The following exchange is from Dialogue Group 11, Thread 16.

1. Health Care
Tue, Dec 29, 1998 - 1:23 PM/EST
senryu

I had an idea this morning, kind of a radical one, and it wouldn't address short term needs, but tell me what you think.

What if control of our own health care meant we could administer care to ourselves and our families when necessary and practical? I don't imagine the typical doctor is some sort of "ubermensch" who has a special, rare ability to understand the arcane mysteries of medicine. You or I could train to be doctors, if we had the motivation and the access to medical schools.

But it's not necessary to be doctors to understand and treat some minor illnesses, perform first aid, or make a tentative diagnosis based on symptoms. We do it every day, every time we treat a yeast infection with over-the-counter meds, bandage our kid's soccer injury, or say, "Gee, you better have that cough seen about."

What if we could institute an reasonable education program of some sort, to teach kids how to take care of themselves physically and psychologically? It might start with Sesame-Street-style basics (toothbrushing, baths, self-esteem, appropriate touching, safe and not-safe to eat, how to take care of a skinned knee, for example) in kindergarten and the earliest grades. Third and fourth grades might learn how to express their symptoms to a doctor, basic reproductive health and what to expect from puberty, and basic infant and child care. Older children could learn to recognize symptoms of food poisoning, pregnancy, allergic reactions, depression/anxiety, and addiction, and how and when to get a qualified doctor, and so forth. The average high school graduate ought to be well acquainted with the most basic principles of pathology, pharmacy, and psychology, and with strategies for dealing with common problems.

Making sure that the average citizen is well-informed and prepared would:

1) Reduce the danger of being uninsured, by empowering people to better take care of their own health
2) Minimize complications of minor ailments, since they are more likely to be taken care of properly before they have time to develop complications
3) Reduce the number of accident deaths where "nobody knew what to do"
4) Relieve some of the burden of minor cases on doctors and hospitals, freeing time and resources for major cases and research
5) Demystify medicines and cause less people to fall for "snake-oil" claims and fake therapies, and
6) Allow people to make better, calmer decisions when faced with major health issues.

I'm sure you could think of more, but I have to get back to work now :)

Peace...

2. Health Care
Wed, Dec 30, 1998 - 7:21 AM/EST
Marnikno

My first point has to be that I am not one of those people who cares who or how others make money as long as I can take care of me and mine. This is an important point as some are just jealous of the incomes of health care professionals so no real discussion takes placeI have worked in health care in one capacity or another since I was 17, that's over 30 years. When I started, docs still made house calls and everyone did have coverage because you paid the doctor last..and on a monthly arrangement if you couldn't afford to pay at the time of service. I watched the salaries rise and yes, some were and are unwarranted. But at this time, the cost to administer a medical office is ridiculous. I happen to work for someone who takes all patients which means our "write offs" are exhorbitant. We almost went out of business as the reimbursement continues to slide downward but the labor to obtain payment increases exponentially. Has anyone noticed that the insurance carriers are the only ones who gets more in premiums, pay less out and has huge, huge profits?
No, we concentrate on these "fraudulent" practices etc. and they get away limiting services and telling us what to do. In answer to education, many carriers now have lines where nurses, PA's are available to help us so cost is reduced. Unfortunately, this is another way they use to decide what services are not "medically necessary." HMO's/national health insurance, what is the difference? They all restrict service, reimbursement and put the money in the wrong pocket. While we live in fear of national health insurance because of the coverage limits etc. I'm not sure at this point it would be worse than the multitude of policies we are handling, all of which are different, all of which require pre-approval etc. before treatment is delivered and then they hold up payment for 90+ after it is delivered. This isn't as succinct as I wanted but you get my drift.

3. Health Care For All!
Wed, Dec 30, 1998 - 8:00 PM/EST
MAYORBOB

I like the basis of Senryu's proposal that we approach the goal of a more health conscious society through education...beginning at an early age and progressively instilling in young peoples' minds an awareness and appreciation for healthcare. I am not a healthcare worker myself, but I am married to a healthcare professional. However, like most of us, one of my major chores is sifting through the plethora of plans to select the one that meets my main criteria of covering most of my families medical needs at a cost which will not drive me into Chapter 13.

