An on-line acquaintance posted this URL ( http://www.aapsonline.org/aaps/brochures/tqm.htm ) on the Net recently, indicating that it was a: "somewhat lengthy -- but very excellent -- exposition about the current state of medicine in the U.S."
While I agreed with her on its containing some accurate assessments of the situation, from my point of view, it was far from complete. (heck, by the time anyone person is able to paint the complete picture, in all its craziness, a generation will have passed, so anything said now, must of necessity be incomplete)
I read it, and it is a fairly honest presentation of internal grievances, taking place between doctors, and insurance, HMO, and possibly governmental regulatory agencies.
Here is my response:
This article deals in minutiae, without addressing what I see as the larger issues:
The medical crisis is really more about money than anything else, i.e., who will pay, how much, and who will get to keep the profits.
Since the money can only originate from the patient base, they are the ones who will pay.
The slice of the financial pie that 'The Medical Establishment' has been taking, has been on the rise for all of the years of my adult life, at least. Regardless of the root causes, or rationalizations for the situation, medical practitioners have had their income increase at a rate faster than most of their patients. People see this financial disparity, and resent it. Once they have been touched by it personally, and have had to pay 'out of pocket', amounts of money that significantly diminish their quality of life, the resentment often curdles into something akin to 'class hatred'.
My guess is that probably 15 to 20% of the American population now falls into this last category, with the figure rising daily. To a lot of them, this article might look like nothing more than in fighting between factions of the wealthy 'Medical Establishment', as to how the money pie will be divided (amongst themselves, of course).
It is pretty obvious that none of the people who have become wealthy (whether moderately or obscenely) as a result of the current state of affairs are getting in line to accept personal pay-cuts. Therefore, the average uninsured member of the 'medical patient underclass' can probably expect the discussions and debates to continue endlessly, in comfortable boardrooms and in fashionable hotel conference rooms, until they (the 'uninsured'... the 21st century equivalent to the 19th century's 'unwashed') either expire, or learn to care for themselves. (I have already opted for the latter.)
It is my contention, based on my life experience, and what I have come to know of human nature, and our social systems, that the present state of affairs will continue to deteriorate until enough of the population (50+%) are uninsured. By that time, the fact that the 'Medical Establishment' is being forced to feed its ever-increasing need for more money on an ever-diminishing slice of the population will cause its collapse. To people who are presently residing in the segment of the population that are uninsured, and existing outside the umbrella of regular, licensed medical care, the collapse has already happened. Of course, I would be thrilled to be proven wrong, if being proven wrong meant that something less extreme, and damaging to our society, were to come along and deal effectively with the disparity, between what the medical establishment currently demands in payment, and what people, uninsured or underinsured people, can afford to pay.
So much for the 'bad guys' in the Medical Establishment. They are, however, only one piece of the puzzle. What about the patients?
People are going to have to realise that medicine begins at home, with prevention. If people wish to practice high-risk lifestyles, eating and drinking alcohol to excess, smoking, not exercising, they should not feel that they are entitled to all of the healthcare that somebody else's money can buy. Absolutely everyone is going to have to get real.
The gnawing question that the Medical Establishment, society and patients alike are wasting their time trying to answer at present, is, where do we draw the line? This question is the embodiment of the difference between bullshit and reality. It's an unanswerable question as long as people abuse what they know to be the truth, on all sides of the issue.
My position is not a position that has anything to do with enforce-ability whatsoever, but with what people know to be the truth, and what they do, or do not do, about that knowledge. If I paint with oils and other toxic substances in an enclosed space, without appropriate air circulation, and sit in front of my computer to the exclusion of any sort of exercise, and eat excessively until I am obese, with self-inflicted high blood pressure, heart disease, diabetes, and am generally a wheezing gob of flesh with liver disease, then I know that I am violating my own common sense. The point is, not to behave this way in the first place, not to argue endlessly about where to draw the line, through an obviously murky and gray central area, which is the place lawyers love the best, and steal most of their money. If people by and large obeyed common sense (even a dumbed-down common sense), in matters of health in the first place, how much of the current crop of sickness would be avoidable, and how much stress would be lifted from the health care system? Remember, I am talking about everyone; businesses and government agencies that behave contrary to common sense where public health is concerned, since they are composed of people, would reflect the same preventive attitude at their end, as the individual would at his/her end.
The vast majority of illness in the USA is self-inflicted, or a result of societal stress, or premeditated business (for profit) and governmental (for power) activity. Our public health conundrum exists for matters of human greed and laziness, more than for any other reasons. Once the very clearly preventable cases are dealt with at the prevention stage, there would be less need to argue about where to draw the line in the cases that remained, especially when the increased productivity of an overall more healthy population was factored in.
Each individual will have to judge for his or her self. At the level of business and government, each individual will also have to judge for themselves. I know the second sentence sounds a little flaky, but the major reason that a lot of business (corporate) and government decisions defy morality is that individuals are to a degree shielded from both public accountability and personal guilt. It is interesting to note that the 'I was only following orders' defense that was disallowed at Nuremberg, is now thriving American corporate and bureaucratic circles to a degree that gives despots everywhere a warm feeling inside, and makes the US Government stance on civil rights appear quite contrived.
As we now drift away from focusing on the Medical Establishment, and the patient, we have to consider how Society-at-Large plays a part in the current situation.
