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.

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.

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.