The great American health care debate has drifted into so many areas of cultural life that the issue of health has been lost in the shouting. The resulting noise has been instructive in one important way; it has shown how shallow our understanding of the issue is and how difficult it is to ask the really important questions.
Health is not a commodity to be purchased or a service to be contracted. When we talk about health we are talking about life. In the present debate on health care this simple truth gets lost. The health of any culture is a reflection of its physical vitality as well as the capacity to enjoy life to its full. Anyone who has studied health and sickness knows that health is most often an outcome of social and individual habits – health is a reflection of the way we live. When health is seen as an accident of genetics, an act of god or being born under a bad star the individual is disempowered and must only hope that things will work out for the best or that some external agency will keep them alive.
A great opportunity is presented to us in the current climate of debate regarding health. We have a chance to reform cultural attitudes toward well-being and ask what health care would look like in a society where many social institutions of the past century have been shown to be lacking in concern for the quality of life on the planet. The link between social, environmental and economic health is an important one and one that demands both the ability to identify where present systems fail as well as what can be done to create a more healthy society.
We live in a world where nations are identified as “markets” and whole populations are reduced to being nothing more than “consumers”. Is it any wonder that discussions of health care use a language that is designed to pull us away from the most important issues regarding the health of the nation? One of the most fundamental issues of society, the well-being of the people has been reduced to an emotional and childish rant motivated by greed and producing fear and confusion.
A Pew Foundation poll in September discovered that 67 percent of Americans found the health care debate difficult to understand. With American health care being the best in the world and the government proposing “death panels” who wouldn’t be confused? This confusion feeds the status quo. If everyone is confused, doing nothing looks pretty good. Finding a path to clarity means asking some uncomfortable questions; it means finding out who profits from sickness. We need to follow the immortal words of Deep Throat and “follow the money.”
America spends more money per capita on health care than every country in the world. Over fifteen percent of the GNP is a healthy slice of the nation’s income. For that amount of money we should expect a tangible return in terms of general health. That is not the case; all that money is not buying us health but it is feeding a bloated bureaucracy stumbling off in the wrong direction.
Despite the best efforts of thousands of caring and hard working health professionals, the World Health Organization generally ranks America about twenty-fourth in terms of general health. It ranks below Italy, Spain and Japan. Japan only spends nine percent of its’ GNP and are ranked number one in health. These figures are based on the number of years that a person can expect to live in “full health” and not sustained in less than full health due to disease or injury. They reflect actual health, so does that mean that although we get sicker that we get treated better? Unfortunately the answer is no.
Rush Limbaugh was recently asked about health care in a television interview. Being blessed with paranormal insight into the issue he stated that, “America has the best health care in the world; people come from all over the world to be treated here.” Unfortunately Rush was not talking about the majority of his listeners. The folks that he was referring to were the same who hop on a jet to travel anywhere in the world to kick a drug habit, have their skin tightened or loose fifty pounds of ugly fat. They do it because they can afford it. In America you can get the top treatment in expensive clinics but that treatment is not available to the general public. In fact we are not so great when it comes to saving lives that could be saved.
Studies have shown that deaths in America that are “amenable to treatment” have not improved to the same degree of most other wealthy nations. These are deaths that should be successfully treated and account for about 23 percent of total deaths under age seventy-five. To quote a report from the Commonwealth Fund, Senior Vice President Cathy Schoen states, "It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance. By focusing on deaths amenable to health care, we can strip out factors such as population and lifestyle differences that are often cited in response to international comparisons showing the U.S. lagging in health outcomes. Other countries are reducing these preventable deaths more rapidly, yet spending far less. "
The great American health care system is costing a fortune and not delivering. The Emperor has no clothes and it’s not a pretty sight. Any meaningful discussion of health care must address the weaknesses of the existing service and not shy away from the danger of being critical of present medical practice. American medicine needs to put its house in order and insurance companies need to stop playing hide and seek.
The “Death Panel” debate is the most disingenuous of all the smokescreens that obscure reform. We already have Death Panels - they are called insurance companies. These are the folks that decide who can have insurance and who can’t, what illnesses are covered, what treatments are covered and what the limits of payouts are. The science of deciding all these life and death issues is quite simply the profit margin. This sounds strangely like the imagined death panels except that it is an accountant rather than a medical professional that makes the decision. The Congressional Budget Office says the gap in life expectancy between rich and poor has doubled since the 1970s, as the number of uninsured grew. At least 22,000 people die every year because they lack insurance.
