Healthcare Reform Essay
In 1992, the last year the figure was calculated, the United States ranked 72nd among the countries of the world in “Health System Attainment and Performance” according to the World Health Organization. (http://www.photius.com/rankings/healthranks.html) In health care expenditures, the United States is number one. Spending a lot (Number 1) and accomplishing only a little (Number 72) makes the U.S. look like a candidate for the Healthcare Hall of Shame. Small wonder that talk of a crisis dominates public rhetoric and media reports, and calls for reform are increasingly insistent. Predictably, opposition rages, and enough hot air circulates to alter local weather patterns. Confusion is widespread, but enough certainties are rising to the surface to make a confident assertion possible: Healthcare reform is urgent, but lawmakers have not yet gotten the plan right for accomplishing it.
Healthcare reform proposals, while correctly identifying some of the problems with the current system, do too little to fundamentally alter the status quo in several key industries and professions: 1) The legal system 2) The health insurance industry 3) The pharmaceutical industry and the legal agencies under its influence 4) The medical profession.
The Legal System
Change needs to happen in the legal area. Does anyone really think that lawsuits alleging medical malpractice is the best way to handle the expenses, pain, and suffering that result from medical errors? What if errors could be honestly acknowledged, wronged patients would receive monetary compensation for costs associated with errors, and incompetent physicians could actually be prevented from continuing to practice carelessly? I like the idea of banning malpractice lawsuits altogether. In addition, Americans should consider a proposal by Philip K. Howard and his colleagues at Harvard University School of Public Health. His model includes ". . . specialized administrative courts, dedicated judges, neutral experts, and explicit compensation guidelines" to deal with malpractice claims.
One obstetrician-turned-lawyer says:
" We as a society must accept the responsibility for individuals with medical needs. Parents caring for a handicapped child should have resources available to them other than suing their obstetrician. The medical community must continue to explore ways to prevent medical errors and protect patients.
When errors do occur, early and honest disclosure and offer of fair compensation should be the norm. " Source
All this makes a lot more sense than the current system with its sometimes-frivolous lawsuits, uneven compensation, high legal costs for wronged patients and high profits for lawyers who win lawsuits--frivolous or otherwise. Another alternative to doing away with the malpractice system entirely would be to simply forbid lawyers to get any share of malpractice awards. Their compensation would come from per hour fees, as happens in many other kinds of legal work.
The Health Insurance Industry
A workable plan would rein in the health insurance industry, limiting or forbidding insurers to deny coverage to anyone with a pre-existing condition. Also, some system needs to be put in place to make it harder for insurers to deny legitimate claims. The current legislation addresses this--not perfectly, but well enough to provide relief to some who are now in very desperate straits because of their health status.
As long as this industry is profit-driven, as some argue is the only good capitalistic American approach, coverage will be expensive, and someone will have to pay the cost--either employers, or consumers, or the government (with money from both employers' and consumers' taxes).
Notably, insurers are not the ones going broke because of high healthcare costs. Quote: The top five earning insurance companies averaged profits of $1.56 billion in 2008 and reported spending an average of “more than 18 percent of their revenues on marketing, administration, and profits.” That year, CEO compensation for these companies ranged from $3 million to $24 million.” Source While a reasonable profit is fair, these salaries and expenditures seem exorbitant--not fair. Insurance companies can afford to be more open-handed without sacrificing overall profitability.
The Pharmaceutical Industry and Its Government Allies
Cozy and unethical alliances between the pharmaceutical industry and its government overseers needs daylighting and rooting out.
A report by Merrill Goozner* is a thoughtful and well-documented discussion of the problem. It contains this quote attributed to University of Minnesota Bioethicist Carl Elliot about how academic and government scientists explain their acceptance of industry-funded research money:
Quote: “I take the money but it doesn’t influence me.” “I take the money from
many different sources in order to keep my objectivity.” “I take the
money but I make sure that no more than forty percent of our center’s
funding comes from corporate sources.” “I take the money but I
always disclose.” “I take the money but I say what I want.” Or my
favorite: “I take the money but I use it to advocate for social justice.”
