Prescription For America
The election of Barack Obama brought with it a major shift in consciousness. A quiet revolution. President-elect Obama has stated his priorities as: 1) the economy, 2) energy and fuel independence, and 3) healthcare. The night after the election, I began writing down ideas that I hope will be useful when it's time to change healthcare.
Healing healthcare is not simply a matter of funding. A new healthcare system requires an understanding of the politics of medicine, medical education, disease vs. wellness, an understanding of why people get sick… and so much more.
I was chatting with a cardiologist at a Christmas party last year, both of us bemoaning the fate of our profession. My friend said, “People are trying to change medicine as if it is a business. It's not a business. It's a profession, a calling.” Medicine, as a calling, has been dismantled. Doctors enter their training with a passion for healing, but medical school destroys the natural urge to heal, then buries doctors in paperwork and regulations, leading to higher costs and less time with patients.
A New Vision
Before plunging into the great task of financing healthcare, a new vision must be brought into focus. We can compare the future changes in healthcare to the process of change in Energy and Transportation. We have a vision that one day we will be driving cars that do not rely on oil. We want to be energy independent, and we know that no matter how far and deep we look for oil, those supplies have been dramatically tapped, and will eventually run out. So, there is a long-term vision of oil-free transportation. We will go through many stages on our way to oil-free transportation, starting with hybrid cars. Without the long-term vision, there cannot be change. Many intermediate steps must be taken on the way to the final goal.
The long-term vision for healthcare includes:
1. Affordable healthcare for all.
2. Rapid access to healthcare.
3. Disease prevention as a goal, and not just disease treatment.
4. Healthcare decisions that are not driven by anyone other than our healthcare providers – our doctors, acupuncturists, etc.
5. An honest assessment of ALL healing modalities to determine which treatments are effective for which particular symptoms and diseases . . . and which treatments are either dangerous or no better than placebo.
6. A fully integrated merging of the world's healing modalities, with mutual respect. While Democrats “rule” Washington for awhile, and then Republicans, in healthcare, conventional medicine has held complete power for about 100 years.
A paper published by Harvard's Dr. Daniel Eisenberg in 1993 signaled an alarm to established medicine. The report showed that in 1990, there were 425 million visits to alternative practitioners, and 388 million visits to all primary care physicians. This reality forced medicine to open up to other possibilities, or simply be swept away and become a piece of history.
While developing and maintaining a long-term vision, short-term emergency measures must be taken. Just as fossil fuels will remain part of the energy equation for decades, medical doctors will remain the driving force in healthcare in the new prescription for America.
A critical step in revolutionizing and humanizing healthcare is to look at some data on cost:
1. In 2000, Health costs were $1.3 trillion.
2. In 2006, Health spending exceeded $2.1 trillion, representing 16% of the GDP (gross domestic product). Health spending had nearly doubled in just 6 years, and in 2008, that figure is projected to be $2.4 trillion.
3. In 1960, healthcare costs, as a percentage of GDP was 5.2%.
4. About half of spending growth is due to medical price inflation — the rising cost of providing existing services to patients. A far smaller portion is due to aging.
5. Nearly one in five out-of-pocket dollars is spent on prescription drugs.
6. If unchecked, health care expenditures are projected to represent 19.5% of the United States gross domestic product by 2017.
7. In 2006, 46% of healthcare was paid by the government, and not the private sector.
8. Per capita spending (each person) was $7,026.
9. While health costs account for 16% of all costs in America, a study of other countries, showed the following health cost percentages:
a. Switzerland: 11%
b. Norway, France, Germany 9%
c. UK, Sweden, Italy 7 - 8%
d. Spain 6%
10. Breakdown of health expense by sector:
a. Household 31%
b. Private Business 25%
c. Local and State Govt. 17%
d. Federal Govt. 23%
Who Holds the Power?
Beyond the question, “What is good healthcare and how do we provide it to everyone?” we need to understand who holds the power. Nobody gives up power voluntarily, without a struggle. While we hold the hope and the vision of “ideal health and ideal healthcare,” we must be aware of who stands to gain financially, and who holds the power. Those with power must be part of the equation. They are not simply going to walk away. We will have a great healthcare system, and it will arrive one way or the other. Those in power will be brought to the table, but they will not be allowed to “own the table.”
The “power brokers” of American medicine are:
1. The Pharmaceutical Industry.
2. AMA, American Medical Association.
3. FDA, Food and Drug Administration, which sets the rules about how new drugs approved.
4. State Medical Boards.
Unless the power of these four groups is broken, healthcare will not be healed. It will simply morph. The Pharmaceutical Industry holds the most power, putting on the conferences that educate doctors, and putting money in the hands of our congressmen. Because this industry is big money, the media and many politicians have a lot of money invested in the pharmaceutical industry.
