Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts

Thursday, October 29, 2009

An Economy in Need of Holistic Medicine

New York Times Article, October 23, 2009, By Anand Giridharadas

CAMBRIDGE, MASSACHUSETTS — The American economy is having what doctors call an acute episode.

Employment won’t throb. The circulation of capital remains weak. Industry is breathing, but barely. And if we can agree on anything one year into this mess, it is that there is little we can do when the patient arrives already this bad.

That is why the talk now is so often of prevention. Prevent the next crisis through health insurance and a green-energy sector, the American president says. Prevent it by cutting spending and nurturing personal responsibility, American conservatives retort.

But the truth is that politicians, and not just in the United States, are rarely willing to invest in a problem that hasn’t occurred. Consensus and action are easier to come by after a 9/11 or a Lehman Brothers than before. Problems in the embryonic, soluble phase don’t interest us; and those that do interest us are often too big to solve.

Which is where acupuncture comes in.

Western medical practices have attracted similar criticisms in recent years, for an emphasis on intervening in disease rather than preventing it beforehand and promoting quotidian well-being. But in health, unlike politics, an alternative approach called wellness has emerged, focused on investing in health before it breaks down.

What can wellness tell us about our present economic malady? As it moves from fringe to mainstream — with wellness programs in the health care reform proposals now in Congress, wellness manifestos on the best-seller lists and a U.S. Army wellness program that asks soldiers to introspect and meditate — I asked experts about the approach’s core tenets and how they might be applied to the body politic.

Nip it in the bud. Wellness argues for cultivating health a little every day, not just restoring it during calamities. We increasingly accept that it is better to monitor a diabetic’s blood sugar with regular clinic visits than to amputate her limbs. We accept that businesses can avoid costly cancer treatments by encouraging workers to stop smoking. But in our political life, we prefer to wait until things reach the emergency room.

We barely regulate financial markets for years, thinking regulation oppressive, until we are compelled to nationalize private firms. We avoid expensive investments and controversial new methods in public education, then pay the price in lower social mobility and vast prison populations. We neglect building roads and bridges and Internet highways, fearing the cost, and then reap the much greater costs of whole regions falling off the economic grid.

“With a lot of social problems, we’re not sure how to prevent it, and therefore we don’t spend money on it, because we always have a lot of other priorities,” said David Cutler, a Harvard economist who has advised both the Clinton and Obama White Houses on health care.

Go to the roots. Western medicine tends to fight symptoms, whether suppressing coughs or flooding the brains of the depressed with serotonin. Wellness is interested in underlying causes. It is inclined to see an infertile woman, for example, as a stressed woman rather than a woman with defunct ovaries, and may suggest that she eat and work differently rather than take ovary-manipulating pills.

In public policy, a symptom bias rules. A housing crisis? Enact a tax credit! Bank failures? Bail them out!

There is nothing wrong with such steps — except for what they leave out, as most economists will tell you.

Even amid all this action, we have virtually ignored the complex weave of issues beneath the issues: meager savings, a debt addiction, a congenitally spendthrift political system, an almost pathological craving for stuff. And, with our topical cures, we should not be surprised to see new symptoms of the old maladies appearing: insurance again being packaged into derivatives, bonuses again soaring on Wall Street.

“We treat symptoms, and we do not look at the causes of the symptoms,” Deepak Chopra, the famed alternative-medicine and wellness guru, said when asked to extend the wellness metaphor to the economy. “We are totally at this moment looking at it in a reductionist manner. The reductionist manner is a bailout. And somehow that’s supposed to solve the problem, whereas the problem occurred because we were thinking reductively.”

Look within. Wellness sees the causes of and remedies for ailments as lying within us. Avoid infection by building immunity. Defeat disease by eating foods that help the body heal itself.

With the economy, we look everywhere but within. It’s the fault of greedy Wall Street bankers. It’s Washington’s fault. Bush’s fault. Obama’s fault. Greenspan’s fault. Somebody fix it!

But what about us? Why can’t we acknowledge that it was us who bought all those unaffordable houses, us who listened to that zero-gravity financial “advice,” us who bought and bought and never kept a rainy-day fund? And why, in solving the problem, do we expect the state to create substitute dynamism instead of renewing the culture of decentralized dynamism that made the U.S. economy so vital to begin with?