The rationalizations always begin with the phrase: “I take the money.”
No one will just say no.
Goozner says that a pool of researchers exists that is not industry-funded. They are the ones that do "just say no." These researchers are under-utilized. They ought to be sought out and hired at agencies such as the Food and Drug Administration (FDA), the government agency that regulates drug companies.
The Medical Profession
The medical profession needs a paradigm shift. Specifically, providers need a lot more training and financial motivation for helping people stay well, instead of focusing primarily on trying to fix them up after they've fallen ill, and profiting financially when that process is prolonged rather than abbreviated.
While a massive reorientation in the medical field is difficult to imagine, heartening changes would begin if physicians did not depend heavily on pharmaceutical company representatives for information about drugs to address health problems. If physicians had a better grasp of how nutrition (among other factors) affects health, their medical advice might not typically result in a trip to the pharmacy, but could involve a nutrition inventory, (for example) and suggested nutritional remedies.
Is this hopelessly simplistic? Think about the clues we find in Scripture. Old Testament laws define dietary and hygiene standards. New Testament teaching talks about spiritual rituals for seeking healing--prayer, and anointing with oil, most notably. Jesus demonstrated God's power to heal miraculously. Herbs like hyssop and aloe are mentioned in the context of healing. A little wine is good for the stomach. Daniel and his friends thrived on "pulse" in preference to eating the king's meat. Gluttony is condemned in Scripture. Moderation in all things is praised. Jesus' followers included the physician, Luke. In short, physical healers were needed, but wellness aids in the Bible did not require expensive potions concocted in chemical laboratories. Practicing good hygiene, eating right, avoiding extremes, judicious use of natural healing substances, professional help, and spiritual disciplines were all part of the wellness picture. Why should people in our day consider heedless lifestyles a right, and pharmaceutical fixes the logical followup?
It's true that our world is, in some ways, very different than the world was in Bible times. More genetic abnormalities have accumulated in the gene pool. More industrial toxins permeate the environment. Foods contain a chemical load, and diminished nutrition. Stress can often not be alleviated with physical exercise. Certainly maintaining good health is a growing challenge, and healthcare professionals are needed. But healers have too often taken the trust that we place in them and simply handed off our problems to those with a pharmaceutical answer. Especially Christians, who have insight into truth as revealed in Scripture, ought to question this reflexive behavior and be open to alternatives to it. Alternatives also require a thoughtful approach--not a reflexively accepting-of-everything one.
Summary
Satisfactory healthcare reform cannot be accomplished in a 12-month long political process. That process would be too likely to yield more of what we already have too much of--out of control medical expenses, exorbitant profits for lawyers, insurance and pharmaceutical companies, and misguided medical approaches. While some relief for uninsured people may be possible, overall, the current problems would not be helpfully addressed by sweeping healthcare reform legislation. Doing things incrementally would be a better approach, and proceeding with integrity, thoughtfulness, and prayerfulness in seeking to right wrongs would offer more hope for substantive change than political maneuvering ever will.
*For some reason, I can't create a live link. The address is: law.hofstra.edu/pdf/lrv_issues_v35n02_b05.pdf
Healthcare reform proposals, while correctly identifying some of the problems with the current system, do too little to fundamentally alter the status quo in several key industries and professions: 1) The legal system 2) The health insurance industry 3) The pharmaceutical industry and the legal agencies under its influence 4) The medical profession.
