Does Anyone in the Healthcare Debate Really Care About Health?

In all of the invectives thrown around during the healthcare dialogue,
amidst the shouting of the neo-Brown Shirts and among the talking heads
speaking out of both sides of their mouths, something fundamental to
the entire issue has somehow been omitted. Lurking just beneath the
subterranean rhetorical level of Death Panels and in the myopic fine
print of congressional bills, there's an unquestioned assumption at the
core that takes healthcare as we practice it here in the U.S. as a good
thing, something of which we need more and for more people. Basically,
the debate is about who will provide this "good," at what cost, and to
whom -- but no one questions the nature of the thing in the first place.

The problem with healthcare in America, so the reasoning goes, is that
not everyone has it and the price of it is skyrocketing in a manner
that, if left unchecked, will someday soon break the bank (or at least
what's left of the bank). And there's a truth in these points:
healthcare ought to be a basic human right, it shouldn't be costly to
attain, and its maldistribution leads to grave societal injustices. Yet
this leaves unaddressed the nature and quality of care, shifting the
debate to mere quantity and distribution instead. Simply put, is more
of a bad thing somehow to be taken as a good thing? It reminds me of
the old joke about the restaurant that serves awful food and, alas, in
such small portions.

Let me be unequivocal here for clarity's sake. The healthcare doled out
via insurance companies (when they actually even provide coverage) and
governments alike is arcane, ineffective, and, at times, brutal. While
there is a place for the Western medical model in certain cases, there
is absolutely no need for a "pills and surgery" approach to healing in
the vast majority of situations. We don't need more healthcare of this
sort in the U.S. -- we need less. We shouldn't be left to advocate for
a more equitable distribution of an inherently flawed product, but
instead ought to be calling for its retrenchment. We cannot let
ourselves be consumed by a debate over whether a "misery machine"
should be expanded publicly or privately, when it really should be
dismantled altogether.

What I'm suggesting may be difficult for some folks to accept. It has
become convenient and comfortable for many people to rely on the
current healthcare system. Prescriptions for painkillers and their ilk
are glad-handed all over the country every day. Radical surgeries are
performed routinely in non-life-threatening situations. Giving birth
has been rendered an "illness" requiring hospitalization and,
oftentimes, surgery if nature doesn't follow the predetermined clock
precisely. Children are given full-spectrum vaccinations before they
can even walk, and when they start to run are medicated
psychotropically if they don't color within the approved lines.
Emergency rooms are staffed by everyone except doctors (who still wind
up billing you anyway) and are filled to the brim with people lacking
true emergencies. And so on.

This is a sick system, and a sickening one too. Most of the reasons for
entering the healthcare system could be attended to in myriad other
ways that are healthier and more beneficial for individuals and society
as a whole. Unfortunately, we've chosen to accept and subsidize in
large measure one model of healthcare to the exclusion of competing
options. How many plans in existence today provide coverage for
midwives, naturopaths, nutritionists, masseuses, or the like? Even in
the few cases where they might do so, how many people utilize these
services in any event? Let's be real about this: our healthcare plans,
and the ones being debated nationally right now, are overwhelmingly
about the "pills and surgery" reactive version and hardly at all about
proactive, natural options. The only talk even remotely along these
lines is about preventive care, but even that becomes about screening
and testing for conditions that then will likely require pills and
surgery.

Again, there's a place in the spectrum of healing for reactive
medicine. Some surgical procedures are necessary and sometimes
pharmaceutical products have therapeutic value. Yet while this is a
relatively small percentage of the extant cases, its imprudent logic
dominates the field to the exclusion of equally viable (if not
superior) possibilities. True preventive care -- not just scans and
swabs -- including better diets and stress reduction techniques, could
serve to obviate the need for much of what passes for healthcare today,
and likewise would significantly drive down expenditures. Holistic
considerations of the totality of factors that contribute to a healthy
person could render the "crisis intervention" form of medicine now
widely practiced an exception to the rule of proactive wellbeing.

A few examples may serve to illuminate the point:

* Japan (which spends around 8% of its Gross Domestic Product on
healthcare compared to almost twice that in the U.S.) has a universal
system made up of various layers from locally-administered national
insurance to government-driven fee structuring. People are free to
select services of their choice, and they have numerous alternative
options including spiritual counseling, folk remedies, herbal
medications, massage, and acupuncture. The UN and WHO estimate that
Japan has the highest life expectancy and third-lowest infant mortality
rate in the world.
* New Zealand (which also spends about 8% of its GDP on
healthcare) has a public system available to citizens and those
"ordinarily resident" (including immigrants there on work permits) that
provides free care for all emergency procedures, children's basic
dental treatment, and healthcare associated with pregnancy and
childbirth including hospital stays. This public plan exists
side-by-side with private insurance, and in addition to myriad free
services also provides subsidies for visits to chiropractors,
osteopaths, and general practitioners. Although less focused on
"alternative" remedies than Japan's system, New Zealanders enjoy robust
coverage and a life expectancy estimated to exceed 80 years of age.
* Jordan (which the CIA estimates has a higher life expectancy
than the U.S.) has a healthcare system built largely on public
contributions and complemented by the private sector. They are in the
top ten countries in terms of low infant mortality and have a high
ratio of medical personnel per capita. Free medical services are
provided by a number of entities, and over 2/3 of Jordanians receive
free public healthcare. Their definition of "health" includes not only
medical care but also matters of education, sanitation, wealth
distribution, nutrition, habitation, and prenatal programs. Lacking
great natural resources, the nation has focused on its "human
potential" and this has included a prioritization of healthcare
services.

None of these examples are necessarily to be thought of as perfectly
applicable to the U.S., and they all have their own flaws and
limitations as with anything in this world. But they do ask us to
consider that we stand at a moment to reform the current medical system
for real and not merely extend the status quo. Let's foment support for
a truly healthy public option, one that looks at healthcare as a
lifetime pursuit and not merely as crisis intervention. Let's talk
about the tainted food supply, the cultural toxification of our bodies
and minds, and the disconnection from nature and each other that is
part and parcel of our workaday lives. Let's demand full-spectrum,
holistic healthcare that provides not only acute care but widespread
knowledge and wisdom about self-care as well. Let's pack the town halls
not out of spite or anger, but with an alternative model that breaks
the stranglehold of the lobbyists and insurance companies. Let's
dismantle Big Pharma and replace it with small farms. Let's actually
care about health for a change.

Obviously this is all quite polemical, and yet this is the world of
discourse in which we find ourselves. Watching this debate unfold, yet
again, between two dominant factions on the same side of the coin is
just too much to bear. Isn't this how politics often appears in
America, as a heated contest between two groups that (at the end of the
day) both support war, prop up profligate corporations, centralize
bureaucracy, and stick us with the bill? It's bad enough when we're
dropped into a forced-choice rubric on matters of technology and
economics, but this is our health we're talking about here. It is not
an overstatement to say that this involves matters of life and death,
so perhaps it's time to bring a little life into the conversation.
Yelling "You Lie" at the President isn't quite what I'm talking about
here, nor is claiming the mantle of "pro-life" while opposing
healthcare reform altogether. We need bold vision now more than ever,
not more Congressional charades.

If we're going to have a healthcare system of any sort, it ought to be
publicly-held and cooperatively managed. The tepid "public option"
being bandied about in Washington -- if you can even bandy something so
microscopic -- has all the markings of another privatized public option
akin to what we have here in Arizona, the misnamed "Health Care Cost
Containment System" (AHCCCS) known colloquially as "Access." This
system essentially administers and oversees contracted health plans and
services. It is not a truly public option, although it does provide
care to people who qualify for medical assistance programs like
Medicaid, and its need-based services are available to only a small
percentage of people lacking coverage. What it basically does is pay
out capped flat fees to private providers for certain services with a
focus primarily on acute care. Notably excluded are alternatives such
as midwifery, or preventive care involving education or nutrition, and
there is little incentive for private providers to actually contain
costs in any way but rather to reach the maximum fee given for any
particular service. Moreover, the presence of Access has not broken the
monopolization of healthcare held in the state by modern-day trusts
like United Healthcare and Blue Cross Blue Shield. Far from yielding
better care and more choices, this lukewarm "public option" has
perpetuated a system that leaves Arizona ranked by the United Health
Foundation (as of 2008) as the 33rd healthiest state in the U.S., 40th
in terms of public health dollars spent, 43rd in the number of primary
physicians, and 45th as to the rate of people left uninsured.

So instead, here's a modest proposal for something different: a public,
universal, free healthcare option that can be used for (a) proactive
and preventive care and/or (b) bona fide emergencies and chronic
conditions. For that middle range of routine procedures, office visits,
and garden-variety treatments, there can be subsidization in the form
of capped co-payments. People seeking more elaborate coverage will be
free to do so in the manner they are now, by purchasing it privately or
securing it through their employer. The plan will be financed by tax
revenues assigned from the Treasury at an amount not less than 1/2 of
the annual military budget, and moreover at least 1/4 of every dollar
spent through this system of primary healthcare services will be
funneled to health education and nutrition counseling. Healthcare costs
will thus be keyed to limiting the ways of war and funding human
services. Such a plan would cover everyone and still come in at far
less than the $2.5 trillion we are estimated to spend on healthcare
this year. Over time the program will cost less as overall health in
America improves, reversing the downward spiral we're presently in
whereby healthcare costs outstrip the growth of our GDP.

In this manner, the focus of medicine will slowly shift from
intervention to prevention as people begin to realize that the best
healthcare system in the world is actually their own mind and body,
with assistance from their families and communities. The emphasis will
be on managing diet and stress, and encouraging exercise and meaningful
work, rather than primarily adding more vials to our medicine cabinets.
Self-care will be restored to individual hands, and removed from gloved
surgical hands, as people take charge of their own patterns of living,
practices of consumption, and methods of coping. By primarily
subsidizing preventive and emergency care, and discouraging costly and
routinely unnecessary procedures, a space will be opened for wider
engagement with broad themes of "education and opportunity" as paths to
better living. Soon, health will itself become infectious as we all
teach each other how to promote wellbeing at every level.

This isn't really all that farfetched, is it? At least it's no more so
than doubling-down on an inherently flawed model that seems to have a
strong interest in keeping us ill. Come to think of it, the entire
healthcare debate has got me feeling a little sick right now. Hmm, I
guess the current system is working perfectly after all....