Friday, March 12, 2010

7 Requirements to Pass Health Care Reform

Health Care Reform must...

1.  Be FAIR and equitable to all (no mandatory or punishments) and yet provide a safety net to those in trouble.
2.  Apply to ALL Citizens, including all government.
3.  Nnot favor big business or any special benefactor interest.
4.  Honor the patient first and push toward non-assembly line medicine.
5.  Allow complete choice of all citizens to have their lifestyles and care for their own health.
6.  Not interfere with consequences of imprudent lifestyle or unsatisfactory choices or lack of personal responsibility.
7.  Have a short implementation and not be mired down w rules.

ps, 'Dyck's 5 Steps to HCR
maybe not polished, but it fits these criteria.

Get to the cause:

Tuesday, February 23, 2010

Dyck's 5 Steps to Health Care Reform (a radical change)

Thomas Jefferson had a radical notion:  When the people are well-informed, they can be trusted to govern themselves.

This solution won't cover every contingency in our complex nation.  But, it can be the container that will hold everyone.  It meets all "7 Requirements To Pass HC Reform." It can be a new way to have affordable, available and competent health care in a nation- that actually cares!  And it spreads the burden of achieving it's many benefits equitably to all who participate in health care, including patients, practitioners, government, and corporations.  Here it is:

1.  Make equal, medical costs for people who have insurance and those who do not.  Eliminate this disparity and insurance requirements and influence.

2.  Require that if people want to lower their medical costs ( undistorted by insurance influences per #1 above) they must participate in their health care.  This means that doctors would also participate by prescribing an expensive drug only after requiring reasonable lifestyle, diet, or environmental changes first.  (instant relief and convenience costs a lot and drives this industry!) This is a primary radical change to medical practice and patient role.  This is the hinge-pin of the plan.

E.g., for a patient to demand and receive 'immediate relief' instead of consultation for a self-limiting (flu or cold) or lifestyle (reflux) condition he would be asking for the 'Cadillac' plan which would cost much more. 

3.  For people with pre-existing conditions or with catastrophic illness, or for people on Medicare or Medicaid, the government would participate.  Similar to beachfront insurance that is higher cost, this problem would be solved in the assumed higher risk insurance pool... which would carry a high cost.  This higher cost would be born by the persons requiring higher cost treatments.  For those who cannot afford this the government would be the safety net and step in to deal with this as a social problem as it does others.

4.  Retail medical insurance would be free to ensue.  Likely there would be more call for catastrophic health insurance.  And this could be supplied based on usual actuarial.

5.  Health care plans for employers:  designs can be numerous and cost efficient by transferring major responsibility for health care to the employee.  Personal education and research become important in this environment.  The capability to discern among alternative practitioners and treatments becomes important.  And this is entirely within the domain of average American and no different from selecting a competent and effective physician or consenting to tests or advice or drugs that may have adverse reactions.  This is solving problems more permanently like teaching someone to fish instead of giving them food.

This isn't so new to mainstream America, is it?  Integrative medicine got a boost of greater public awareness -- and funding -- after a landmark 1993 study. That study showed that one in three Americans had used an alternative therapy, often under the medical radar.  And none of this was 'covered' under conventional insurance.
Integrative Medicine  IM, as it's often called, depends on a partnership between the patient and the doctor, where the goal is to treat the mind, body, and spirit, all at the same time.  Well known Dr, Andrew Weil is an advocate and practitioner.  In many, if not most instances the patient will not require a physician at all.

While some of the therapies used may be nonconventional, a guiding principle within integrative medicine is to use therapies that have some high-quality evidence to support them.  But, this is under the discretion of the patient.  So, again they have responsibility for their own care.

Participatory Medicine is a new approach that encourages and expects active patient involvement in all aspects of care. It builds on the work documented at the blog, whose slogan is “Because health professionals can’t do it alone.” The group’s landmark 2007 paper “E-Patients: How They Can Help Us Heal Healthcare” tells many stories of engaged, empowered e-patients who substantially improved their own outcome and the outcomes of others by supplementing or even going beyond what their physicians alone could do.

