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 e-patients.net 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: