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.

  1. #1 by Mike Lovell on March 6, 2009 - 16:14

    “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”

    Part of the problem with this, as I see it anyways, is caused by the arguments laid forth by education advocates, lawyers, and of course the people who felt the need to reclassify what is the proper weight (i.e.- normal, overweight, obese, morbidly obese, etc). Now bear with me, I might go all over the place here really quickly.

    For many years the United States strived to be the leader in education. And for many years we were. As the Department of Education grew, the money flowing into the education sysytem grew immensely. If I remember correctly, despite Reagan wanting to eliminate most or all of it, he instead doubled it. Over the years, this money has continued to increase, yet most of it goes to the bureacratic and administrative sections, with a small percentage actually making it to the classroom level. Local control always bowed to the supreme power and knowledge of those at the state and federal levels. More of this, more of that, and at the same time, bring the special education kids up to par witht he other students. It seems instead of bringing them up, we have slowly over the years retarded the growth of the “normal” students until some sense of equilibrium was achieved. (personal note…despite being one fo the “good” public schools in the DSM metro area, my kid is only now bringing home work that reflects what I was doing a grade prior). Rarely does one fail, despite their grades, but is often passed on to the next grade level, enabling them to fall farther behind for lack of knowing the foundations required for the new courses. So they start paring down recreational activities like Physical Education, recesses, and the like. And yet, as you monitor the world’s standings in education, despite massive spending increases, we have slipped considerably in the elementary and secondary levels of education.

    We strived to be the most competitive in sporting events such as the olympics (partially as part of the Cold War competition between the U.S and U.S.S.R.)
    We pushed the Presidential Fitness Challenge, we pushed sports on kids. You were recognized for athletic achievements, not mere participation like you see in many organizations today. I mean, why try when yu get a medal or trophy just for showing up?

    Lawyers step in, and now people get sued because someone was clumsy and tripped on a crack in yur sidewalk. A kid gets injured playing tag at recess, or dodgeball in gym class, and these activities are reduced or eliminated altogether. Less strenuous activities are being introduced, which just goes to reduce the kids’ ability to burn off calories, to tone and build muscle etc.

    So the kids are now getting lazier, less motivated, and also told that they are perfect even if they are 8 gazillion pounds overweight. Because we don’t want to damage their fragile self esteem, we continue to make exceptions for what is what. And yet, you have health advocates telling adults now, that what you weigh, may have been normal before, but now “our science” has decided that you are classified as obese, or overweight. The kids in the latter two categories got upgraded to morbidly obese.

    So we complain that our kids are all overweight and we need to do something about it. But we cant give them any more time in the gymnasium, and any form of playing is for all intents and purposes banned because of litigious worries. Educators are saying we can’t give more gym time because it interferes with the much more needed classtime.

    And yet most of us, who are old enough, remember getting plenty of both learning and physical education. Some kids were a bit hefty, others were too skinny (like me), and others fell right in line where they needed to be. Some of us were smart, others were average, and some kids just didn’t get it and had to get the additional help. And if you didn’t make the grade, you had to do it all over again,until you were satisfactory enough to move on.

    But if we’re serious about the obesity issue, we’ll give the kids more of what they need (gym classes and games that invovled actual physical activity during recess), we’ll remove the money makers that are called vending machines (which didn’t exist in my school until I was a sophmore, but too poor to afford after I bought my own groceries at home). And maybe, just maybe, if we sent the money where it would actually make a difference in their learning curve, that would be a step in the right direction to re-introduce the gym time as far as the obesity thing goes.

  2. #2 by Scott Erb on March 6, 2009 - 16:22

    I’m with you Mike! Life has dangers, kids trip on cracks in the blacktop, and things happen. Trying to use law suits to create some kind of perfect environment of safety is simply to try to deny reality. Let kids play and explore! I agree completely!

    Self-esteem is another misunderstood issue. Someone with self-esteem can be criticized or even insulted, and not be too bothered. That’s what self-esteem is, it’s knowing and appreciating yourself enough not to let others have power over your self-image. So trying to “protect” self-esteem by avoiding anything that might hurt someones’ feelings is really just protecting their LACK of self-esteem.

  3. #3 by henitsirk on March 7, 2009 - 03:18

    I’m not sure we can fix our health insurance issues in this country without somehow detaching medicine and money. As you said, health insurance companies’ interests are valid — because they are companies (or rather corporations), and therefore their main motive is profit. That’s not bad — that’s how the game is set up.

    Now, health insurance companies saw that promoting relatively inexpensive preventive care was a way to maximize profits (by minimizing later risk of catastrophic illness), and hey — it helps people too, great. But they also saw that sharply delineating and limiting healthcare coverage also maximizes profits by minimizing risk of catastrophic claims, so they do that too. (And of course employers are in this game too, because they want to minimize risk so that their portion of the cost is lower.)

    So you have what should be purely medical issues being affected by financial considerations. In my experience in the health insurance industry (9 years, 1993-2002), the overall structure was partly dictated by medicine and partly by money, although if you went far enough down the line into appealing denied services, you ended up with just medical personnel for the most part. It’s a very complicated game, but a game it is — how can we balance the needs of the insured, the insured’s employer, and the insurance company’s shareholders?

    The other wrinkle is that after so many years of relatively inexpensive and comprehensive managed care, in which the cost to the consumer was quite low and the amount of care available increased (and aggressively promoted, in the case of preventive care), the consumer began to see insurance coverage as a right instead of a financial agreement. The misconception arose that health insurance companies were denying the consumer’s ability to obtain care. Not so: the insurance companies were merely denying that they would pay for the care. I know that could be considered splitting hairs given the high cost of many procedures and prescriptions, but it’s still the truth — a health insurance cannot block you from getting any health care you want.

    I’m not sure that any of this would be vastly improved with nationalized/socialized healthcare, but at least centralized management might make things simpler in a sense — less complexity in the number and varieties of coverage, consistency in policies and procedures, standardization of the financial aspects, etc. Medicare has its problems, but the policies and reimbursements come from a single source and are communicated consistently to providers and consumers. If you know how Medicare works, it’s easy to handle because it’s standardized.

    I’m not necessarily a big apologist for health insurance companies, but it seems to me that people are not seeing the facts behind all the emotional aspects. Health and money just don’t mix well.

  4. #4 by Lee on March 8, 2009 - 01:27

    I am frustrated by our health care system too. And I would agree that there needs to be a sea change in what we as Americans do to keep our good health. I think if we could somehow stop the “super sizing” of fast food that a large number of people would become less ‘large.’ I am continually mystified that many american ingest as many calories with a McDonalds meal as some people eat all day.

    I have been a vegetarian for around 20 or so yrs now and my weight has always stayed within 5 pounds plus or minus. I exercise but more in lifestyle things of hiking, playing with the kids etc. I’d like more but for now my days at a dojo are a distant memory.

    I also see a society who increasingly amuses itself with video games and may wind up with well toned thumbs but big behinds. Sadly, also the lack of gym time is a big thing in our area as well. More and more time is needed to teach to the MCAS test and those luxuries like gym class are pitched out the door.

    I would say that affordable health care is of huge concern to me with a growing and still young family. Health insurance could certainly block me from getting services, prescriptions or a procedure because the reality is there is not a viable way for me to pay for these should my health care not cover them.

  5. #5 by Mike Lovell on March 9, 2009 - 17:08

    ” I think if we could somehow stop the “super sizing” of fast food that a large number of people would become less ‘large.’ I am continually mystified that many american ingest as many calories with a McDonalds meal as some people eat all day.”

    I don’t know about this so much. I have no problem with the option to supersize my meal. I think people need to exercise a little restraint on occasion and not have the stuff everyday. Now I eat a lot of fast food, as I work overnights, and I find the amount of food a little more filling than the high priced junk at convenience stores. I’ll admit my diet of the stuff has allowed my body to go horizontal a bit more than I’d care for, but I also realize that I dont exercise as much as I used to back when I ate nothing but junkfood in those great days of high school sports and being generally more active where I burned off at least as many calories as I took in. (man i miss the days when I could eat a whole herd of moose and a field of grain followed by an entire plant’s daily production of soda and not worry about getting fat) And due to my economic situation I am not allowed to sleep that much and makes dropping weight a bit harder than a person who gets regular amounts of sleep.

    As for our video gaming generation (add that to addicted tv/movie watchers), I’m in agreement..and after awhile I get too bored and have to do something else….if only I wasn’t so lazy I might start exercising! Maybe that’ll be next years resolution…. LOL

  6. #6 by Scott Erb on March 9, 2009 - 17:20

    I know people who say “Wii Fit” is great exercise. Maybe video games and exercise can come together!

    In Italy one thing I noticed is that I always cleaned my plate and never left feeling stuffed. That’s because their restaurant portions were ‘normal,’ not as big as those our restaurant chains provide. That also meant I would have room for dessert. I’m less worried about having the supersize option at fast food places than having massive quantities as a matter of course in restaurants. There you have no option — it might mean an extra meal (my wife usually gets two meals out of one of those), but I’m one who cannot stop eating fries if they are in front of me, no matter how stuffed I am… I can exercise the restraint to say “small” at Burger King for my meal size, but I can’t when the food is right there, on my plate, begging to be eaten…

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