“Conventional medicine is very unbalanced in placing all its emphasis on external interventions rather than looking to advance that internal capacity to maintain healing,” said Andrew Weil, founder of the Arizona Center for Integrative Medicine and the author of several books on wellness. Likewise with the economy, he said: “Instead of simply identifying external threats and developing weapons and strategies against them, we should instead identify and strengthen immunity and resistance.”

A politics of wellness would transcend party. It would emphasize the up-front investments that Democrats like in order to achieve the long-run fiscal solvency on which Republicans insist. It would fulfill the liberal belief in a positive role for government in maintaining well-being but would honor the conservative conviction that government’s chief role is to help the social organism heal itself. It would acknowledge, with the left, the complex lattice of cultural and institutional influences that govern a society’s well-being, while emphasizing, with the right, the limits of what any external healer can do.

Think wellness in these hard times. The most urgent problems, after all, may be the ones we haven’t had yet.

http://www.nytimes.com/2009/10/24/world/americas/24iht-currents.html?_r=1

Monday, October 12, 2009

Producing a Healthy, Long-Lived Populace on a Budget – Who in the World is Getting the Job Done? Part 2

The debate on health care reform in Congress continues. Who’s right and who’s wrong? Are those who oppose some of the proposed reforms evil, selfish people who delight in seeing their fellow man suffer? Are those who staunchly support the proposed reforms living in a dream-world?

I am not qualified to give a definitive answer. But what I am qualified to do is poke around online and see who in the world is achieving the objective of health care reform explicitly laid out by President Obama – providing a way for all individuals to receive health care without fear that they are “one illness away from bankruptcy”, and reducing costs in the process.

So, who is doing the best job in the world achieving this goal?

The answer might surprise you.

In this relatively small island-nation, you can be treated to views of towering skyscrapers, mosques and temples of ancient Malay and Hindu civilizations, as well as innumerable Western-style shopping malls. Welcome to Singapore!


Singapore boasts the 6th best health care system in the world with an infant morality rate almost 1/3 of that of the U.S. (there are just 2.3 deaths per 1,000 live births in Singapore as opposed to 6.4 deaths per 1,000 live births in the U.S.). Its populace is the fourth longest-lived in the world, with an average life expectancy of 81.98 years.

And Singapore accomplishes this by spending only 3.7 percent of its GDP (only $381 per capita) on health, as opposed to America’s 15.4 percent expenditure!

What can account for Singapore being a shining example of a functional, frugal health care system? How does this system work?

In Singapore, individuals are required to set aside 6-8% of their income into what is essentially a health savings account (employers contribute to these accounts as well). This money earns interest, is tax-free, and can be withdrawn at any time to cover the health care expenses of ones’ self or family members. Unspent money accrues and rolls over from year to year. This program is called Medisave.

Citizens of Singapore may purchase additional coverage for catastrophic events with Medishield (or Medishield Plus which offers even more coverage), and their premium payments may come out of their Medisave accounts.

The government subsidizes the health care of those who cannot cover their expenses with either Medisave or Medishield through the Medifund program. For the elderly and disabled, government-subsidized ElderShield pays for health care expenses that the individual cannot cover himself.

http://www.moh.gov.sg/mohcorp/hcsystem.aspx

Here are some important points:

• Singapore’s vision as a state is “adding years of healthy life,” by focusing less on healing sickness, and in the words of the Singapore Health Ministry, more on “the more difficult but infinitely more rewarding task of preventing illness and preserving health and quality of life.”

• The people of Singapore willingly take responsibility for their own health by spending their own money to fund most of their health care costs.

• “The reason the system works so well is that it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers. The state’s role is to provide a safety net for the few people unable to save enough to pay their way, to subsidize public hospitals, and to fund preventative health campaigns.”

• 75% of the populace of Singapore uses less-expensive holistic/complementary medicine at least once per year in preventing and treating illness. http://linkinghub.elsevier.com/retrieve/pii/S0965229904001189

• Complementary medicine is widely accepted by the medical community at large as an important contributor to the nation's health.

Phua Kai Hong, associate professor of health policy and management at the Lee Kuan Yew School of Public Policy at the National University of Singapore gives the following reasons for Singapore's successful health care system:

• "the creation of incentives for responsible behavior and the efficient delivery of services;

• the discouragement of overconsumption through cost-sharing;

• the regulation of hospital beds, doctors, and the use of high-cost medical technology;

• the promotion of personal responsibility;

• targeted government subsidies;

• and the injection of competition through a mix of public- and private-sector providers.’”

http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model


What can we in the United States of America learn from Singapore? Why don't we try to emulate some of the things that have worked in Singapore in our own health care reform?

