A healthcare history lesson

Since I am a 50 year old woman, there are days, weeks even at times, when I simply cannot think. Today is one of them. So instead of trying to think, I am simply going to report.
When I was going through boxes I inherited from my Grandmother, I found a Saturday Evening Post magazine from June 15, 1963 with a cover story: Exclusive-A penetrating study of The American Doctor, Troubled by his wealth and his changing image.
The article was written by Evan Hill, a World War II Veteran who spent four years in a military rehabilitation hospital and wrote about those experiences in a May 1960 article called My Memorial Day. Mr. Hill's article about his war experiences show him to be someone who experienced healing in a very intimate way. He watched and knew about patients and doctors. So I have selected quotes from his cover story on the modern doctor of 1963. The remainder of this is direct quotes, no commentary. As I said at first I cannot think today.

The American Doctor: Death of a Legend in an era of Miracles, by Evan Hill

"Old Doc could do almost nothing for pneumonia and many other diseases except relieve pain, stress and distress. . . Today Young Doc uses a magic needle instead of a magic personality. . . there is often little more than swift, lifesaving science and almost equally swift medical and pharmacy bills."

"The result of specialization is impersonalness, but the fact that it's impersonal does not mean that it's poor medicine. . . Both doctor and patient have difficulty adjusting to what Doctor Gipstein calls the 'general dehumanizing of everything throughout society.'"

"Yet. . .the AMA and the great complex of city, county and state medical societies which is identified as organized medicine has served the nation very well. Perhaps 80 percent of it's efforts and money have been devoted to science and the education of public and physician alike in medical matters. But this work goes on quietly, with scientific caution, for the medical profession - not unlike other highly trained professions - seems to have an innate distrust of both the patient's and the public's judgment."

"Today, with such a small number of uncollected bills, there is little justification for the old time Robin Hood philosophy of soaking the rich to take care of the poor. Yet there are still physicians who adhere to this practice. This is where the grievance committee comes in."

"In all fairness it must be pointed out that the doctors receive only a fraction of what the public spends for its health. Physicians fees were 27.6 percent off the health-care dollar in 1961, and they have risen less than have all services listed in the Consumer Price index."

"The desire for independence is perhaps the most significant facet in the profile of the doctor."

"The physician, like the Amish, is so used to doing things in one economic way for years that he is simply resisting change. He feels, as a minority, that he is fighting for his rights. In fact, much of his resistance to an intermediary- whether government, unions or insurance companies-is simply because he doesn't want to feel he's working for someone other than himself."

"This brings us to that much discussed doctor-patient relationship, the sanctity of which organized medicine sees threatened by Medicare, group practice, hospital insurance and any other alterations in the pattern of medical practice which it opposes. Organized medicine warns that the relationship will suffer greatly, or entirely disappear, if American medicine ever is 'socialized' Yet , closer examination of the problem shows that the forces of society and science are stripping the doctor of his warmth, often preventing the patient from receiving it when offered. Neither the patient nor the doctor has time to get acquainted."

"Times have changed: science has changed the patient has changed, and so has the doctor."

"The doctor's innate independence is not helping form a fonder image, and he is unlikely to change. The patient will not become less educated, less demanding, or less critical. I addition, Americans, despite the cries of organized medicine, are beginning to feel that medical care is a 'right' and not much different from such established services as education, fire protection and public roads, regardless of who pays for it or how."

"It is true, as a mid-western physician says, that the profession has deteriorated in the public eye even though medical care is better than ever before."

"The public does not hate the profession- Generally it has great respect for it, and it has reason for such respect. But it has little love-at least not the love it had for Old Doc-because neither the New Doc nor the new patient has much time for love. And with the immense growth of specialization coupled to the phenomena of the vanishing family doctor, the patient finds it somewhat unrewarding to love a scientific instrument."

"The fact is that the problems of the American doctor are born, not of despair, but of progress."

Unions and Health Care

Everyone is talking about government unions today. I remember being an administrator for a government institution at one time. I dealt with three unions and in the early 90's, unions were losing popularity. Japanese companies were coming in and creating worker oriented factories that cast off the burden of union hierarchy by promoting an unlimited rather than a limited view of the participation of the worker in the auto industry. As a result of labor laws and of philosophical altering of employee/employer relationships, very little of the old time union task is still needed in the modern worker's life. For this reason, the news today reports that the largest section of unionized employees is in the government. The stat has been out about a year, but people are talking about it today.