Just a few thoughts on education as a vehicle to accomplish this. First, I believe that the longest lived lessons we learn in life, we learn from family -- mother, father, brother, sister, aunt, uncle, grandparent, etc. Due to the fact that we are discussing extremely personal, intimate areas of knowledge (e.g., what is happening to our bodies), these are areas which should be the primary province of the home to deal with. Second, anytime you turn to the schools to carry out a comprehensive educational program such as this you are entering the hornet's nest of politics (particularly when you get to areas of sexual education and hygiene).

I agree with Marnikno, we should live in less fear of national health insurance and be a little more wary of how the "magic of the marketplace" will tend to crowd out the sick and only end up servicing the affluent.

4. One solution to healthcare expense
Wed, Dec 30, 1998 - 9:18 PM/EST
Jamest

Is healthcare the only service we demand the best? I mean, when is the last time you took your loved one to the emergency room or clinic and said, "Please, just give him the third best possible care."? We don't do that. Medical treatment will always be expensive because we all want the best for ourselves and our loved ones.

Eventually, no matter which plan our society adopts, less choices, limitations and/or rationing will be part of the solution.

Too bad.

5. Interesting topic; tough problems
Wed, Dec 30, 1998 - 11:17 PM/EST
Larry W.

Thanks for starting the dialogue on health care. As someone who contracted Legionnaire's Disease two years ago and is still struggling with complications (asthma, frequent respiratory infections, suppressed immune system), I am acutely aware that our nation's health care system has problems.

In my case, I received inadequate care for the first two months of my illness. Three factors combined to create my long-term problems: my doctors' current reliance on antibiotics to treat illnesses, their arrogance about their craft, and the pressure from insurance companies to move patients through the process. In my case, I was originally diagnosed with a "common" form of pneumonia after a 5-minute exam and given a standard antibiotic. Even after 9 days, when my temperature rose to 105 and my blood pressure had all but disappeared, my doctor's solution was to keep me hydrated and send me home with a prescription for a stronger antibiotic. For two months, none of the doctors I saw--even the pulmonary specialists--ever suggested a diagnostic culture. I finally found a "caring doctor" (mid-50s, female, wheel-chair-bound) who listened to my story, looked through my inch-thick file, and immediately ordered a range of diagnostic tests. The test results showed that successive bouts of pneumonia and bronchitis had given way to fungal pneumonia (apparently encouraged by the high doses of antibiotics). Working together, my new doctor and I finally stabilized my condition, then got me on a new diet, inhalers, and vitamins. I haven't felt so good in years. Unfortunately, the health care service I use is so near bankruptcy and so understaffed that I have to pay the emergency care fees out of my own pocket if I want to see the doctor I trust.

I believe that sorting out the health care crisis is more than just where the funds come from. It requires changes by the medical community in their understanding of health and their role. Sometimes patients need more than a cursory look and a prescription for amoxycilin. That was true in my case, but until I found a doctor who would listen, I got the 5-minute bum's rush. The only part of the file most of the doctors looked at was the prescription page.

Also required are changes in the insurance companies' notion of what constitutes health care. I can afford to spend out of pocket a couple of dollars per day for the vitamins and minerals that stabilize my immune and respiratory systems. If I couldn't, I'd just have to get sick and leave it to my employer and insurance company to foot the medical and leave bills. It sounds dumb....

Also needed are changes by the public in our attitudes toward health, as some of you suggested. As I've learned, we have to become experts in our own health and health problems. The web is a powerful learning tool, even though there is a lot of wacky stuff out there. I've used it for my recent health care problems and when my daughter had kidney failure 5 years ago.

My illness has given me the chance to get to know a number of doctors. The ones I've talked with are a fustrated group, pressured to know more and do more, all the while dealing with insurance companies looking over their shoulders. I thank them every chance I get, for making the decision to practice medicine. They tell me that the economic rewards are not there as they used to be. And I talk with them about the need for reform at all levels, from the organization of the facilities where they work all the way to how the nation funds its health care.

