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Tuesday, August 11, 2009

and our responsibility is...

Andrew Weil put up a great article on Huffington Post that should make all of us stop and give some thought: [The Wrong Diagnosis].

Weil's premise is that the analysis of the health care problem is wrong. What the government is currently proposing won't fix it. What the 'other' side is throwing up as a barrier to it also won't help.

Please read Weil's article. He is known for being a naturopathic doctor, but he is a real doctor who came to believe that traditional medicine wasn't solving all the problem. In fact, regular medicine wasn't even addressing the problem.

Oregon's health care plan for the poor ran into this problem in 2008. Basically it's that a poor woman (she isn't the only one but is the most well-known story) was denied treatment for her lung cancer based on assumption it could only extend her dying and not cure her, and instead offered a prescription for end of life. Mean Oregon! Heartless Oregon with its evil right to death with dignity law.

Of course, these accusations were coming from the bunch who want to deny any such insurance to anybody who can't buy it. Logic though wasn't coming into play as the right said this will happen to everyone. Let me see, so instead of having government insurance and being able to appeal the decision, she would have nothing and that would have been better?

Farm Boss heard the story on the radio. When I went digging for more information, all I could find were right wing sites expressing outrage at the poor lady's situation. Despite their only wanting to use this to prove we should have no government insurance (how exactly that would help her is beyond me), the situation does bring up an important point in this debate.

The most expensive treatment in medicine is end of life. IF a patient wants to extend their dying by 6 months or even less, the government (in this case the state of Oregon) should pay for their desire? Is health care to be about extending dying or living?

The thing is what he heard on the radio was that the lady in question had not quit smoking. I saw no such information on any online articles. But it does give us the issue--what if she hadn't? Should the state still continue to pay for this expensive drug? She thinks so: and her doctor thinks so .

The problem is that health care is rising in cost at an astronomical rate. There are some assumptions that not so many years in the future, it will cost half of a working families' income (that's if we do nothing and stay with the status quo).

If there is no recognition that we might be causing some of our own problems, if there is no responsibility for us to act upon that, then the costs can only go up-- or there will be rationing because at some point nobody can really afford those kind of costs.

What if she had been denied this state of the art treatment because she still smoked? Would the far right draw a line in the sand or still say she should get that treatment ($4000 a month for the pills) instead of say a small child get inoculations? Oh wait, the anti-government health care bunch wouldn't have given her any of this to begin thereby solving that problem.

In the case of this lady, her doctor wrote the company that made the drug and they gave it to her for a year with the right to renew her application at the end of that time. The argument he made, and it's a good one is maybe this wouldn't just extend her dying but save her life. He argued that medicine moves fast in its ability to treat such cancers. I couldn't find anything about her current situation or the prognosis, nor whether she finally did quit smoking.

Here is the problem from health care reform. How do we deal with people who are bringing on their own misery through lifestyle choices. There was a time if I had visited a doctor, he'd have said to me-- you need to lose weight-- because I do need to lose weight. Today a doctor is afraid to say that for fear of being sued and yet it's just as true today except we want to hold patients unaccountable for doing anything for themselves. Some of us can still realize we need to lose weight but others figure if the doctor didn't say it, they don't need to do it.

Coincidentally in Huffington was this other article which relates to something I believe and to what Dr. Weil was saying: [8 Ways to Read your Body's Warning Signs for Health].

This is not saying don't go to the doctor at all, but rather to look to your own body and wisdom also. There are some symptoms that require immediate visits to a clinic but how many visits are not that kind? Are there things we can and should be doing instead of reaching for the magic pill or a surgical solution?

I totally relate to the desire to not have to change my ways when I like how they have been but aren't liking the current results. It's a tough thing and the older I get the less I can escape consequences. When I don't exercise enough or do the right kind of exercise, my knees rebel. I noticed it's harder to lift straight off the ground without feeling rebellion in those knees. Whose fault is that? Can medical science address what I won't? Maybe it can but should it?

There is no way I think people should never visit doctors. I believe there are genetic factors that impact health as well as lifestyle choices. Sometimes it's an environmental thing we cannot fix.. I don't believe every problem can be solved by positive thinking, correct breathing, the right exercise and diet, but shouldn't we be responsible for doing what we do know?

Right now it's the insurance companies we are paying, but that means we all pay for people who live reckless lives. We pay through our insurance premiums and through our taxes whether it's insured or uninsured.

Nobody likes to hear talk of the health police but will that have to be part of a health care solution that won't bankrupt us all? What I wonder is how did we, as a culture, go so far off base on our health habits?

17 comments:

Darlene said...

Rain, I think one of the strong reforms being stressed by Obama's health care plan is teaching healthy living and in preventative care. We all know it's cheaper to prevent a disease than to treat it.

I don't think the we can ethically withhold treatment because a person is going to die soon anyway, but I do think that we can demand that they do their part (such as stop smoking if they have lung cancer). I don't know how me mandate that, though.

Another part of the reform is the way the Mayo clinic treats patients with a team of doctors from the outset. Their final recommendation determines the treatment the patient will get. That often means avoiding the costly tests that are unnecessary and are now used by doctors to avoid malpractice (or because they are paid more for ordering them).

Darlene said...

I should preview what I write before publishing instead of after. I guess you know I meant "how we mandate" and not "me". :-(

Rain Trueax said...

I am guessing most of us know what we should do. We just don't do it. If we eat junk food, we know it's fattening. Educating won't change that alone. It could be helped by better school lunches but that is fought by the right where they resent those lunches anyway but if children are taught that eating health helps, might they carry that habit into life?

Ingineer66 said...

It is cheaper to prevent pregnancy than to get an abortion too. Maybe we should teach birth control or abstinence. That should work.
If health care is "free" the demand will just go up and people will have even less reason to try and lead a healthy lifestyle.
Lots of things are good ideas but they do not always work out so well in the real world.

PS this right winger has no problem with school lunches. I resent that some kids get them for free and some do not. If good nutrition is important it should be free for everyone just like the education is. Especially when the entire program seems to be based on lies by the parents. But when Bush tried to require proof of income from parents for a free lunch the left said he was trying to starve kids.

Rain Trueax said...

I like the idea of free school lunches that are nutritious and for all children who request them. The problem is so many kids are educated at home to eat junk that they throw away the good food. Maybe it has to start younger and they need to know why it's good. I don't know as we don't seem to be able to convince adults to live healthily either

Rain Trueax said...

For those who say they don't know why we need to do anything about insurance and health care, here is another story from Sullivan: The View from Your
Sickbed
. These stories are worth reading for understanding the human element to our existing situation.

Diane Widler Wenzel said...

Interesting. The multifacetted medical industry in the United States is unsustainable and becoming more expensive. In a few short years into the future if nothing is done families will be paying a major portion of their income for health care. Why is it our neighbors to the south of us rated higher for better care when they are poorer countries? Our southern neighbors are different because when they were colonized there was not a frontier like the United States. We have a higher population density than when the West was settled meaning we do not have a feeling of community with but a few others in comparison to the whole population. We are sure that the others must be lazy and will take advantage of a government regulated health industry.
The very step of making universal health care a governmental duty is frightening. But my fellow citizens we are not the same anymore as the frontier settlers.
Engineer is hitting on a major chord of truth because when people are given free stuff they abuse it by over using it. I do not see that happening. The use of emergency rooms for people who can not afford early preventative measures, for example simple exercises my doctor has given me for scary aches and pains of aging will save the system. I do not understand the idea of cutting back on unnecessary visits to the doctor.

Rain Trueax said...

I think some people will misuse health care when it's free by going in when they wouldn't do it if they paid $60 out of pocket. There are others who have the coverage and don't use it; so it varies with the person. What I think is good is when they send us a statement of the actual cost of whatever treatment we received; then even if insurance covered it, we know what benefit was involved and the actual cost of what we wanted and can assess its value to our lives. I think a lot of us have no clue of the cost insurance (which means all of us) are paying right now. It's hidden.

Paul said...

Folks follow the money trails and you will find the culprits in the health care debate !!

Diane Widler Wenzel said...