Before I discuss this in a subsequent post, in my next post I will outline the health care system of a part of the world where a push to give health insurance to all is doing just that, but costs are continuing to skyrocket and hardships for middle class citizens in obtaining health care continue in full force.

Unfortunately, the latter is the system we are emulating, and it appears that almost no-one is paying attention!

Wednesday, August 26, 2009

Debunking the Health Care “Myth” Debunkers?

This morning I got up, turned on my computer, and checked out the headlines on my Yahoo home page. This is a regular occurrence for me – not so much because I am dying to know what is going on in the world, but because I am curious about what is wanted for me to believe about what is going on.

I came across an article entitled “Majority of Americans Believe Health Care Reform ‘Myths’”. http://news.yahoo.com/s/livescience/20090824/sc_livescience/majorityofamericansbelievehealthcarereformmyths .

I decided to open this article on up and take a look at what ridiculous “myths” people were believing now. We’ve all seen Sarah Palin and others mocked and ridiculed for their claims that Obama is trying to “pull the plug on grandma” with an Orwellian end-of-life counseling provision purported to be a part of the health care bill.

So I decided to take some time to check out the gargantuan 1,000-page bill itself to see what I could find.

http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf

Are all those health care “myth”-believers out there either shameless fear-mongers and/or jealous Republicans grasping at straws seeking defeat Obama in his lofty goals? Or is there some merit to their concerns?

I figured the bill itself would have the undisputed answers – what was truth, what was fiction – on any controversial points, or “myths”.

Thankfully, I was also able to draw upon a document written by some Dr. Stephen Fraser to Senator Bayh of Indiana in which he cites pages and lines that refer to certain contentious elements of the bill, giving me a great head start.

(see http://www.facebook.com/home.php#/note.php?note_id=123784720765 )

So, here it goes. “Myth” # 1 of this Live Science.com article is that wait times for health care services, such as surgery, will increase. Apparently 67% of respondents believe this will be the case. Why would anyone believe this?

Reality – Maybe because it is self-evident that when demands go up for any given service and the infrastructure to meet those demands stays the same, the service will become more scarce. I’m no guru of economics or economic theory, but this one is a no-brainer even for me!

“Myth” # 2 – Apparently about 80% of Republicans, 25% of Democrats, 56% of Independents (or 50% of respondents) believe the federal government will become directly involved in making personal health care decisions. I’m not sure how this could qualify as a myth, since:

Reality – According to page 30, Section 123 of H.R. 3200, there will be a government committee made up of between 19-27 individuals that decide which treatments and benefits are given for which illnesses. This committee is led by the “Health Choices Commissioner”, who is appointed by the President. Maybe it would be more appropriate to call him the “Health Choices Restrictor”, since the choices he makes will actually restrict the choices available to doctors and patients.

Further, page 42 of H.R. 3200 reaffirms that the Health Choices Commissioner will choose your health care benefits for you in the following delightful and engaging language:

“Sec. 142. Duties and Authority of Commissioner.
(a) DUTIES. – The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALITIFED PLAN STANDARDS. – The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury. . . .”

Blah, blah, blah.

O.K. – this next one is big. “Myth” # 3 -- Roughly 60 % of Americans believe taxpayers will be required to pay for abortions on demand (78% of Republicans, 30% of Democrats, 58% of Independents).

Reality – There is no language in the bill that specifically forbids taxpayer funds to be appropriated to abortion. However, there is a piece of legislation called the Hyde Amendment that was passed in 1976 and which prevents Medicaid funds to be used for abortion except in cases of rape or incest. Some argue that the current healthcare bill would be subject to the Hyde amendment, and therefore abortions would not be funded except in extreme cases.

