The Titanic. Photo by Jens Schlueter/Getty Images
A veritable sea of ink has already been spilled impugning the planned replacement for the Affordable Care Act (ACA). One would think that when a product launch is so soundly repulsed by both its intended demand, and its intended supply, it would give the vendor pause. But so-called healthcare in the U.S. has long defied any such logic, if not logic altogether, so we surely can’t count on it.
I oppose the replacement plan, in the company of essentially every individual and organization I respect or trust, and for all the same reasons. But since those reasons –the likelihood of millions losing coverage, cost burdens shifted to those who can handle them least, the likely reallocation of healthcare dollars by states to other causes, financial benefits to those who least need them, the failure to enroll people until sick dooming the system financially- have been expressed so emphatically and ubiquitously by others, I won’t belabor them here in their particulars. I will simply say “amen,” and shift to a more general perspective.
To get it, let’s return to that sea I mentioned at the start, and put something like the Titanic on it, ourselves on its deck, and the inevitable iceberg up ahead. As we stare at the looming doom, as the actual passengers did back in 1912, let’s add a plot twist and put Democratic and Republican co-captains on our bridge.
For starters, we need to note that we got into this fix- a large ship bearing down on an iceberg- on the watch of both co-captains; no one on that bridge is entirely innocent. That is true of our healthcare system too. But want of full exoneration does not commensurate culpability make.
Seeing the imminent calamity to ship and crew and passengers, the democratic co-captain wants to throw the engines into full reverse, with some hope of missing the iceberg still, and more hope of saving the ship and all the lives aboard. She knows, of course, it would have been far better to have planned a different route, anticipated icebergs, controlled ship speed in advance, but all that is quite literally now water under the bridge. A hard reverse is the best way to save lives.
But the republican co-captain disagrees; not necessarily about outcomes, but about priorities. A hard reverse at high speed will almost certainly damage the ship irreparably, and damage from so obvious a human error would preclude insurance coverage (it’s in the fine print). Since his private equity friends financed the ship, they will be very upset if it winds up uninsurably broken on his watch. Fortunately, if the ship is destroyed by a so-called “act of God,” for which an iceberg encounter qualifies, the insurance company will be on the hook. And since they can pass the mess along to a re-insurance company, almost everybody wins, except for everybody who loses.
Of course, hitting the iceberg means a lot more serious casualties; but this captain is not the “go down with the ship” type, and won’t be one of them. He put in a call for a helicopter before ever casting his vote. Come what may, he’ll be in a bar on shore, drinking martinis. He can read about it tomorrow.
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So, there’s one if by sea; let’s examine our healthcare inanities on land, too. Imagine Humpty Dumpty sitting on that wall, on a beautiful day, as the birds sing. The wall, representing the U.S. healthcare system, is of course high, unprotected, with jagged rocks at its base. We count on personal responsibility to prevent calamity.
That mention, by the way, warrants a very brief digression. The very factions in our government that call most often and stridently for personal responsibility to manage health apply it least to matters of government. Those very factions refuse, again and again, to invest in the “preventive medicine” of infrastructure repairs and upgrades. The very factions telling us that responsible individuals take care of health problems before they develop only attend to the nation’s health problems after they are established, if not catastrophic. Now, back to our regularly scheduled program.
Sitting there on his wall, Humpty has, poor fellow, very little money to his name. Along comes a vendor in the calm spring air, inviting him to buy health insurance for much more money than he has in the bank, or an iPhone for less money than he has in his pocket. He buys the iPhone, of course, just as any human (or good egg) in the real world of seductively pernicious defaults would.
Immediately after, alas, gale force winds blow him off the wall, and the rest is history. He now has a pre-existing condition, and while he can’t be denied coverage, he can be offered coverage he cannot possibly afford. Because the “system” did nothing to make the wall safe in the first place, his injuries are quite horrific. The costs of attending to them, however they will be paid for, will be astronomical. But what’s worse is that, despite the best efforts of the King’s horses and men, we still lack the means to unscramble an egg. Humpty, in other words, is pretty much toast.
These cheeky illustrations are about nothing less serious than years lost needlessly from lives, and life lost needlessly from years. They redound to our great shame. A better managed Titanic would have far better choices than how best to hit an iceberg. A better managed wall would do much to prevent falls and injuries.
Healthcare might, I suppose, even take a lesson from nutrition. In nutrition, we have focused for decades on select nutrients in sequence, seeking scapegoat or silver bullet, at the expense of wholesome foods in sensible arrangements, and the costs have been calamitous to public health. This parade of boondoggles, in tandem with predatory profiteering, has siphoned away countless years from lives, and immeasurable life from years, too.
We have done nothing but repeat the follies of history with healthcare coverage as well, focusing always on dollars at the expense of sense. Although the Affordable Care Act is certainly an effort in the right direction, it is a half measure; the compromise product of opposing factions. We have never managed to put together a healthcare system that is first and foremost about health, and care. After decades of frustration, I would settle for even one out of two.
A system about health would be seeking ways to cultivate exactly that, not just treat often unnecessary disease after it develops and advances. An even better system would invest actively in health promotion, and the promulgation of lifestyle practices, social supports, and environmental exposures conducive to it. As noted, the ACA did not do enough of this- but it moved in the right general direction. The replacement plan, of course, annihilates all such provisions.
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A system about care would seek out models of genuine caring, models that make patients feel true comfort, security, and confidence. The ACA had provisions aimed in that general direction, and- need I even say it?- they are road kill on the ramp to the replacement.
It would not take much to have a better healthcare coverage and delivery system than we have here, and certainly than we are headed toward now, in the U.S. Countries all around the world spend less for better outcomes. We could borrow ideas that have been proven elsewhere, and maybe all that stands in the way is isolationist conceit. That both money and lives should be lost to that vice is a national disgrace.
The fundamental problem with the system we call “health care” is that it isn’t about health, or care; it is mostly about disease and money. The Affordable Care Act has been a partial correction- the best that could be navigated through a divided government.
A better managed health care system would save both lives and money. It would simply require that, first and foremost, it be about health, and/or care; more about lives, and less about money.
Don’t hold your breath, and look out for icebergs.
David L. Katz, MD, MPH – President, American College of Lifestyle Medicine; Founder, True Health Initiative
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This article was sourced from http://forumsnews.info