Healthcare Reform

It may disappoint some of you to know that this blog post has nothing to do with the most recent health care reform which was declared constitutional this summer and will be put into effect in the coming years. While I do (mostly) support so called "Obamacare" in theory, I am still suspicious about how it will actually be put into practice. Beyond that, I don't think that the most recent "reform" really even scratches the surface of the reform needed in this country in order to actually become healthy. But none of that really pertains to this post, so back to the real reason I'm writing. 

Tonight I went to a documentary showing put on by an interdisciplinary group on campus. The documentary was "Escape Fire: The Fight to Rescue American Healthcare" and you can see the trailer below: 

It was hard not to get inspired once I saw the trailer. I was hooked and needed to see the whole film. I've kind of been on the whole healthcare reform train for a few years, so really this isn't anything new, but it's always good to continue learning about topics which you are passionate about. Sadly, there wasn't a great turnout for the showing of the film because it truly was great.

The issues presented in the documentary are as follows: (descriptions are taken from the "Escape Fire" website which can be found here: http://www.escapefiremovie.com/issues)

1. An Entrenched System: Pharmaceutical companies, medical device manufacturers, hospitals, and insurance companies are all profiting on our declining health. And all those companies spend their money lavishly – millions of dollars go to Washington lobbyists – to ensure that nothing ever changes.
2. Over-medication: We spend roughly $300 billion annually on pharmaceutical drugs – nearly as much as the rest of the world combined.
3. Over-treatment: One of the hardest things to understand as a patient is that “more” doesn’t necessarily mean “better.” But it’s imperative that we do. Recent studies have shown that “more” can often mean “worse” when it comes to our health.
4. Paying More, Getting Less: We pay more, yet our health outcomes are worse. We give well-intentioned doctors, nurses, and hospitals the wrong tools and the wrong incentives, and it results in higher costs and poorer health.
5. Preventing Disease: 75% of healthcare costs go to treating diseases that are largely preventable. That’s a lot of unnecessary money, and worse, a lot of unnecessary disease.
6. Reimbursement: The healthcare system often uses a “a fee-for-service” model of payment – government or private insurers pay a hospital or a physician every time a procedure is performed.
7. Treating the Whole Person: Your body isn’t a car, but that’s how it’s handled when you take it into the doctor’s office. Instead of being treated as a person, your broken parts get fixed separately, one by one.

After viewing the documentary, several points are still resonating within me. The point was made time and time again that our current system is a flawed, fee-for-service system. The trailer even called attention to the fact that spending 5 minutes with a patient before performing a surgery could earn a doctor $1,500, but spending 45 minutes with a patient determining feasible treatment routes would only earn a doctor $15. That seems utterly backwards. Moving beyond the money, our current system does not reward patients or doctors for healthy behaviors, but instead keeps us coming back for more. One quotation from the documentary, "We don't have a healthcare system in this country, we have a disease management system" (Dr. Andrew Weil, Founder of the University of Arizona Center for Integrative Medicine) was especially poignant if combined with a point made by medical journalist, Shannon Brownlee. She talked about the fact that our current system doesn't actually want us to become healthy (to be fair, it doesn't want us to die either) because then the system doesn't make money. We are simply managing diseases in many cases (several of which are fully preventable), instead of encouraging health  because it keeps us coming back for more in order to keep the industry alive. 

I know that this reform will not be easy. It will require overhaul of several, very politicized lobbies of people. These include insurance companies, hospitals, pharmaceutical companies, the farm lobby (in spite of my Cornhusker heritage, I can recognize that the subsidies for corn are not beneficial to national health...you will be hard pressed to find foods that do not contain corn or corn byproducts on the shelves of our grocery stores which are truly not all that healthy for us...this also will require elimination of food desserts...oh now we're into a whole other bird's nest of issues), schools (health classes that actually teach healthy behaviors, school lunches that provide adequate nutrition to students, etc), fast food corporations, all food production corporations, and many, many more.

This is no feat to be taken lightly nor will it be easy. 

If reformed, Americans would have to begin living in a manner which is completely foreign to many of us. No longer would we be managing disease, we would be maintaining health. Our lives as we know it would be over. Over in an absolutely terrifying, but absolutely rewarding way. Benefits to better healthcare would include, but not be limited to:

• Better health. Simple as that! (this is not to say that we will be in perfect health as a nation. There are still germs present within our lives, but many major chronic conditions which affect millions of people nationwide could be drastically reduced)
• Increased life expectancy (clearly this leads to the problem of over-population, but that's for another blog post...)
• Reduction of preventable chronic conditions such as diabetes, hypertension, high cholesterol, heart disease, certain cancers, etc. 
• Decreased insurance premiums.
• Increased productivity at work...better health=more energy=ability to accomplish more.
• Reduced national deficit.
• Lowered incidents of mental health fatalities and associated stigmas.
• Fewer unplanned pregnancies, abortions, and reduced STD/STI transmission. 
• Increased education. When people, especially children, are healthy, they are capable of learning. And eventually they can do something productive with that knowledge. Perhaps even change the world. 

Moving beyond my concerns as someone who loves the practice of medicine for its scientific components, as a person of faith, I personally feel that I am even more obligate to help my patients work towards being healthy in mind, body, and spirit. My philosophy on this front is highly influenced by Dr. Scott Morris of the Church Health Center. I've written about CHC on other occasions, so I won't bore you by rehashing the details, but Dr. Morris believes that we, as a Church, are called to preach, teach, and to heal. Generally, we do a pretty good job of preaching and teaching and not so great of a job with healing. At some point in history, we adopted a dualistic philosophy (thanks a lot Descartes...not!) and our bodies, minds, spirits became considered separate entities causing physicians to stop treating the whole person in our medical clinics. I cannot, in good faith, treat a person without considering their mind, body, and spirit as a budding physician (or in science-y terms, without considering a patient's biopsychosocial situation), Christian, or a human. The current system of practicing medicine does not allow for me to fully treat patients with this approach.

Don't get me wrong, obviously I still like Western medicine. After all, I am writing this critique on a blog about becoming a medical doctor. I have even taken full advantage of the student health program here at school this fall. It's not that the system is worthless...it helps millions of people each year. BUT (a big, emphatic "but" at that) it doesn't provide infinite amounts of health care. It also doesn't provide care in cost effective manner. Not only that, we currently allow for millions to fall through the cracks of the system, never seeing, preventing, or treating their health concerns.

We are in dire need of an overhaul. My generation is sitting on the horizon of change, I hope we are able to enact it, so that our patients/the nation can work towards becoming healthy in mind, body, and spirit. I know that I'm still in school and ideology overshadows what will likely be actual experience, but without acknowledging that there IS a problem, we can never work towards solutions to said problem(s). At the very least, I now open the floor for conversations to begin about healthcare for those of you who read this. I look forward to our discussion!

We are overly-medicated, overly-treated, overly-charged, disease-ridden people. It's about time that changed for the better, if you ask me.

"Let your food be your medicine and your medicine be your food." -Hippocrates