The Legal System
Change needs to happen in the legal area. Does anyone really think that lawsuits alleging medical malpractice is the best way to handle the expenses, pain, and suffering that result from medical errors? What if errors could be honestly acknowledged, wronged patients would receive monetary compensation for costs associated with errors, and incompetent physicians could actually be prevented from continuing to practice carelessly? I like the idea of banning malpractice lawsuits altogether. In addition, Americans should consider a proposal by Philip K. Howard and his colleagues at Harvard University School of Public Health. His model includes ". . . specialized administrative courts, dedicated judges, neutral experts, and explicit compensation guidelines" to deal with malpractice claims.
One obstetrician-turned-lawyer says:
" We as a society must accept the responsibility for individuals with medical needs. Parents caring for a handicapped child should have resources available to them other than suing their obstetrician. The medical community must continue to explore ways to prevent medical errors and protect patients.
When errors do occur, early and honest disclosure and offer of fair compensation should be the norm. " Source
All this makes a lot more sense than the current system with its sometimes-frivolous lawsuits, uneven compensation, high legal costs for wronged patients and high profits for lawyers who win lawsuits--frivolous or otherwise. Another alternative to doing away with the malpractice system entirely would be to simply forbid lawyers to get any share of malpractice awards. Their compensation would come from per hour fees, as happens in many other kinds of legal work.
The Health Insurance Industry
A workable plan would rein in the health insurance industry, limiting or forbidding insurers to deny coverage to anyone with a pre-existing condition. Also, some system needs to be put in place to make it harder for insurers to deny legitimate claims. The current legislation addresses this--not perfectly, but well enough to provide relief to some who are now in very desperate straits because of their health status.
As long as this industry is profit-driven, as some argue is the only good capitalistic American approach, coverage will be expensive, and someone will have to pay the cost--either employers, or consumers, or the government (with money from both employers' and consumers' taxes).
Notably, insurers are not the ones going broke because of high healthcare costs. Quote: The top five earning insurance companies averaged profits of $1.56 billion in 2008 and reported spending an average of “more than 18 percent of their revenues on marketing, administration, and profits.” That year, CEO compensation for these companies ranged from $3 million to $24 million.” Source While a reasonable profit is fair, these salaries and expenditures seem exorbitant--not fair. Insurance companies can afford to be more open-handed without sacrificing overall profitability.
The Pharmaceutical Industry and Its Government Allies
Cozy and unethical alliances between the pharmaceutical industry and its government overseers needs daylighting and rooting out.
A report by Merrill Goozner* is a thoughtful and well-documented discussion of the problem. It contains this quote attributed to University of Minnesota Bioethicist Carl Elliot about how academic and government scientists explain their acceptance of industry-funded research money:
Quote: “I take the money but it doesn’t influence me.” “I take the money from
many different sources in order to keep my objectivity.” “I take the
money but I make sure that no more than forty percent of our center’s
funding comes from corporate sources.” “I take the money but I
always disclose.” “I take the money but I say what I want.” Or my
favorite: “I take the money but I use it to advocate for social justice.”
The rationalizations always begin with the phrase: “I take the money.”
No one will just say no.
Goozner says that a pool of researchers exists that is not industry-funded. They are the ones that do "just say no." These researchers are under-utilized. They ought to be sought out and hired at agencies such as the Food and Drug Administration (FDA), the government agency that regulates drug companies.
The Medical Profession
The medical profession needs a paradigm shift. Specifically, providers need a lot more training and financial motivation for helping people stay well, instead of focusing primarily on trying to fix them up after they've fallen ill, and profiting financially when that process is prolonged rather than abbreviated.
While a massive reorientation in the medical field is difficult to imagine, heartening changes would begin if physicians did not depend heavily on pharmaceutical company representatives for information about drugs to address health problems. If physicians had a better grasp of how nutrition (among other factors) affects health, their medical advice might not typically result in a trip to the pharmacy, but could involve a nutrition inventory, (for example) and suggested nutritional remedies.
