The alleged reformation of our "broken" health care system has received unparalleled political attention over the last few years. This issue has generated debate between politicians and other politicians in Washington DC, along with conversation between people from "Wall Street to Main Street" (to borrow from one of the campaign slogans of our chief of the executive branch). When the President signed the health care "overhaul" bill into law in late May 2010, confusion and uncertainty were the predominant feelings among US citizens, relating to the unclear, behind-closed-doors approach legislators took in creating this thousands-of-pages of perceived red tape. Much of the country is polarized about the issue. However, this heap of legislation has not been defined; its true essence remains rather ineffable.
The key elements to creating meaningful change to the U.S. health care system -- physicians and nurses -- were overlooked. Instead, out of touch, deal-making politicians (over 95 percent of whom are lawyers by training and unaware of the health care system's modus operandi) acted as the impetus for change. Our president alluded to physician support of his health care bill, claiming it was backed by the American Medical Association (AMA); the truth is that less than one-theird of physicians are members of the AMA and even this non-representative organization was outraged at the President's lack of willingness to consider tort reform, (his July 2009 speech at AMA headquarters in Chicago received a flock of boos). United States citizens have been continuously deceived by a leader very skilled in the practice of rhetoric (rivaling the rhetorical dexterity of any leader in modern history).
One thing needs to be cleared up before we go further: the United States has the best quality of health care in the world. However, this quality of care exists in a problematic system. The politicized numbers that have depicted U.S. health care as mediocre are tools of propaganda used to promote a political agenda. In reality, physicians come from all over the world to participate in residency programs in the United States in order to learn how all fields of medicine are practiced. The standards of medical care and expectations of quality are second to no other country in the world.
The World Health Organization (WHO) ranking system skews this picture, which is why the United States received a lower-than-is-reality ranking. For example, the WHO uses infant mortality as a key ranking figure. Very few countries in the world attempt the number and degree of high risk births as the United States. When our obstetricians are attempting 22 week deliveries of fetuses (38-42 weeks is normal gestation), there will certainly be a degree of morbidity and mortality associated with this practice, accounting for the low rankings in this weighted field.
Additionally, very few other countries in the world assume the care of anyone brought into the hospital (emergency departments in the United States are at this interface), including indigent patients of all varieties (homeless, jobless, criminals, drug addicts, and non U.S. citizens). Lack of ability to pay does not matter in the United States emergency room (which will be addressed later). This practice of treating all patients hurt the U.S. in WHO cost-efficiency ratings. Nonetheless, physicians in the United States are pioneers, innovators, and the force that drives the greatest health care engine in the world.
Experience in the trenches on the front lines of medical practice, together with communication between various levels of health care workers, has revealed four key areas that must be elucidated to provide for continued amelioration of the U.S. health care system. Attention to these areas could also create a great deal of cost-cutting. The crippling effect the medical-legal system has on health care in the United Sates is the number one issue.
Next, the U.S. population is the unhealthiest population in the world, which manifests as exorbitant health care cost through a protean number of related diseases. Thirdly, the ever expansive social welfare state further puts Federal accounts and balances into the far negative. Lastly (and probably least important in terms of health care cost), the solution to provide increasing insurance coverage through Federal means will be debunked by the above oversights and as a result, compromise health care.
http://www.healthcare-now.org/newly-formed-150000-strong-nurses%E2%80%99-union-pushes-for-single-payer-healthcare/
I don't see a lot of solutions here. I don't share your perception that U.S. care is being represented as "mediocre". Instead, it's too expensive, and not available to everyone. (Rule #1, if we're going to price some people out of getting medical care, then we need to eliminate the requirement that only a physician can authorize access to prescriptions. Otherwise, I'm in favor of indigent patients holding up pharmacies.)
The part about emergency rooms is a bit glib. They have to stabilize, but not cure. Once the patient is stabilized, they can call a cab and discharge the patient in cardboard box homes alley.
Other patients are sentenced to death for inability to pay, as shown in this 60 minutes segment.
http://www.cbsnews.com/stories/2009/04/03/60minutes/main4917055.shtml
We're paying 50% more per capita than what is paid in other industrial countries, and yet everyone is not covered. We should have done what Ross Perot said to do, and check out the other industrial countries, and copy the best health system being used among them. We're getting price gouged.