Charges have been made by some parties that the bulk of medical expenditures go to a particular class of patient, who can be described as 'overly concerned with their health', who go running to the doctor at every ache and pain. I disagree with this assessment, in that I acknowledge that the situation exists, but that is both mis-described, and also mis-attributed as a large source of expenditures, because while some people who fit the category will consume huge amounts of expense, others with the same problem, will not. The largest part of health care cost goes to those who are well insured. There is a 'medically privileged' class in the USA, that is composed of government employees and employees of large corporations, especially in the higher echelons, who have unlimited access to medical care, at virtually no personal cost. Since 'they' are not paying in full for the care they receive... who is?
Two broad spectra of individuals who could be described as being 'overly concerned with their health' are, in fact, genuinely ill, their diseases being hypochondria and psychosomatic in nature. An uninsured hypochondriac cannot be much of a drain on the health care system, since such a person will receive very little free attention from the health care system, and an uninsured person suffering from psychosomatic illness will eventually die, while waiting for treatment.
I am sure that psychosomatic illnesses and hypochondria account for a big chunk of health care costs. However, neither, in my opinion, can be classified in terms as mild as 'overly interested in their health, since they are genuine illnesses, in their own right'. Like most everything else, a person's attitude toward health is a fuzzy, gray place in certain areas. As a stroke survivour, I am intensely interested in my own health, but in a manner that involves health care almost not at all, and incurs very little personal cost, except for an occasional bottle of 'One A Day Silver' vitamins, good shoes, a working scale, and a few good diet/ cooking and exercise books and computer software calorie counter/ nutrition programs. The biggest expenditure is in time and commitment, to making sure that none of these very simple tools gather dust.
I believe a lot is determined by the individual's, and the society's overall mental condition, since they are inter-related. American society, and human social structures in general, are in my opinion, clinically insane. There is also less distinction between physical and mental illness than the dichotomy suggests; they are essentially flip sides of the same coin. Illness, by and large, is what happens when stressors exceed an individual's level of stress tolerances, both physical and mental, which vary tremendously from person to person. American society presently presents an enormous disparity, between its spoken social 'reality', and what people know internally to be the truth. It is a society literally drowning in its own lies. While our society may not present as great a level of physical stressors as early 20th century America did, emotional stressors have gone through the roof, causing a shift in the types of illnesses people present with, from physical-stressor induced, to emotional-stressor induced. Once a stressor level exceeds an individual's capacity to resist it, whether it is physical, emotional, or a combination of both, that person will present with illness. Some people are very robust, others, not at all. When an ever-increasing number of people in a society present with 'mental' illness, it says more about the rising level of emotional stressors in the society, than it does about the individuals who become ill.
Another factor, that exacerbates dealing with the situation, is this:
American medicine (and American society at large) also has to put into practice, what they at present only pay the thinnest of lip service to; that physical and psychological illnesses are so closely related that they are in fact different sides of the same coin. American society is p-p-petrified at the thought of mental illness, which is somewhat amusing, since mental illness is running rampant, undiagnosed, and untreated in the population at large. Television really is a mirror of the emotional and intellectual state of the society. The fact that most people are so numb they no longer see all of the ads and most of the programming as indicative of mental illness, is proof of just how deep-seated the craziness is. In addition, our society stands helpless before the everyday onslaught of lies, that pour from the mouths and the pens of their 'leaders': guaranteed government orders are ok but subsidies are not, alcohol is OK but tobacco not, Israelis are ok but Palestinians are not, big cars are good, global warming has not been absolutely proven to have any basis in human activity, ad nauseum. American society presently presents an enormous disparity, between its spoken social 'reality', and what people know internally to be the truth. Such public displays of dishonesty are quite clear, for everyone to see. What sort of emotional state does it engender in the minds of people, to see the 'leaders' (read bosses) of government and business lying through their teeth daily, about just about everything, in their (the bosses) all-important quest for more money and power, especially when they already have more than enough of both? To a large degree, honesty = mental health, and in a society where honesty is suppressed, and people are punished for displaying it, dishonesty = mental illness.
People will have to decide whether or not to lie or tell the truth, and behave honestly, or dishonestly when they go to work each day, and live with the emotional and financial consequences of those decisions. At the same time, though, we are all fish living in the emotionally polluted waters of our society. Much of the 'self-medication' we see, whether it takes the form of drug, alcohol, food abuse, escape into the fantasy of TV, psychosomatic illness, hypochondria, whatever... is a response to environment.
To bring this commentary full circle... back to the issue of medicine, I personally have more faith in traditional Chinese medicine, than I do Western medicine, about 95% of the time, while still favouring Western medicine in cases where surgery, and advanced procedures are concerned. Chinese medicine stumbled onto a lot of the right answers in the preventive medicine and healthful living fields, by trial and error, over 1,000 years ago. By comparison, American medicine is downright primitive, and is just now beginning to take its first baby steps into the area.
Why?
There's not as much profit in telling people what they don't want to hear (that their health is really their own responsibility, in large part), as there is in 'making them well again', once they are sick.
I realise that this commentary is full of holes and omissions, which I will happily leave for you and others to either plug, or tear even further open. The subject is so huge, not even a book of 1,000 pages would be enough to cover it adequately.