The cost of health care is expensive but not because some people overreact. It will not become more expensive in a govenrnment run system because of overreaction. For example some may go to see the doctor because they are lonely or have not spent the time to learn first aid procedures. I think the big cost in health care is underreacting. In a government run system more people will go when they think they might need a doctor and find that they really needed to do some preventative work. Maybe the lonely person is depressed and tehy could get support before it is more costly to treat them.

Ingineer66 said...

Is the government plan going to cover mental health?

I heard on the news this afternoon that now if you are opposed to government health care it is because you are a racist and do not like having a black president. Are the dems going to play that card every time someone disagrees with them.

Rain Trueax said...

who said that, Ingineer? I think many figure the crazies at the town halls are some racists and you can tell it by the signs they carry, but their objection to health care might be from many reasons. Many of them have it and are ignornat of the costs today for having the system as we do. The birthers are definitely racists in my opinion as this wouldn't be their cause if he was all white instead of only half white.

And parapluie, I don't think being under treated is generally a risk. My mom hardly ever went and she lived to be 85, died in her own bed quickly and with no need to be in nursing homes. You can't ask for more than that or I wouldn't. I know some want to live older than 85, but if I get to that age, I'll be quite satisfied especially if I can go fast like she did. She had maybe one physical in her whole life and was furious at its invasiveness. After that her doctor gave her the bp meds but didn't insist on yearly physicals for her.

My big concern is younger people who do have real symptoms and need to get treatment but can't do it. That is where costs might be greater by putting off dealing with something. It can also be an issue for people (of any age) who need a joint replaced to avoid becoming cripples. We also would save money by making sure insurance covers physical therapy because then people will get it.

Doctors don't always find things right away though. I went two years before they figured out what was wrong with me in my mid 50s. I was going in with a specific set of symptoms and they still couldn't diagnose the problem for years. From what I have read routine physicals catch very little of what is wrong with people except for the blood work. It's why you hear of someone going in for one and dropping dead of a heart attack a year later. So many things are hard to find until there are symptoms and sometimes the symptoms are too late. You cannot save everybody.

The thing is we need to have our overall medical costs going down or the program will be sky high for covering everyone. It's heading that way now.

Frankly I'd favor doing away with co-pays for routine office calls, lowering insurance statements, and covering people for the big stuff. When I was a girl, we paid for our office calls and expected insurance to cover the major tests and surgeries. Now we want it to cover everything and we are paying a high price for that. Most of us are ignorant of what the costs really are unless our clinic sends us a bill telling us and letting us know what insurance covered.

Rain Trueax said...

that should have been a 'week' later not a year :) I am a believer in staying in touch with our bodies, noticing what is not right and then dealing with that. being responsible.

Diane Widler Wenzel said...

http://www.whitehouse.gov/realitycheck/faq

Anonymous said...

I'm not sure that x years of birth control are cheaper than an abortion (somehow, I know not the value of "x", nor the cost of either option at this point in my life); but, I'm fairly certain that having an abortion costs less than carrying a pregnancy to term and raising a child.

We have a problem living healthfully, at least in large part because we are not insects - we don't spend all of our time trying to figure out how to feed ourselves. Abundance is our "problem".

Human reaction to abundance was demonstrated by the non-profit at which I volunteer. During a month-long series of training classes, large numbers of snacks were provided to the participants. Much money was spent on snacks that month. Six months later, during another training session, a drastically smaller supply of snacks was set out. Wonder of wonders, not all of the snacks were consumed; but, the total number consumed was about 1/10 of what had been the case when snacks were bountiful.

We have evolved to grab while the getting is good. Unfortunately, some people will grab at all of the health care they can get (as I've observed a few people with employer-supplied insurance doing). Too, many people will think/feel that they are entitled to try anything/everything that is available - regardless of the efficacy of the medicine/procedure and regardless of the cost. Some people grasp at life as if no one else mattered. Indeed, to some of us, other people matter not at all.
Cop Car

Rain Trueax said...

Robert Reich had a good piece on this issue: How to Fight health care fearmongers and the comments were about as interesting. It appears that a lot of the seniors are worried their Medicare will suffer if this passes. In short, I have mine and who cares about you.

Fran aka Redondowriter said...

I had missed the two pieces in Huffington so thanks for the links. Excellent analysis by you, too, as always.