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I read the article with interest. Yet I found the major thrust confusing. While praising the system as "best quality of health care in the world", the author goes on to outline its major pitfalls and uses them as excuses for the shortcomings.
The above comment is most pertinent, because it is symptomatic of the multi-faceted and interrelated problems we face in healthcare. The above occurs because we use hospitals and healthcare to address social issues. Something similar has occurred with our educational system.
Hence, we use high technology hospitals, staffed by highly skilled medical professionals, to deliver high cost medical care to address social problems. A major reason for this approach is because all these medical services are individually paid for irrespective of their need or outcomes. Our "private enterprise" healthcare delivery system (doctors and hospitals) 'love' the current set-up and does little to remedy it.
Now one gets an idea why cost of healthcare per person is 30%-50% that in other countries.
Hey, buddy, I guess you must be one of those "death panels" advocates. Don't you know that the Good Book says we need to spend a trillion dollars to prolong a persons life 2 months?
That said, there is a second reason why our health care prices is skyrocketing. And, that is the pricing structure in health coverage, which encourages unhealthy lifestyles. At my work, I'm seeing adult onset diabetes II patients devouring pizza, double cheeseburgers, wings and fries, and cheesecakes, and so forth. Not all for sure. But, a majority of this class at my place of employment considers dietary changes off the table, and the rest of us are absorbing medical costs to deal with the symptoms of their diet, while the root cause, namely reducing saturated fat and total calories remains off the table.
The health reform tries to make no distinction for pre-existing conditions. That makes sense for things like cancer, because we in the aggregate elect politicians who support air pollution and, while we test pesticides individually, we don't test synergies among pesticides, but subsidizing consumption of pizza, ice cream, cheesecake, double cheeseburgers, and the like, - well, we won't turn around the inflation in health care so long as we're doing that. Food is the primary medicine. So long as the emphasis is on a pill, we're going to pay.
50 million AMERICANS uninsured. Millions more under insured. Health care cost out of control. Health insurance monopolies expanding. Fact health care cost are going to bankrupt the country.
Who cares how great American health care is if no one can afford it. Porsche 911 is a great car but who can afford it?
Wake up!
The mediocre reputation comes from the fact that medicine can’t tell us a lot about what is going on with our health or what causes Autism, MS, FM, Lupus, Alzheimer’s, Scleroderma and many more diseases that are likely being caused by the a number of toxics we are bombarded with on a daily basis including many that are injected into us or taken orally. Main Stream Medicine treats the symptoms of these diseases it does not cure or prevent them. One can only guess why; perhaps these chronic diseases bring billions in profits to big PhARMA and doctors.
“The crippling effect the medical-legal system has on health care in the United Sates is the number one issue.”
This can be easily remedied by self policing incompetent doctors and making the reporting of adverse events mandatory. You have your profession to blame for the legal problems you have. I can only hope it gets worse for you because that means it will get better for patients.
"Nonetheless, physicians in the United States are pioneers, innovators, and the force that drives the greatest health care engine in the world."
Most physicians in my opinion in the US are afraid to step out of the box and/or are in bed with big PhARMA. They treat symptoms and promote procedures vs. prevention and cure.
Comments on the medical legal system will be further elucidated in the next post.
The truth is a high percentage of diseases are man-made including doctor-made as in Nephrogenic Systemic Fibroisis (NSF) or Gadolinium Assoicated Systemic Fibroisis (GASF). Let's see how medicine gets out of this one. Instead of looking at this disease as a teaching moment as to what heavy metals do to us when they enter the body medicine is trying to mimimize the disease saying it has gone away. Yet we are only beginning to understand what is happening after 300M doses of gadolinium based contrasting agents GBCAs since the late 80s have been administered. Explain to me how retaining 1% of these doses of GBCAs in the bone are good for us? And explain to me why are they finding gadolinium in the reproductive organs of women of childbearing years long after it should have been chelated out of the body?
You can write all all the posts you want but you are missing the point that most that post here understand; that is there is something terribly wrong with the way medicine is practiced in this country and it has nothing to do with legal costs.
Politicians continue to amaze me with their lack of insight.
1) Lawyers
2) Unhealthy Patients
3) Too many welfare people with access to health care
4) That any over site by a medical provider's peers, HHS, CDC, etc. would compromise health care.
