Sunday, June 11, 2017

Health Care

Health care is complicated  … if you insist on attaching ring-o-levio capitalism to it. Even Donald Trump, who likes things as simple as capitalism unencumbered by rules and regulations, has said “I have to tell you, it’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

Gadfly dissents. Health Care can be as simple as Medicare for All. You may call it by other names such as: National Health Care, Universal Health Care, or Single Payer Care. Most folks, even Seniors who object to socialist anything, such as socialized medicine, are passionate about Medicare. At a town hall in Oklahoma, held by a Congressman in his home district, he was told by a voter, “You tell the government to keep its hands off my Medicare.” Oklahoma, as we know, is a very red state.

In the previous Administration, President Obama took a baby step in the direction of National Health Care with the Affordable Care Act (ACA). The Republicans maligned it, calling it Obama Care. Strangely, it was much favored by most corporations whose costs for employee benefits were getting exorbitant. But, for the Americans included in the ACA, if you didn’t like any of the private plans offered in its marketplace concept, there was no public option.

You still had to navigate through the jungle of deductibles, co-pays, co-insurance, and out of pocket expenses. You would need a Humvee with a PCP (primary care physician) co-pilot at the ready with a laptop computer and a 7-column spreadsheet. The HMOs, PPOs, EPOs, and POS plans are ever on the prowl, and those carnivores view you as prey. 

The private insurers insist that private industry will always be more efficient than the government and produce better results less expensively. Let’s see. The private health insurance industry has administrative costs (beyond what they pay to doctors and hospitals) of 15 to 25%. These include: salaries paid to senior executives, salaries of clerks who check on the accuracy of medical claim forms, dividends paid to stockholders, marketing costs, and the cost of hired guns known as lobbyists. The administrative costs of Medicare include none of the above and are kept down to 3% (three percent). 

The US health care industry is costly, but how about the excellence of the care? We can look at the rate of infant mortality and the rate of healthy life expectancy. The US does not do well in either — not even in the best 25 of nations surveyed. You might expect Japan and Iceland and Finland and Norway to do better than the US; but Italy and Greece? Yet. the US spends more, per person, on private health care than anyone else does on national health care. Even Maggie Thatcher didn’t try to privatize Great Britain’s National Health Service.

How do we get more health for our dollar? First, we must change to some system of universal health care coverage. Call it “Medicare for All” so no one will scream Socialized Medicine. Then, make it true health care, not just medical care. preventive care must have at least equal status with medical care. What we eat, how we move (exercise), and how we relax are generally more important than any medications we may use. Add eliminating abuse to the lifestyle list — don’t take heroin, cocaine, psychedelic (hallucinogenic) drugs; don’t smoke; always wear a seat belt riding in a car, even in an armored HumVee. Don’t drink alcohol to excess — more than 2 glasses of (red) wine is excessive.

Physicians are very good at examining and testing — they generally get paid for each. They think that prevention is mostly a matter of more examining and testing. On a large scale, it’s called screening. But, it’s all just finding disease early, not actually preventing it. Establishing a diagnosis, and then treating the disease (usually with prescription meds) doesn’t pay so well (except for the pharmacist and pharmaceutical company).

It is known that lifestyle factors, as noted above, can be preventive for most  chronic disease: 
   Diet that is largely plant-based (but low in carbohydrates) and free of toxic chemicals is a good starting point. Then, to insure getting all the 5,100 vital nutrients, a Variety Diet is key — not the same old favorite foods.  
   As to effective exercise, strength training (weights & machines) will maintain muscle mass and bone density. But, to beneficially change carbohydrate, fat, and protein metabolism and to better balance the neurotransmitters of the brain — high grade aerobic exercise is needed. The definition of high grade aerobic specifies: a rhythmic use of  the large muscle groups in a weight bearing way, far enough, fast enough, and often enough. I have seen a physician prescribe exercise for prevention only once. She wrote on her Rx pad: “Exercise.” When a medical insurance company recognizes that exercise can be preventive, they offer a six month membership in a fitness center. All the while, the medical literature reports that aerobic exercise will reduce the incidence of breast cancer by over 50%, and colorectal cancer by as much as 75%, and hypertension, diabetes 2, obesity, coronary heart disease …
   Relaxation, while less effective than exercise and diet, is also important. Meditation is the one procedure that has been tested in the clinical laboratory and should be included in the Wellness Triad. 
There you have it. CDC&P (Centers for Disease Control & Prevention, after an extensive review of the medical literature, concluded that 70% of all chronic disease can be prevented by lifestyle means. Dr. Koop, in an article in the JAMA, was in full agreement, yet ignored by the medical profession.

So. here in the US, we have an opportunity to do better than France, Germany, Britain, Canada, Australia, and all the other industrialized nations. The answer is Medicare for All for medical insurance and the Wellness Triad for preventive care. We need not feel sorry for the poor pharmaceutical companies which will cease making obscene amounts of profit. They can just cut down on costs such as hiring such an expensive cadre of lobbyists.

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