But I was not in the auto industry. I was an administrator at a State Hospital. I know what the union's role is when the boss is the government. I never belonged to a union as a laborer except when I worked at unionized State institutions, but when I became and administrator I was a HUGE fan. Ever since my short term experience as a Director of Nursing for a State hospital, I have believed that even though laws and relationships may genuinely make corporate unions unnecessary, the government worker has to have a union representative because he or she is dealing with the government, and does not have the government as an objective force to regulate his or her employer.

But as a government administrator, the unions were a blessing to me for a very different reason. The union had contractual expectations that I could hold employees to. The administration of our institution had dissolved into a mushy "family" of people who were sticking together to keep the State from cutting their institution from the budget and working order was horrible. Administrators had no reason to push for results but more than that, administrators were tired of pushing for results. Government work does not produce the motivation of pride by natural results of accomplishment like making a car or bringing energy to the nation. The government worker has to have a passion for the laws of the land that can keep him or her happy about doing the task at hand even if no results are visible. They must overcome the worry of being a brick in the wall due to the belief that the wall has a big picture purpose that is good. Most of the time they have to do this with full knowledge that they are restricted from doing things that would actually "work" in the moment due to the importance of the big picture. So when I was suddenly called on to serve, I was looking at a group with relationships that were so skewed into favoritism and false communication, the way a dysfunctional family interacts, that the only solid expectation I had to work with was that union contract. I'm not sure anyone else in my position had even read it in the last five years, but I clung to it like a Bible and got some order back in my department (not to mention respect).

So I developed a two fold reason for having unions for government workers 1) so that the worker is protected from his or her all powerful employer, and 2) so that the government can actually require work of people and fire them if they don't work.

But the word on the street today is that government unions are a drag on the budget and poised to ruin the country. I'd like to say that the answer to that problem is not to get rid of unions for government employees, but to reduce or at least not add to employment in the government. I am not addressing reducing at this time, but I have a very big concern about the area that might be added.

In the past, hospitals and health care workers were considered "ineligible" for unionization. This came from the old philosophy that the hospital was a charitable institution and for that reason, lower wages were considered a necessary part of keeping them going. Of course the issue of life and death in the face of a strike was also a big deterrent to compatibility with unions. People worked there for a purpose greater than earning a living, because they were healers, or in some cases totally committed to God (many early nurses were nuns and deaconesses with no families). As the lines between providing a service to the community and making money in a market have blurred, unions have been slowly gaining ground in health care areas. I do not sit and research before I blog. I think about my experiences and what I have seen pass, and I don't have the details on the approach of unionization in health care, but I did see that last year unions were planning to work in California on adding the 85% of nurses that are not represented by unions to their roles, so this is a very active issue. Both the fact that 85% were not represented and the fact that the unions were working to change the situation make this a current "to be or not to be" problem.

Hospitals were in the past what the Japanese car companies were trying to be in the 90's. The supervisors made rounds, and the administration took care of their employees. To place union intervention and rules of relationship in the middle of that employee/employer relationship would be like caging a bird. Nobody came to a hospital expecting that there was any great amount of money involved in the proposition, so everyone worked to keep dedicated people happy. Dedication and happiness were important when there wasn't money to compensate for the actual work.

But, the one place where hospitals were more likely to be unionized was when they were government hospitals. The private hospitals had boards of directors, and philosophies (usually religious) that an employee could use as a basis for appealing to good treatment, but the State has no such guiding principle. State facilities had to spell out in black and white what would or wouldn't be rewarded because no one had the right to make an independent judgement based on the sacred trust of the purpose of the institution. The State just doesn't work well with the sacred, it has totally different rules.

So where this draws me to for the current times is the importance of rejecting government health care where myriads of health care workers suddenly are employed by the government instead of independent institutions. I don't really know to what extent anyone has considered this, but it won't work. A public option for a health insurance plan would whittle away at the free market boundaries of assessment of resources, and a public service system would be unsustainable with the demands that government employment requires.

Unions served a role in industry to help workers because the pots of money were not being fairly distributed. There are not very many pots of money in the field of health care no matter what the commercials for pills make you think. Health care is a duty of love, which is very different from inventing and selling a new chemical. You can't buy love, and since the only commodity the government works in is money, they need to stay away from providing health care.

Time conflicts in health and wealth

One of the biggest conflicts in the "market" of health care is the problem of time. There is an old saying that time heals all wounds. While this is not a quality control statement, as in time heals the loss of a loved one much more cleanly than time heals an untreated broken bone, there is still an element of reality about this statement to the healing process. In most cases the body, that which is being treated for health care, is a living, changing thing that has a plan for its own recovery over time. One of the reasons health care is progressive is that it can speed up the healing process with treatments. One of the biggest examples of this is orthopaedic practice in sports. Athletes whose knee injuries used to end their careers are now back in the game in weeks. The big motivation for speeding up such healing is obviously money. That athlete is a multi-million dollar player and healing the money makers keeps the market going. Being able to contribute a money saving procedure into a big money business like sports also keeps the economy going. But not all injury occurs in an environment where such vast amounts of money are on the line. At a certain point, the costs of speeding up healing have to be weighed against the available money for doing so. In the past, antibiotics became over used because they were taken when the real answer for the flu was rest. But we have an unforgiving society that perceives stopping to rest as a character flaw, so almost no one will actually rest for the amount of time needed to recover from a cold or flu or other small setback. Staying home for a week to recover from the flu is now seen as too much loss in job time to be considered a legitimate choice for health care. The answer now is to get the flu pill and not miss any days. These social changes indicate a serious change of philosophy about the purpose of living. The person whose life can stop to get well is a person who has self respect and individuality. A person who doesn't dare get sick because money will be lost to someone whether it is an employer or his own household is a slave to money. I am talking about attitude here, not literal slavery. Much of the American citizen's disgust with health care in the year 2010 is because since the year 1980 no one has been willing to wait to heal. The whole concept that healing is a process that requires diagnosis, treatment, adjustment to individual aspects of healing and time has been replaced by the demand, " Where is the pill to fix this?" People rail against the drug companies for eating up most of the money for health care, but just like our dependence on oil, the providers are only marketing to the demand. Whether legal or illegal, prescribed or self medicated, we have a generation of health care users who do not want to change their lives, their diets, their work habits or their expectations, they just want a pill to make it so they can keep doing whatever it is they wanted to do without the pain, stress, or work. Thus, making money became a big part of health care. If you are the kind of person who is willing to drop out of the fast paced world of high expectations and choose a slower method of healing, you do not have to buy anything. If you are a person who needs to keep up with the world of fast, hard work no matter what, you will buy anything you feel is needed to do that. (This is the primary reason Cocaine is so popular in the USA, but that is another story.) But even after the fall out of the great pill age, where the next generation is reacting with narrow minded attachments to all things natural in a way that would make the average Amish man think them obsessive, the element of time has still been ignored. In markets, time is money, money is time. It is very simple to understand the world that says the less time you spend the more money you make. That world prints out in black and white, the numbers add up and the computer understands it. The worker does not really have to understand it, because the machine does, and the worker can function as the machine instructs him or her. The problem is that that world is not an exhaustive enough picture for health care. The classic word for knowledge that included a sense of the necessary timing of change, recovery, and development was wisdom. Wisdom takes time, and wisdom uses time. And wisdom is not really programmable. A decision maker who knows how to seek out useful information that is not already available and then apply it to the individual for optimum benefit of both healing and economic pragmatics is an artist. The medical artist chooses which people he or she will spend time with and which ones will not be given time according to their healing needs. Science applied with only financial principles will fail to heal. Healing requires a priority be given to time and financial principles demand that time be limited regardless of other issues. This truism is chasing doctors out of medical practice and chasing patients away from health care that is based in modern science. Time to treat and time to heal are not cost effective in the modern philosophy of health care. The person is not valued more than the economy (making the person a slave) and the physician is ever conscious of not giving away too much time (making the physician a robot instead of an artist). This is a primary part of our loss of spirit in health care. We have a society wide lack of respect for those in need. They are no longer looked at as the weak, deserving protection and attention, they are looked at as the demanding, who need to be fixed to do their part like the rest of us: the quicker the better. But the demand is really our own expectation. Many people who would be willing to stay home and heal, quit their jobs to care for a loved one, or otherwise make a personal choice that would disrupt economic expectations are driven away from such choices by the voices of those around them who tell them how such things would ruin their lives and or reputations. The caretaker, who used to be the heart of human interaction, and the reason everyone else bothered to make money, has been eliminated as a factor in productivity. "No one cares" is said truly of our health care system, not because the professionals have lost feeling for the people they seek to heal, but because the professional system has eliminated the time for care taking due to an inability to value health over wealth.

