Archive for March 6th, 2009

America’s Health

Back when I was blogging on my university server, I wrote this on July 12, 2007: (link)

The President in 2009 should call a “Health Summit” of leading hospitals, the AMA, insurance companies, patient advocates and other interested parties to try to craft a way to achieve the goal of assuring health care for all Americans without financially strapping the poor or creating a gigantic government agency.  The President should lay down a challenge: ‘The American people want quality heath care, affordable, and available to everyone.   Many want a national health care plan, and Congress will take that issue up.  But perhaps you stakeholders can come up with an alternative that may be more effective and which will be transparent and can be assessed’…The best bet is to see whether or not, given the public shift towards wanting major reform in the health industry, the relevant players can’t themselves figure out a plan they can make work with government only involved in assuring transparency and assessing that the plan does as promised.”

I am not used to the President doing what I call for in my blog!  I am used to Presidents having a fundamentally different mindset than myself, and still am trying to get used to having a President who actually thinks pretty much the same way I do on politics.   Yesterday President Obama had such a summit, supported by meetings by citizens groups across the country over the past year.   It seems almost a certainty that health care reform will finally come to the US.

Health care is in crisis, and now opponents of the 1992 Clinton plan are lining up to be part of the solution.  Part of this is good politics by Obama — you don’t look to create an internally driven plan and then try to ram it through Congress without consulting and taking seriously the interests and needs of the stakeholders.  Insurance companies, hospital associations, labor unions and business leaders all have legitimate interests, and none of them are ‘bad.’   Insurance companies are finding it hard to break even given sky rocketing health costs, hospitals are losing money and risk bankruptcy.  Here in Maine the state is years behind in Medicaid payments to hospitals because it can’t afford to pay.  Companies are hurt by high insurance costs, which contribute to layoffs.   We’re in this together.

The way in which the health care system has fallen apart in the US is analogous to the collapse of the I-35W bridge in Minneapolis two years ago, or the inability of the US to deal with Katrina — to this day there remains suffering and unresolved problems, and that disaster hit in 2005!   Simply, the country is in a steep decline and unable to detail with internal problems.  The infrastructure is erroding, the government is increasingly too weak to respond, and the health care system is dysfunctional.

Simply, the problems with the US health care system are symbolic of the problems facing the country.   The way to approach this is symbolic of what the country must do to get itself back on track.

The problem is multi-dimensional.   CNN had a story yesterday about how the economic crisis is helping military recruitment, though only 25% of the population 17-30 is eligible to serve.  The rest don’t meet physical requirements, usually because of obesity.   Obviously one reason health costs are soaring is because people aren’t taking care of themselves, aren’t exercising, and don’t live healthy lifestyles.   You can get away with this when you’re younger, but as people age these poor habits catch up, and we see spikes of diabetes, heart disease, high blood pressure, and other expensive but avoidable ills.   This obesity epidemic is a result of a “you can have it all” culture that says consumption has no consequence.   People are even told that we should consider it “OK” to be fat; that it is a ‘life choice’ that should be respected in order not to damage the self-esteem of the obese amongst us.

Now, I don’t want to be cruel to fat people, and though I exercise, I would love to drop 10 or 20 pounds.  Yet the fact is that real obesity — people who need to lose more like 40 or 50 pounds or more — damages lives; there should be a campaign against obesity much like the campaign against smoking.  It not only condemns people to health problems later in life, but the quality of life sinks, and the costs to the public are immense.

Yet, obviously, that’s only a contributing factor.  Another is the high cost and proliferation of prescription drugs.  It’s gotten to the point that commercials target the audience and urge them to go to the doctor and ask for a drug by name, often to deal with minor problems that seem on their face to be less severe than the side effects of the drug.   The problem is that today’s aging boomers are from the ‘culture of youth’ where growing old was seen as something bad, to be avoided.  Gotta keep the wrinkles away, can’t accept aches and pains, need to medicate every inconvenience or potential difficulty!  The result is an over-medicated country, and companies that aren’t striving for things to help improve peoples’ health, but the newest profit making drug — who will find the next viagra (to assure that 55 year olds can have the sex drive they had at 25).

And all this doesn’t even touch the issues involving governmental policy, underfunding of programs, and gaps that leave even otherwise healthy hard working Americans uninsured, afraid to go to the hospital because they may not afford it.  And while the wealthy may sniff that “hospitals won’t turn anyone with a problem away,” the truth is they’ll also go after the money in a way that can lead people to financial ruin.  For many uninsured, the gamble to avoid the doctor is worth it.   But when they lose, families can lose a parent and/or breadwinner.

So I wish them luck in the effort to craft a health care reform proposal this year.  I hope that they keep in mind that this is not just a failure of policy, but also a symptom of deeper cultural ills, in part caused by our society’s penchant for consequence-free consumerism.   Just as the credit crisis wasn’t caused by banks alone but by the credit and consumption crazy culture, this is deeper than just patching up laws.

If they do this right — develop policies that can work, address issues like obesity, emphasize preventitive care, reign in the drug companies and develop a holistic plan that sees health care as touching all aspects of Ameircan life — they may find they have template for solving our other problems as well.