Others argue, however, that without specific language in the actual healthcare bill itself to disallow abortions on the government plan, an overturn of the Hyde amendment by abortion advocates would essentially make abortion-on-demand a state-funded benefit. Besides, the Hyde Amendment is specific to Medicaid and one could argue that it has no legal bearing on H.R. 3200. (See http://www.lifenews.com/nat5247.html)

This next part is what gets me. Another amendment proposed by Rep. Lois Capps of California, who incidentally has a strong pro-abortion voting record, was passed in July 2009 by Congress. This amendment specifies that abortion would be covered in a public option health care plan (using the taxpayers’ funds) should the Hyde amendment ever be reversed. Hmm – looks like someone in power has some plans for widespread government-funded abortion. (See http://www.lifenews.com/nat5306.html)

Here’s another biggie: “Myth” # 4 – 46% believe reforms will result in taxpayer subsidized health care coverage for all illegal immigrants.

The truth is that Medicaid already covers the health care costs for illegal immigrants with conditions that could jeopardize their lives, including the delivery of babies and emergency room care, at great cost to the taxpayers. With all due respect to illegal immigrants, it’s definitely true that expanding full coverage to these individuals would come at an enormous cost to American taxpayers.

Reality -- Page 50 Section 152 in H.R. 3200 has these elucidating words to offer: “All health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.”

I have to be honest with you here. My 12 years of public schooling plus 8 years studying at an institution of higher learning did not prepare me to decipher such convoluted verbiage as this. If you can figure out what that means, please let me know, because the longer I look at it, the less sense it makes.

What I was able to gather from the bill is that nonresident aliens not having “acceptable coverage” are exempt from paying the 2.5% tax on income required of everyone else who is not suitably insured (Page 170, Lines 1-3), and that “individuals not lawfully present in the United States” are ineligible for affordability credits (Page 143, Section 246).

I looked up the term “affordability credits”, because I wanted to see if having them was equivalent to having health care coverage. I found that this is not the case -- ineligibility for affordability credits in no way equates ineligibility for any other benefits of the government-run health care system, and nothing else is specified about illegal non-resident aliens and health care coverage in the health care bill.

For a more detailed discussion of how illegal immigrants will likely be able to access the government-run health care system with few problems under the system being proposed by Congress, check out this document penned by the Federation for American Immigration Reform (FAIR):

http://www.fairus.org/site/DocServer/2009_07_24_Analysis_Section_246_is_Ineffective_vFINAL.pdf?docID=3101

Next -- “Myth # 5” – 54% of Americans polled (78% of Republicans, 28% of Democrats, 58% of Independents) believe the public option will increase premiums for Americans with private health insurance.

Reality – This can in no way be considered a myth to be proven or refuted, since it is merely a projection of a possible future outcome rather than a verifiable understanding about what the policy actually says. I did look around to see if I could find a precedent for private premiums either increasing, decreasing, or staying the same when a government system is introduced. I couldn’t find anything. I would be curious to know if such a precedent exists – let me know if you find something on this!

The truth is that an increase in the premiums of private health insurance due to the institution of government-run health care is a possibility at the very least. Check out what this guy has to say on the matter (scroll down about halfway to point number 2.):

http://www.americanthinker.com/2009/07/the_failed_promises_of_governm.html

“Myth” #6 – Half of all Americans polled think cuts will be made to Medicare in order to cover more Americans (66% of Republicans, 37% of Democrats, 44% of Independents).

Reality – Page 341, lines 5-9 state: “. . . the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.”

I’m not quite sure what that means, but it does appear that there could be some restrictions to senior citizens using Medicare Advantage plans. With this type of plan, senior citizens retain their own private insurance while still utilizing the benefits from Medicare. It is conceivable that such restrictions would, at the very least, lead to fewer health care choices for some senior citizens.

This article would not be complete without looking into the claims that the health care bill would support government-sanctioned euthanasia. The LiveScience.com article reported that only 30% of respondents believe the government will “require the elderly to make decisions about how and when they will die.”

Reality – read pp. 425-430 of the bill and decide for yourself what it means for grandma:

http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf


It is interesting to me how much space is dedicated to regulating end-of-life services for senior citizens. For whatever reason, this is clearly an area of health care that the policy-makers want completely spelled out ahead of time.
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Conclusions – After spending hours pouring over the health care bill proposed by members of Congress, many things are still unclear to me. One thing, however, is as clear as day – transparency in the specifics of the policies they are proposing is not a top priority for these guys.

Second, the various news stories and reports in the media about the health care reform bill should under no circumstance be taken at face value. Just because someone who writes a widely-circulated article states that something is a “myth” or a “truth” concerning health care reform (or anything else either, really) does not make it so.

Lastly, if you found reading this article to be tedious, you should try reading the health care reform bill!

http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf