7 Ways Health Care Could Be Improved in the US

So after a year of debate that was full of backroom deals, posturing and ultimately the demise of anything resembling bipartisanship, we have a radical but weakly constructed Health Care Insurance reform law aptly and anemically named: The Affordable Care Act.

Okay, before I discuss what I hate about this bill, let me make some concessions to my liberal friends:

• Yes, this goes way further than anyone has gone before;
  
  
• Yes, it is good to do away with the discriminatory practices of the predatory health insurance industry such a pre-existing conditions and dropping insurance when one is sick;
  
  
• Yes, there are some immediate benefits that are helping some people; and
  
  
• Yes, this will most likely result in some improvements both in the cost and delivery of health care.

But this is a drop in the proverbial bucket and Michelle Obama's anti-childhood obesity campaign tells me all I need to know about how much this administration knows they have failed to produce real change. Just like the Clintons in 1994, blaming fat people is a great way to blow smoke and use mirrors to make the failure disappear.

So why am I profoundly disappointed in this bill?

• First, no public option other than some lame expansions of Medicaid and some temporary fixes like High Risk pools which will go away when the full non-existing condition prohibition goes in effect in 2014.
  
  
• Leaving these lame expansions in the hands of states and demanding that states provide matching funds. Nevada's a-hole of a governor (and my boss--I'm technically a state employee) Jim Gibbons had decided that it is better to sue the federal government than provide the extra medicaid and high risk pools. Thus, a beggar-thy-neighbor affect has already begun. And yes, he's acquiescing but it is really too little too late.
  
  
• No effort has been made to even begin to address social inequities inherent in medical relationships or to ask the hard questions about the money and power held by hospitals, pharmaceuticals, physicians, insurance companies and other big-time players in the system. (Like, I don't know, maybe a regulatory system that allows patient's complaints to be heard.)
  
  
• Health care coverage is still tied to work. This is a ridiculous idea and it belies the latent function of health care in America: keeping the working class compliant. This is not a natural fit at all and all the celebration of tax credits is a perfect example of politicians pretending they are doings something when they are not.
  
  
• In fact, the health care tax credits for personal income tax is essentially making school loan debt, tax debt and non-payment or being behind in child support payments a death sentence. If you don't have enough money to pay these things, you probably are not going to have enough money to buy insurance. If you get the tax credit to supposedly help pay for insurance, it goes to pay these other debts, which means you have no money to pay for the insurance the government requires. This in turn means you will owe more taxes because of the penalty and therefore you will be further in debt and the cycle continues.
  
  
• But the biggest reason I find this law to be distasteful is that millions of Americans who have been bullied and mistreated by the nation's health insurance industry are now going to be forced to buy insurance from that same group of people. You see the dirty little secret is that the insurance industry knew they were in a win-win situation.
  
  OOH, if reform failed, their unbridled profiteering at the expense of our health and well-being would continue unimpeded. OTOH, if reform passed without a public option, then a whole new group of people would be forced to buy insurance. Not that wonderful group they hate -- the sick, but that wonderful group they love -- the young folk who rarely get sick.
  
  Now let me make this clear -- for a universal system to work, mandatory insurance has to be a part of it. The whole concept is that everyone buys in whether they are sick or not, then the cost for all is lowered and the protection for all is in place. But that is only valid IF everyone receives the same protection. This bill leaves in place all sorts of stratification, meaning that young people and their parents (till they are 26) are going to get the short end of the stick, or in other words, the stick is going to be stuck someplace where the sun don't shine.

If I believed that people in Washington really saw this as a first step towards true reform, I'd be more excited. But as near as I can tell they are all celebrating the victory or mouthing off about repeal and no one is discussing the next move.

The fact is no one has really faced some fundamental truths about for-profit health care systems, and as long as lobbying and corporate money flows unimpeded, they are probably not going to face those facts. As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

So not ever wanting to be simply "anti" anything, I offer some specific Ways to Improve Health Care in the United States. Some of these are shifts in perspectives, while others are downright practical:

1. True reform must begin with understanding the collective nature of health care. Germs do not care which bodies they infect. The water, soil, air and environment surround us all. Our well-being is collective and pretending this is an individual's business only is costing us. All health care is public health care. This basic fact is radical because it is the crux of the whole debate. When other countries debated how to achieve universal health care they took this as a given and then discussed reform. Americans are still pretending that they are in total control of their lives and it is costing them their health, their well-being and their livelihoods. This paradigm shift has to happen or we will never achieve good health care that is sustainable.
   
   
2. We must eliminate the primacy and monopoly that allopathic medicine and the physicians who practice it have on our health. What little regulation through licensing and academic accreditation that we have gives a virtual monopoly on this form of medicine and it is to our peril. The reason chronic illnesses are on the rise in the United States is that practitioners who have methods to address these conditions are systematically pushed aside in favor of the "magic pill" form of medicine. I love what surgery and pharmaceuticals can do. I'm alive because of advances in these areas, but I am, along with millions of others, in daily pain and disabled because these are the only advances that have been encouraged. Any reform that does not get rid of the monopoly of the allopathic doctor and overblown reward that monopoly affords him or her is going to fail. We need multiple modalities and we need to be rewarding these modalities and allowing them flourish.
   
   
3. We need to allow more locally based systems in the practice of medicine while finding ways to use economies of scale in the acquisition of resources. In other words, local communities should have more control over their clinics and practitioners but acquisition and distribution of equipment and medicines should be organized in such a way that lowers costs. Such organizational schemes are not without precedent but they are often defeated by monied interests. There should be no reason we cannot have medical boards in a community that oversee the practices of health care providers locally and still have vaccinations, medical supplies and equipment bought on a national scale and distributed according to local needs.
   
   
4. We need to divorce health care from wage slavery. This is not a natural marriage. It has a specific and sordid history and if we really want to have health care for all, this marriage must die. As long as health care is connected to employment we are enslaved by both systems. It's just that simple.
   
   
5. We need to recognize that it IS NOT and it NEVER CAN BE a level playing field between health care provider and sick person. This means it should never be "for-profit." The provider is always going to have far more information than the sick person. The sick person is in desperate straights when ill and therefore does not have time or ability to seek out good information and shop for the best price, best service and so forth. Thus, the opportunity for price gouging and fraud is always present. It cannot help but be corrupted and therefore it can never be a free market. Pretending that the patient is a "client" is ridiculous. In our current system, we cannot trust our providers. How do we know they have our best interest at heart? We cannot truly know if a doctor is prescribing a drug because we need it or because he owns stock in the company that produces it. We cannot know if the procedure the doctor suggests is because it is the best thing for us or if he just needs to pay for his daughter's tuition this month. We think we trust our doctors, but how can we know the purity of their motives when they make more money when we are sick than when we are well?
   
   
6. We need to recognize that social ills create much of our personal ills. If we really wanted to lower our health care costs we would be working towards the end of poverty, we would be working towards a better ecological balance and we would be working towards the end of war and violence. Corruption, pollution, violence and lack of access to care are the leading causes of ill health. We will not be serious about improving our health and well-being until we are seriously trying to change these things.
   
   
7. Finally, related to #6, but not quite the same thing, is we need to end stigma and the medicalization of prejudices. Far from improving our collective well-being, the unintended consequences of many public health programs is to reinforce stereotypes, prop up bullying and paternalistic behaviors of bigots and mark people as less than human because of who they are or who they associate with. There is beginning to be ample evidence to support the notion that stigma leads to ill-health. Creating programs that continue to stigmatize, even if it is "unintended" will make true health care reform impossible.

Yeah, I know, if you made it this far, you are probably saying, "Yeah, but..." Well, reform is supposed to be change. Reform is supposed to be something radical. The so-called reform we have to date is just same ole, ahem, well you know. If we really want change, if we really want reform, we are going to change our core values. Right now we care more about profit than people, we care more about ideology than truth and we care more about getting our way and not having to make any sacrifices than we do about life and the future. There is a price to be paid for everything we believe that is not true. The price this time might be our lives, our children's lives, our civilization, and our planet. We cannot afford anything but reform.