, things are lost in the hours of paper shuffling and getting to dinner on time.
The government of the United States is simply not set up to accomplish things well. They are protective, slow and unwieldy. They are reactive and defensive. They have not been able to maintain good immigration policy in spite of that being a primary governmental duty, they certainly have no foundation to maintain good health care policy.
I have one hope for immigration lessons that may help with getting this crazy health care bill off our necks. If the Feds do challenge Arizona and tell them in court that immigration is a Federal role, not Arizona's prerogative, then maybe Arizona and the rest of the States can get a foot hold to say, Hey Feds, health care is our problem, get yourself out of our business, because we may have troubles, but we know carrying your weight is just going to make it worse.
Now that may seem like a horrible thing to say, but by 1998 advise was on the table that stated the primary problem with US immigration is that the task of legally getting people into America was not a priority and even though ignoring the need for good service in that area had increased illegal entry exponentially, the government still had not changed anything.
All the priority and power was given to enforcement of those trying to go "outside" the gate, and no one was addressing the fact that smoother direction to the appropriate gate and better facility of legal entry would help the illegal problem. So for decades, governmental advisers had been asking that a separate entity be created, like the EPA for just the supervision of people coming properly to the country. To make a long story short, since The Department of Homeland Security was set up for the sake of security, it hardly made a priority out of making legal immigration function well, and of course the border issue is even worse than before.
So why should I mention this on a blog about health care? Because the issue really is government, not health care. My research says that for almost two decades advisers had been trying to get the government to change and get someone who cared about the art of service to the immigrant to make the flow better so that we would be seen as a peaceable neighbor and not a walled city that had to be overcome. And yet, no change had happened, and after catastrophe occurred, no good change was possible. And now look at our mess.
My personal opinion is that if the government did that to itself, it did it to itself, and since who comes and goes in this country really is the government's right to decide, a twenty year negligence of their own administrative responsibility probably explains why they have the trouble they have now, and they probably deserve it, though I feel very sorry for the people caught in the middle.
But what is going to be the situation when that kind of negligence works its way into the health care of citizens.
Sometime in the past month I had to commit a patient to a State facility. No less than 10 professionals were involved over two days to jump through all the hoops to get the permission for this to happen. By the time I was able to connect with the professional who could receive the patient, eight of those professionals were eating dinner and two of us were working overtime to actually get the care to happen. Both of us were cursing the system that took two days and 10 approvals to function and was still so dysfunctional that it burdened off shift workers with extra work. But ask anyone you know who works in government and they will tell you that the only way things actually get done is the occasional person who is motivated handles it. Otherwise, things are lost in the hours of paper shuffling and getting to dinner on time.
The government of the United States is simply not set up to accomplish things well. They are protective, slow and unwieldy. They are reactive and defensive. They have not been able to maintain good immigration policy in spite of that being a primary governmental duty, they certainly have no foundation to maintain good health care policy.
I have one hope for immigration lessons that may help with getting this crazy health care bill off our necks. If the Feds do challenge Arizona and tell them in court that immigration is a Federal role, not Arizona's prerogative, then maybe Arizona and the rest of the States can get a foot hold to say, Hey Feds, health care is our problem, get yourself out of our business, because we may have troubles, but we know carrying your weight is just going to make it worse.
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