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.