From my Grandmother's refrigerator

TAKE TIME
Take time to think; it is the source of power.
Take time to read, it is the fountain of wisdom.
Take time to play, it is the secret of staying young.
Take time to be quiet; it is the opportunity to seek God.
Take time to be aware; it is the opportunity to help others.
Take time to love and to be loved, it is God's greatest gift.
Take time to laugh, it is music of the soul,
Take time to be friendly; it is the road to happiness.
Take time to dream; it is what the future is made of.
Take time to pray; it is the greatest power on earth.

Charity and Health Care

When I was going to Sunday school I learned all of my memory verses from the King James Version of the Bible. This really helped when I got to high school and started reading Shakespeare, but that is another subject. The point is that when I learned about the greatest things in the world, I knew them as faith, hope and charity. But in high school
I was also thoroughly trained on the reasons that charity could be translated love, and "should" be for the modern era. When I went to graduate school I studied linguistics and there I learned about changes in language and how and why words like charity evolve into words like love and what is gained and what is left behind. Since charity was an important part of the development of health care in America, I am going to talk about the change from charity to love and what has been lost that has affected the spirit of health care in America. The Oxford Dictionary of English Etymology says that the word charity comes from Latin words that mean Christian love. The word itself has to do with the kind of interaction that comes from the principle that if we really love God then we will love our neighbors as ourselves. But I would like to take the definition of Cristian love a step farther. To love ones neighbor as ones self is far older than Christianity, but Christianity takes it to the level of looking at every person as a child of God or a neighbor,
and behaving toward others as though God is looking out for them even if that person is not socially, racially, religiously, or sexually like ourselves.Christian love includes a humility that looks at each other person and fears God's wrath if I treat that person in a way that does not please God. Of course the discipline to treat others with dignity becomes the security that God is pleased with us, and the fear factor wanes, but there is an underlying obligation before God to see all people as worthy, and a forbidding to do good for self promoting reasons. Unfortunately, though, charity became so linked with giving money to the poor, that the word lost its meaning. Handing over money is a far cry from looking at ones neighbor with an obligation to God to serve his or her needs. Thus, to try to replace the spirit of charity, modern translators thought the word "love" would give us back the concept that charity included thoughtful observation and action and wasn't fulfilled by tossing money to the obviously needy. I remember what Peter and John said to the alms beggar at the Temple Gate "Silver and Gold have I none, but what I have I will give thee" and then they healed the man and the charity was far greater than giving money. It was in this spirit that many of the great health care institutions were developed. Those hospitals and care homes are not named Good Samaritan, Bethesda, Sisters of Charity, St. Luke, etc. etc. because someone thought it was a good market plan. They were named those things because they were offering love in the name of Christianity. Other religions do the same for the love of God, but at this time I am talking about charity which comes from Christian love. But over the years, using the word love has undermined the origin of the spirit of the love. Good can be done in the name of humanity, or because of natural law, or because that is what is "fair" according to tradition and or law and or popular opinion at the time. And this good is also considered love, but it has lost its base and purpose. Christian love always requires a foundation of principle that both offers good and disciplines the individual to participate in the love through mutual respect and learning. The discipline is gone without the Christianity. The love has become indulgent instead of instructive; stretched from unfulfillable promises instead of firm about what is and isn't possible. And the other real loss is the money. People did give out of love, and charity reflected that Christian principle that if you wish the best to your brother but send him away with no food you have not loved, so money was given. As we look at trying to make the government provide what only free will charity and Christian Spirit have been able to provide in the past, we have to face that it may not be possible. The government is not equipped to discipline people into those working relationships called love and mutual respect that are the backbone of charitable service institutions. The government is so impotent it can't even tell individuals who want abortions that they have to go to non-Catholic hospitals so that the hospital won't close and end health care services for multiple other purposes. It tries to tell the Catholic hospitals they have to offer abortions and then many types of health care services are lost for everyone because if Christian servants have to abandon their principles they cannot accomplish the great things that the spirit of their principles carried them to. Watch Chariots of Fire for a good character study of this principle. Since the government can not even figure out which decision works for the greater good in the simplistic case I just described, how do we ever expect its baseless decision making to really provide a structure that will successfully offer the love of physical health to the vast diversity of Americans that need it. It won't. The government cannot love the people. It can only hand out other people's money. And anyone who has given money for a cause they care about knows that they will not be satisfied to give this money to the government to decide how to distribute it. Having the government be the monetary provider of health care is like bringing back the obsolete definition of charity that meant giving money to the poor. All that will happen is the registering of dollars used in appointed places and the gathering of statistics to "prove" care was given.The people will not be healed because no one will be observing the needs and taking useful action.