The AMA came into existence about a hundred years ago with a specific goal”— to wipe out homeopathy. In the 1800's, one-third of the medical schools in America were homeopathic. The AMA succeeded totally and completely, in wiping out homeopathy. Mission accomplished.
While the FDA approves and regulates drugs, the Office of Management Budget (OMG) has determined that 25% of all drugs in US pharmacopeias don't work. It is FDA philosophy that “drugs cure.” Nutritional supplements and herbs are not believed to work, in general FDA policy. If you ingested something and it helped you, it was a drug! They can't make money on herbs and they believe that only drugs work.
I will write some things that sound too ridiculous to believe, and this is one of them. If an herb is believed to have some benefit, a pharmaceutical company may decide to turn it into a drug.
They will analyze the dozens of components in that herb, determine which is the most potent ingredient, and will then synthesize that component artificially.
It costs the pharmaceutical industry $500 million to bring one drug to market, which means they need to be very selective about where they focus, and then they need to pour enormous amounts of money into advertising and marketing a new drug.
The FDA does not understand that the benefits of an herb lie in the synergy of all the various components, and not in one single ingredient. One thing I recommend about the FDA is to divide it into two agencies. It is absurd that this one agency governs both food and drugs, two critical aspects of life that should not be lumped together.
With this FDA'“herb” issue you can see that mainstream medicine does not see health the same way Complementary and Alternative (CAM) practitioners see things.
The FDA and Pharmaceutical industry determine “what heals,” ignore the 25% of drugs that do not work, and block the admission of natural approaches, that are usually less expensive than medications.
The State Medical Boards were set up to police medicine, find doctors whose behavior or competence is questionable, and discipline those found guilty. Nobody wants to write about the medical boards. They fund their departments by fining doctors. At least half of serious prosecution by medical boards is against a doctor who did not “chart correctly.”
He failed to write in the chart that he did a physical, wrote a prescription, or anything else. Failure to “Treat the Chart Correctly” is the main reason doctors are disciplined. Incorrect charting can cost a doctor his license and easily cost him $100,000 - $200,000 or more in fines and legal fees. Medical boards appear to be “catching bad doctors and protecting the public from them.”
It is fair to say that the 50 state medical boards are renegade agencies that exist outside the US judicial system in the same way that Guantanamo Bay exists outside the US judicial system. The medical board bankrupts doctors with legal fees, so that most doctors never actually have a legal hearing “within the medical board system.” They are broke and end up making a settlement with the board. Only rich doctors (mainly ophthalmologists, radiologists, and plastic surgeons) can afford to fight the board.
If a doctor has the funds, which easily runs up to several hundred thousand dollars quickly (in penalties and legal fees), eventually he or she can have a hearing with the supreme court of that state, which is the first time he is able to step out of the clandestine workings of medical board justice . . . into the state justice system. It can take 5 – 7 years to have a day in a U.S. court – the California Supreme Court.
A major job of medical boards is to make sure that the status quo does not change, and to try to eliminate alternative health the way the AMA demolished homeopathy. Right now, 80% of holistic or CAM doctors in New York State are under investigation by the medical board – for being “alternative.”
In North Carolina, if a doctor orders a hair analysis test for heavy metals…or a blood test for food allergies, that order is a red flag that is reported and begins an investigation.
New York State has outlawed 3 or 4 nutritional/metabolic tests, including a blood test for food allergies, parts of the comprehensive digestive stool analysis, hair analysis, and a urine test for organic acids. One highly respected CAM doctor, and a terrific author, lost his license last year for ordering 2 of the lab tests listed above.
The Right to HealthCare
President-Elect Obama must understand the powers (and abuse of power) that govern healthcare. We have a healthcare crisis that requires that initial changes be made within the existing structure, bad as it is, so that everyone has affordable healthcare.
No one should be turned away from an emergency room, or refused necessary treatment. In this regard, I will offer just a couple of suggestions and observations.
1. I believe healthcare is a right and not a privilege. While Canada, the UK, and France have nationalized healthcare with a number of problems, while waiting lists may be long, treatment is regarded as a birthright.
2. A doctor's calling, as put forth by Hippocrates, is a sacred bond between doctor and patient. It is not primarily a financial relationship.
3. I believe that managed care has played a large role in the explosion of costs. When I entered private practice 30 years ago, there were a handful of insurance companies, and doctors and hospitals did not have to deal with any intermediaries.