Is this hopelessly simplistic? Think about the clues we find in Scripture. Old Testament laws define dietary and hygiene standards. New Testament teaching talks about spiritual rituals for seeking healing--prayer, and anointing with oil, most notably. Jesus demonstrated God's power to heal miraculously. Herbs like hyssop and aloe are mentioned in the context of healing. A little wine is good for the stomach. Daniel and his friends thrived on "pulse" in preference to eating the king's meat. Gluttony is condemned in Scripture. Moderation in all things is praised. Jesus' followers included the physician, Luke. In short, physical healers were needed, but wellness aids in the Bible did not require expensive potions concocted in chemical laboratories. Practicing good hygiene, eating right, avoiding extremes, judicious use of natural healing substances, professional help, and spiritual disciplines were all part of the wellness picture. Why should people in our day consider heedless lifestyles a right, and pharmaceutical fixes the logical followup?
It's true that our world is, in some ways, very different than the world was in Bible times. More genetic abnormalities have accumulated in the gene pool. More industrial toxins permeate the environment. Foods contain a chemical load, and diminished nutrition. Stress can often not be alleviated with physical exercise. Certainly maintaining good health is a growing challenge, and healthcare professionals are needed. But healers have too often taken the trust that we place in them and simply handed off our problems to those with a pharmaceutical answer. Especially Christians, who have insight into truth as revealed in Scripture, ought to question this reflexive behavior and be open to alternatives to it. Alternatives also require a thoughtful approach--not a reflexively accepting-of-everything one.
Summary
Satisfactory healthcare reform cannot be accomplished in a 12-month long political process. That process would be too likely to yield more of what we already have too much of--out of control medical expenses, exorbitant profits for lawyers, insurance and pharmaceutical companies, and misguided medical approaches. While some relief for uninsured people may be possible, overall, the current problems would not be helpfully addressed by sweeping healthcare reform legislation. Doing things incrementally would be a better approach, and proceeding with integrity, thoughtfulness, and prayerfulness in seeking to right wrongs would offer more hope for substantive change than political maneuvering ever will.
*For some reason, I can't create a live link. The address is: law.hofstra.edu/pdf/lrv_issues_v35n02_b05.pdf
posted by Mrs. I at
4:59 PM
3 Comments:
Useful and succinct essay! I happen to agree with much of what you say, especially the thought that as long as health insurance is a for-profit game there is little incentive for best practices in health care.
There is one additional thing that was originally bandied about: electronic medical records. One of my good friends who is a physician in a major hospital ER feels that this is a great need. Having instant and accurate information about a patient's medical history would prevent unnecessary tests and procedures and assist the physicians in making accurate diagnosis, she feels.
Thanks for taking the time to research and post your thoughts!
By
Deb, at 11/30/2009
I agree with much of what you say under "The Medical Profession", but I believe you hold a romanticized view of the "natural" ways of living in Bible times. Your argument that following Biblical dietary ideas, while perhaps true in the relative sense, are vastly untrue in the absolute/historical sense. That's a complicated sentence, so let me explain.
The sentence I would take the most issue with is "In short, physical healers were needed, but wellness aids in the Bible did not require expensive potions concocted in chemical laboratories."
While Biblical dietary ideas certainly may impact one positively in the relative sense (i.e. someone in Daniel's time was better off eating pulse than pork and someone in this time period is better off eating shredded wheat than Big Macs), to propose that they were better off overall without "expensive potions concocted in chemical laboratories" seems to ignore history. When you compare such things as life expectancy, birth mortality rates, etc of the two eras, it is strikingly clear that, while every era feels the pain of their health problems which we tend to compare with the healthiest among us rather than the historic average, we are much better off with our chemicals (and our pulse!) than with just our pulse.
In other words, while I agree 100% with you that basic foods which were espoused in the Bible are better for us, the whole "chemicals" (i.e. modern medicine) bit is a false dichotomy (either chemicals or basic foods) and separate issue.
By
Hans Mast, at 12/27/2009
See my response in a new post.
By
Mrs. I, at 12/27/2009
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