A General Accounting Office study found that over the past ten years, premiums have risen 120%, compared with inflation of 44% and wage growth of 29%. According to John Shells of the consulting firm, Lewin Group, "Profits in the industry are as high as we've ever seen." This is why the insurance lobby is throwing millions of dollars into blocking reform and giving large contributions to lawmakers on both sides of the aisle. Several companies hold a virtual monopoly on the business and they are becoming more sophisticated in tailoring their business to reduce risk and maximize profit. A recent study by the American Medical Association found that in 56% of America's 314 urban areas, a single insurer controlled over half the market.
The triumvirate of Big Medicine, Insurance Companies and Drug Companies has made such an expensive and unjust mess of things it’s time for a change of substance not image. Corporate interests must stop being the final arbiters of public policy. When bankers dictate economic policy, oil companies decide energy policy and vested interests in the sickness industry use the 1950’s fears of socialist takeover the public is lost. The current proposals for reform are only a stopgap in any case. They represent the illusion of health care not the reality of what it should and could be.
Our present approach to health care is about sickness, not health. We do not have a Health Care Service we have a Sickness Service. When we start talking about health care we will have to conjure up the courage to change our definition in a revolutionary manner. True health care will be about education. Improvements in health will be about reforming public attitudes toward creating a healthy environment and addressing issues such as physical activities in schools, public support for healthy food and creating a focus on preventing the root causes of sickness, not waiting till it develops. Modern health care will always be about crisis management till these steps are taken. We need to learn the basic life skills of prevention as well as developing a medical treatment system that is able to function when needed.
The concepts of prevention are simple and that may be part of the problem. We have been schooled to expect health as an outcome of complex technologies and deep intellectual study not simple daily actions. The rigor of science is essential in the treatment of serious illness but is not essential for health. It is interesting to note that when prevention is brought up we are told that it would make no difference to health costs.
While the cost of prevention would seem a strange point when weighted against human misery and disease a closer look reveals that the prevention being talked about is medical screening. Early screening for diseases is not prevention; it is early detection. This is an example of trying to make the personal into something requiring professional guidance.
These attitudes reflect a faith in treatment rather than an understanding of health. Virtually every professional body that investigates the causes of disease agrees that the vast majority of degenerative illnesses in America could be avoided by changes in habits of exercise, smoking and diet.
Smoking has already been exposed as a major health risk and steps have been taken to curtail it with generally good results. Exercise as a health requirement needs attention as many schools lack adequate physical education and school sports seem to be the dominated by only elite student athletes. It is in the area of dietary reform where social education is most desperately needed. It is also the area where there is the most governmental and social resistance to change.
Changes in diet inspire a great deal of emotional and cultural conflict. We often associate foods with family, culture and comfort - sensitivity to these issues need to be addressed. This does not mean the government cannot be a vital force in prevention. The massive power of the food industry outstrips even the insurance and drug industries. The fact that the modern American diet has long been known as a major cause of the deterioration of health is no secret. The fact that politicians have shied away from all but the most oblique criticism of the food industry simply demonstrates how dangerous the food lobby is.
It is the high meat, high fat, high sugar foods that dominate the American diet that need to be brought to check. Government subsidies for corn based high fructose corn syrup, water rights for cattle, subsidies for cattle feed and the milk industry need to be reduced so that the true cost of these un-healthiest of foods are reflected in the price. Subsidies should be directed toward regional growing of fruit and vegetables. Labeling laws need to be clarified so that people better understand what they are eating and the FDA needs to be populated by nutritionists that are not the pawns of the food industry. This will not be an easy process but it is essential for a healthy nation.
If true prevention is not instituted, our present system will not be able to withstand the tidal surge of illness created by an aging population and the increased obesity that is a clear predictor of a rise in diabetes, heart disease and cancer in the near future. Many of the problems our overloaded hospitals and clinics experience could be dramatically reduced with proper effort to reduce the causes of disease. No matter how much money is funneled into the present system it will take a population more focused on health than frightened of sickness to turn the tide. That can only happen through the efforts of individuals, civic groups and government working to gather to focus on a truly healthy way of life. Dismissing the possibility of this as a utopian vision is something that will be regretted by future generations.