Both PM and IM routinely make use of the not-so-available (can't talk to my doctor) mainstream Allopathic Medicine, and more accessible, less cost Alternative Medicine.  Alternative care such as Homeopathy has eluded conventional testing and understanding.  But, in spite of this, it  often has amazingly effective results at low cost AND often allow a patient to self-treat.  And it has been around over a hundred years longer than our current allopathic medicine.  Chinese medicine has been around over a thousand years more.

Let's be open to our wonderful world of resources... even if they do not cater to the propaganda of, nor support the big profit margins of the corporations milking the medical industry, e.g. drugs, insurance, law... and other benefactors, e.g. many members of Congress et al, lawyers, etc..

Don't forget about the personal aspects of Patient - Doctor experience and effectiveness.  This topic intends to honor this connection.  Please see more at Sun Magazine's Then There's the Doctors

PS, the only people who won't like this solution is the patients (only at first), doctors (at first), insurance, drug companies, lawyers, congress, other government.  So, why not do it?  Let us force Congress to start with this!

Background regarding the cause:

Saturday, January 23, 2010

Alternative Health Care - WORKS!

Alternative Health Care is Legitimate Quality Health Care.  And it works!!  More humane, costs less, not necessarily faster, takes more patient participation, makes one less dependent, many more lasting cures, many other benefits. Let's integrate!

Alternative health care is far far far far far less cost.  It often does far less harm.  Some examples are:  Homeopathy, Chinese Medicine, Vitamin Therapy, Nutrition, Visual Imaging, Hypnosis, Reflexology, Trigger Point Therapy and other manual therapies, Pilates, Prayer, Chiropractic, Shaminism, etc..  Dr. Andrew Weil has written extensively on this topic and is worth reading.  One of his early books Spontaneous Healing covers this.

But, it means most Americans have to participate in their care and learn new and fundamental truths.  It means beginning to look at health as a whole, connected to the health of the world.   It includes the whole of our body-mind-spirit.  It includes the environment the body is in and the food that fuels and grows and repairs the body.

This tack to health care does not exclude Allopathic medicine.  It simply uses it only when it makes sense to do so.  This tack is older and wiser than our conventional 'hotshot' Allopathic medicine which tries (politically and as a business) unsuccessfully to be all things to all people.  And it has been coercing and forcing it's will as a business force.  It has been deceiving and brainwashing us to believe it alone is a credible.

And although there are many awe-sum scientific breakthroughs, there have also been errors and mistakes.   For most of us there has been equally awe-sum price to pay for medical advances.  The cost is not only measured in dollars or percent of income.   The cost to us is in erosion of humane treatment, lack of access, adverse reactions, lack of care, suffering, humiliation, lack of self-determination and real choice, bewilderment with cost complexities, stress in dealing with one's illness, stress with insurance refusals and requirements, stress in dealing with the system, no patient advocate.

Get to the cause:

Thursday, January 21, 2010

Dirty Medicine

What should be treated medically?
Immediate gratification, no pain or discomfort, no changes, continue doing what I want.  These child-like attitudes are the American patient. No?
By satisfying these demands, medical and pharmaceutical industry has created a monster and gotten wealthy and powerful.
I am questioning the Need versus Convenience of many of our drugs and our procedures.  Let me explain. This may go to the heart of Health Care Reform. 
A simplified example would be if someone has reflux (and associated various symptoms).  Upon examination it is revealed a diet of excesses (coffee, alcohol, spicy, fried food, raw onions, etc.). 
Most physicians would counsel and provide a acid blocker and a flier to educate.  But, let's look more closely.  First, is the patient 'really' given an informed choice?  Is it emphasized the common sense "if something is hurting you.... Stop doing it!?"  What about the probabilities of an endoscopy ($2000+) or the Blue Pill ($3/ day forever)?  & Insurance will pay !x?*
Should this even be a medical treatment issue at all?  Drug companies love the 'spoiled brat attitude' because they can sell lots of drugs that cater to that.  They find ways to make it sound like the aspirin has been obsoleted and charge 10x or 20x the cost for not much added value.  Physicians do similar by replacing 'doing nothing- medically' (and advising lifestyle changes) with expensive procedures and drugs (maybe some self-protection too). And procedures and drugs then have their own risks and causal affects, deepening the problem.
So, I am introducing the term Value into the health care vision.  And, like the good ole days, it still appears to be the ethical responsibility of the physician to ensure the patient gets a good value and wise care.  Responsibility can be interpreted here, but in the light of our existing crippled health care system I am thinking this is a requirement.
Physicians must take the lead in educating us.  So, they must become educated.  They must know about the affects of food (& contaminants), environment, and lifestyle (& attitude) on the health of a whole body.  They must not be small minded about natural and alternative means of staying healthy.  For example, ever heard of fennel and anis seed, cumin?  These herbs can help heartburn and reflux.
Let's change the way we dish out medicine.  Push the Patient to take more responsibility for their lives by educating them.  Many common sense ideas on the Joe & Terry Graedon (Pharmacologist & Medical Anthropologist)     Show on NPR?  

Get to the cause:

Tuesday, January 19, 2010

Can We Start Over in Health Care Reform?

Trying to solve Everyone's problems will necessarily infringe on rights and create new problems.  Diagnostically, it is most sensible to isolate and determine (understand) cause.  Then treat the cause. 

If I were to begin isolation I would start with significant costs of being sick:

1.  Intervening of Insurance (a middle man who takes profit out) and which causes secondary costs of claim disputes, heavy admin requirements on everyone, illogical & unnecessary procedures, errors from complexity,  incorrect care decisions, etc..  In other words, it managing by averages to maintain profits... a business model with a captive customer base (shared monopoly?).

2.  Intervening of Pharmaceuticals which is linked to Insurances 'allowed' treatments.  Any scrutiny on the Insurance-Pharma relationship?  High profit drugs replacing older low profit drugs or non-drug therapies.  There is a constant pressure for profit and no incentive to produce and distribute cheap drugs or herbs in favor of 'faster acting' or 'more powerful' or 'without a particular side affect'.  Although these often product many adverse reactions and then can in fact exacerbate dis-ease calling for more medical treatments.  The often dubious rationale of a 'better' drug appeals to society weakness for 'immediate relief' or 'not having to change'.  So, if one smokes, over eats, eats poorly,  eats things that aggravate, has stress, etc., they can get rid of the problem symptoms with a drug.  On some level this is unethical to pander to those needs.  That is why ethics versus  profit is so important in medicine.  People are vulnerable here.  There appears to be no advocate that promotes lifestyle changes to cure disease except Alternative Care.  And Alternative Care is predominately Not Covered by Insurance.

3.  Medical treatments and equipment.  I don't understand deeply this category but read that advances in procedures and equipment are very beneficial and often reduces pain and cost.  However, I have seen that the relationship between Insurance coverage and procedure is dubious and cloaked.  For example, Medicare won't commit to paying or not paying for an MRI until after the patient receives it.  So, this category introduces the fact that patients cannot have control or even understanding of what they are being charged medically nor what will be reimbursed.  This surely is the kiss of death to any cost containment process-- no control or knowledge.

4.  People who are now sick or at risk cost a lot.  From an insurance point of view these are not the kind of policy holders desired.  Why?  Because those who must be paid are bad, and those who have no claims are good-- because we need to make money to run a large company and for our investors who want to make lots of money- as much as possible-- whatever the market will bear!

The sick and at risk are minority and represent high cost patients.  Some of these people are in need and some are not.  Some are wealthy and some are indigent.  It is obvious, as a society we must be compassionate.  We must also be wise so as not to remove consequences that instruct human behavior toward happiness and away from pain or undesirable condition.