I am still waiting to meet someone from an insurance company who can explain why their industry operates as its does......


Larry

6. Insurance perspective?
Thu, Dec 31, 1998 - 7:28 AM/EST
Pat B.

I'm not sure I can respond for the entire industry and I don't work in Medical insurance (I work in the Property and Casualty side--homes and cars), but I'll try.

While we prefer to think of those in the medical industry as healers, they are also small businesspersons. If you look at the for profit hospitals, you see it is not "small". The physicians who are in private practice are operating a small business and all of the headaches associated with it.

Insurance Companies are also a for profit business and they are trying to maximize that profit for their stockholders. In order to know what their exposure to loss will be and therefore how much to charge and still make a profit, the companies write a contract to limit what they will pay. Most people don't read their insurance policy and so their expectation of the coverage is much higher than what the policy is intended to be.

All of that to say that I think it is the "profit motive" that is causing the current problems. If that were eliminated, then the primary concern would be on the health of the patient. I don't mean to say that healthcare professionals don't care about their patients--they do and even the physicians Larry went to had in their minds to give the best care they could, but they were also driven by administrative costs. The insurance companies "care" about the patient too, as much as the claims person can, but are limited by the policy which was written and priced to maximize the profit for the stockholder.

My suggestion is to nationalize healthcare. Educating our youth is a significant part of that program, but going further is needed now.

I'm not sure I would offer that same solution to my side of the business---is that hypocritcal?

7. Nationalizing Healthcare
Thu, Dec 31, 1998 - 10:19 AM/EST
Jamest

Pat B. Thank you for your post. Sometimes we look at the profit motive as something evil. Profit is what makes America what it is. We should all want to see companies become and remain profitable. It gives them the option of expanding and creating jobs which in turn increases tax revenues which keeps our schools and roads open.

Excessive profits is another story of course.

9. Healthcare "crisis"... one provider's thoughts
Fri, Jan 1, 1999 - 9:07 PM/EST
lagniappeman

I have enjoyed the thoughts from other members, and I share the concern and the frustration.

As a doctor (if you can call a surgeon a doctor) practicing in a small town in the south, I have seen the best of government funded healthcare, and its inadequacies. I have also seen abuse of the system by the rich and the poor, leading to overuse of expensive technology, unnecessary treatments, and the resultant cost burden which we all share. We all share in this because most of us pay taxes, and most of us pay for insurance.
Essentially no other payors exist, because very few of us pay for our healthcare as we need it, though virtually every other service we procure is paid for as the need arises.

Real reform will require many of the elements mentioned in previous postings, but I feel that there are a few key features:

1) Education! Education! Education!
Most of our chronic illnesses are brought on
by, or worsened by behaviours that we can
control (smoking, drinking, sedentary lifestyle
and obesity)
Most disabilities and accidental deaths are
preventable.
Most unavoidable acute illnesses (colds,rashes,
headaches, etc) can be treated with common
sense and commonly available over-the-counter
remedies.

2) Responsibility!Responsibility!Responsibility!
Since we all pay premiums and we all pay taxes,
we all think that we should be able to use as
much healthcare service as we want! Only a
small proportion of what gets paid to
providers comes from out of our pockets, so
the incentive to be conservative just ain't
there. In fact, we have "drive-up window"
expectations when we go to see doctors or
seek care at hospitals. Sometimes my hardest
task is explaining why an x-ray will not help
us, or why an antibiotic may do more harm
than good! But the patient wants it, and they
"by golly" have paid their premiums.



I think that establishing a single payor (national health insurance) would be an improvement over what we have now because it will standardize payments/benefits so that providers and consumers (oops! patients!) will have realistic expectations without the confusion that accompanies the current system of thousands of payors.

The MOST ATTRACTIVE PROPOSALS, however, are the programs that encourage people to become responsible for their own payments. Tax incentives for establishing a medical savings account should receive more attention. Tax incentives favoring mortgage interest have provided unmatched economic stimuli (not just in home construction, but consumer spending in general via home equity accounts!)

We will be shed of the crisis when we learn to take better care of ourselves, and become directly responsible for payment of our costs.