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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:



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*       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....

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Randall Amster

Randall Amster

Randall Amster, JD, PhD, is Director of the Program on Justice and Peace at Georgetown University. His books include Peace Ecology (Routledge, 2015), Anarchism Today (Praeger, 2012), Lost in Space: The Criminalization, Globalization, and Urban Ecology of Homelessness (LFB, 2008); and the co-edited volume Exploring the Power of Nonviolence: Peace, Politics, and Practice (Syracuse University Press, 2013).

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