If it were in my power, I would dissolve the managed care system. Since managed care is not going to go away, I favor consolidating, decreasing the numbers of the thousands of PPO's and HMO's, and divert dollars away from large payments made to managed care CEO's.
However the details are worked out, the first priority that a new administration will face is how to minimize cost, and provide healthcare, as we currently know it, to all…at a reasonable price.
A New HealthCare Committee
We cannot move forward in healthcare if the AMA, FDA, pharmaceutical industry, and state medical boards make all the decisions. A bold leap into the future, into an honest healing model, requires that the best minds from ALL healing modalities come together.
We need to dare to step beyond the idea that Western Medicine is the“real” medicine and everything else is”“alternative.” We need an advisory committee consisting of MD's, PhD, Doctors of Oriental Medicine, Homeopaths, Ayurvedic Practitioners, Chiropractors, specialists in Mind-Body Medicine, and others.
Each healthcare system has a different idea about what causes illness and what cures illness. We need to become pragmatic about all modalities, discarding aspects of western medicine that don't work or that are harmful, and identifying the areas in which it is the most effective. We need to look at the scientific data in each modality, as well as underlying philosophies.
Comprehensive research of any modality needs to analyze benefits and risks for: 1) disease and treatment, 2) symptom relief, and 3) effect on the “process” that causes disease.
If a person with any kind of mental/emotional problem sees five psychiatrists, he is likely to get five different diagnoses. If you've had a chronic illness for years or decades, you have received quite a number of different diagnoses. If doctors have a hard time agreeing what to do with a single patient, think of the complexity that awaits President-Elect Obama!
This article, which is the first in a series, is my attempt to start thinking about healthcare ahead of its time. The new president will have other priorities, with healthcare being his third priority. But, once healthcare is a high priority, it must be understood that simply coming up with more money cannot solve healthcare problems. First, the power and financial structures that have the greatest influence must be understood.
Then, it must be understood that western medicine is just one point of view. It will be essential to look at other healthcare systems, like Chinese Medicine and Ayurveda. And it is important to understand that the philosophy of a healthcare model determines the treatment. It will very important to move away from a model that is based solely on “diagnosing disease” and looking for the best drug to treat it. It is essential that we put a great deal of emphasis on the “mechanisms” that cause illness. Inflammation is the mechanism underlying 80 chronic diseases, but it's not a diagnosis. It is the mechanism or process that causes most illness. In addition, there are other important mechanisms, such as:
1. Heavy metal toxicity.
2. Environmental pollution.
3. Problems with the body's ability to detoxify.
4. Neoplasm (cancer, or run-away cell growth).
5. Mind-body connection.
7. Impaired digestion and absorption of nutrients.
It is exciting that something major is going to be done. I have a request of — you. I am writing this series with the intention that it eventually reaches President-Elect Obama. If you know someone who knows how to get this into his hands, please let me know. This idea is not grandiose. In 1993, Hillary Rodham Clinton held the first White House meeting on Alternative Medicine and I was contacted and asked to write a document on “Cost Effectiveness of Alternative Healthcare.” That document was presented during that first meeting. So, don't think small. It is a time for hope and unity, so please hold a long-term vision and think Big.
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com.
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Healing Computer Addiction
Are you addicted to computers? Maintaining appropriate levels of interaction with Blackberries, computers, video games etc. is a challenge. One reason is that when your brain is over stimulated, it actually seeks more stimulation rather than less. Another reason is that the focus required to navigate virtual realities makes real world timelines and troubles vanish – temporarily anyway. It's easy to gravitate to this quick fix. The problem is self care relationships, finances, and spiritual practice often take a dive.
Here's the tip. First, ask yourself how you would cope with no computers for a day, week, or even a month. If letting go seems an impossible agony, you may need professional help. If, however, you're ready to shift this pattern, make a list of activities you enjoy (or used to enjoy) — like hiking, visiting friends, gardening, meditating, making music, art or poetry.
Next, practice turning away from your computer for a short time daily. Set a timer for the three minutes (or so) it will take your brain to calm down while you transition from virtual to corporeal experience. You may feel squirmy. You may discover sad, mad, scared feelings arising. That's normal. Keep your focus in the sensations in your body. Be sure to look for what feels good as well as what feels bad.
Remember, your body is designed to seek balance and well being. Breathe and be here now. You have nothing to gain but your life.
Penelope Young Andrade, LCSW www.penelopetalk.com Call: 858-481-5752 fax: 858-484-8374 email: email@example.com
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