5.  Oh, I almost forgot the ballooned costs charged to those without health care insurance to pay for the artificially lowered prices insurance companies and Medicare have coerced from medical providers.

A non-cost consequence of our medical system I call the assembly line care.  It is de-humanizing and disrespectful.  It demeans the patient and the well-intended doctor.  It places selfish motive and profits between my self determination and my health, making it stressful and often inefficient or ineffective the cure.  It introduces First Doing Harm into what was sacred.

I'm getting old and my mind has let loose of some other points I wanted to make.  But, I can still say it doesn't seem necessary for us all to suffer hardship and loss of freedom to accommodate a universal answer to an ill-defined problem.  I've mentioned several problems.  It seems they can each be tackled with a right-minded attitude.  But, these can not be tackled with selfish-mindedness or greed.

Who among us can see with integrity-- without selfish motive (including me)?
LA Times Opinion, What does it mean to start over in healthcare? 

Monday, January 11, 2010

A Congressional Draft

Get to the cause:

Congressional Draft is a new concept where citizens are called upon to serve in the legislative branch of government.  If confirmed they would serve their country for 2 or 3 years as a representative Of The People.  This would function similar to our system of jury duty.  Draftees would be paid adequately.  They would be covered by reasonable public benefits.  They would go through a brief training prior to serving. 

The PROS:  direct citizen involvement in our government, enhance citizen education and vitality, less chance of war, less tolerance for corruption or ineptitude, no campaigns, no more prima donas who are immune from their own legislation, little or no more big business influences and coercion, no more career self-centered motivation, less legislation, fewer lucrative government retirement packages, much less government expense, etc. etc. etc..  There would be a shift away from the legislation approach to solving all problems.  The People's dependence on government would lessen.  A return of a more free market system would be enhanced.  Save our Democracy from historical fate.

The CONS:  citizen sacrifice to serve, it will be an arduous and dirty fight by our existing, self centered legislative branch of government. 

Some PROBLEMS to solve:  Develop the idea and engage the public.  Likely basic shift away from legislative approach to all problems.  Who would have the leadership and energy and power and vision and knowledge and integrity and funding to spearhead this effort? (I would volunteer, but I may be missing a few requirements.)

No matter how you feel... tell it...  start a dialogue!

"Not rule of majority. Protection of the minority."

Get to the cause:

OK, this is one of the few political things in my life (sorry, but Health Care Reform is important to me).   I want to engage with others and find a way to our representatives.   If I can't find a way to help them represent me, I want to eliminate them... are you with me on this?  I realize there are many interests and that we live in what we like to call a democracy. 
Abraham Lincoln described Democracy as "Not rule of majority. Protection of the minority."   "I would not be a slave.  SO, I would not own one.  This embodies my idea of Democracy."

Congress Duality:  (they) want to spread mandatory health care insurance cost to the healthy to make it less cost to the unhealthy.  And among the more basic things this is devoid of improvements in Patient-Doctor effectiveness or caring, and it completely ignores the foundations of good health (prevention).   This is such a mess when there isn't acknowledged in our government leadership (or the public?) a Connection of the Health to food we eat, a healthy earth environment, life styles we choose.   
What about those who need help?  How does freedom and charity co-exist?  Is it best to just Give or to Educate?  These are some of the serious questions to engage in personally, and collectively.
And, beyond all this, with the feathers flying, Congress remains immune?  I really feel sympathy for Congress.  They don't have to contend with problems of retirement systems, social security, medicare or healthcare systems of the working class.  They have their own.  But, they must earn those priviliages.  They must please the giant powerful lobbies who get them elected and line up big favors.  They must find ways to perpetuate legislation that will assure the advancement and supremacy of the legal professions. They must maintain a public image that doesn't get their constituents mad or tarnish themselves publicly.  And they must try to say and do what sounds & looks like sweetness to all ears.  Surely an impossible job!

A following Blog explains how we can "get rid of Congress".