Instead of :
1) Ensuring medical errors don't happen in the first place
2) Preventative care and resolution before medical issues require Hospitalization
3) Trying to cover all Americans
4) Requiring that Americans receive an adequate and competent level of Health care.
Well you didn't convince me.
Now the government has predicted the future, because of that, investors can invest and innovators can innovate. Now the home medical office is a reality.
References
EHR http://en.wikipedia.org/wiki/Electronic_health_record
XML http://en.wikipedia.org/wiki/XML
XML schema http://en.wikipedia.org/wiki/XML_schema
XForms http://en.wikipedia.org/wiki/Xforms
web-services http://en.wikipedia.org/wiki/Web_service
IETM Class V http://en.wikipedia.org/wiki/IETM
DITA http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture
A presentation by IBM using DITA
IBM http://dita.xml.org/sites/dita.xml.org/files/IDCMSBlue.pdf
Cloud Computing http://en.wikipedia.org/wiki/Cloud_computing
SaaS http://en.wikipedia.org/wiki/Software_as_a_service
An excellent article from a Brookings Institute Study from a medical standpoint http://www.brookings.edu/reports/2009/0901_btc.aspx
Interesting topic with lots of gray areas to explore. Can you explain why if we have the best health care and we pay more than twice as much, American docs are paid much more than those in other countries and yet we die sooner than those in Canada and some other countries? Wouldn't the best health system effectively prevent illness?
And if we are the unhealthiest people in the world, does that explain why we are the most medicated people in the world? Or are all the medications Americans take simply making it less likely that Americans will change their lifestyles to become more healthy?
Do you have any sources you could point me to for that claim that we are the most unhealthy? I'd be very interested to see how that data was structured and analyzed.
The unhealthiness measure was a function of the world obesity statistics from numerous sources (just google world obesity statistics 2010) showing the US to lead the world in this category. A future post will portray the extent to which obesity creates morbidity and morbidity in increases health care costs.
Your questions in the third paragraph answer themselves. Medications are given to treat disease, which for the most part make people in the US less inclined to change their lifestyles. Why put forth effort to fight the obesity epidemic when its manifestations can be temporarily quelled with pills?
The system needed corrections, granted. But not this way, agreed.
My approach to the broken health-care system is primary prevention - avoiding the development of disease in the first place, thus also avoiding the medical community, except in the case of accidents or injury. Primary prevention is an anathema to the medical business model, so it is not taught in medical school. In fact, it is not even a recognized discipline.
The medical community has coined the term "preventive medicine," which I view as an oxymoron invented by BigPharma to sell drugs. Why would anyone need medicine or the medical community to prevent illness? After all, if primary prevention was successful, medical schools, doctor's offices, medical insurance companies, pharmaceutical companies, and hospitals would become ghost towns.
So, who do you look to for answers on how to stay healthy? I chose nature. Some people still remember her - she evolved us. My research in the fields of primatology, paleopathology, evolutionary biology, anthropology, and zoopharmacognosy (animal self healing) yielded a wellness plan designed by nature to maintain our species at the peak of health. One example of such a plan, with references, can be found in "The Wellness Project."
Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization
I would like to give you a heads up. I believe what you are say. Did you know that the FDA recently came out with a black box warning regarding gadolinium based contrasting agents (GBCAs) used with MRIs, MRAs and sometimes with CT scans? And then they came out with a stricter warning of three of the brands, Omniscan (GE), Optimark (?) and Magnevist (Bayer). Gadolinium is a toxic-heavy metal and 1% of each bolus dose stays in the bones. And it’s causing a new disease called Nephrogenic Systemic Fibrosis or Gadolinium Associated Systemic Fibrosis. Three-hundred million of these doses have been administered worldwide since the late 80s and it is being found in the reproductive organs of women of childbearing years long after it should have been gone. I personally think that this is going to be an emerging disease and the toxic affects of these highly-toxic injections are only beginning to be understood. This represents medicine at it’s darkest for sure. I do hope that more people learn about this disease and that it doesn’t get covered up. You do not need to be renal impaired to get this disease. You only need to have AKI at the time of the exam which is a common occurrence.
Again thanks Roy for your post.
I am familiar with the gadolinium debacle, and have been looking for some non-toxic natural compounds that can bind with it for removal from the body. The closest I have come is some anecdotal reports, supported by urine tests, showing a particular form of zeolite dramatically increases gadolinium excretion. Google search: acz nano gadolinium .