Sunday, August 30, 2009

No more of this sick-care system; we need a public option plan

The healthcare debates have gotten more intense since my last post. It seems as though most of the politicians want to pass a healthcare bill that doesn't have a public option; but as I've heard multiple times, if it doesn't include a public option, it's not healthcare reform.

Why do we need a public option in healthcare reform? Well, there are many issues with our healthcare system as it now stands. We spend more on healthcare than any other country yet don't rank nearly as high in terms of life expectancy and overall quality of life as some other countries which have more of a public option plan in their healthcare system. Maggie Mahar, author of the book Money-Driven Medicine that got made into a documentary, explains that three decades of research at Dartmouth University show that this is due to the fact that there is a great amount of waste in the system - nearly one third of the more than $2 trillion spent on healthcare is spent on "ineffective, often unproven procedures, overpriced drugs and devices, that are no better than the drugs and devices they are replacing... unnecessary hospitalizations, unnecessary tests." There is no limit on spending for healthcare in the US, and it has gotten out of control. Another point made in the documentary is that our system is based on physicians "doing" things (tests, procedures, appointments) instead of being focused on improving the health of the patient. We don't have a patient-centered model anymore, even though medical students take the Hippocratic Oath to put the patients first. Why is this? Because medicine and healthcare have become intertwined with the free market economy of the US. Hospitals took a corporate model when they began to hire MBA professionals as CEOs of hospitals instead of MDs. Doctors are influenced by the pharmaceutical industry and product makers who are trying to sell items to them, and the patient-centered model takes the back burner because doctors are getting paid based on the most expensive tests they can conduct, not on the most efficient way they can instill positive healthy change in their patients. This corporate model has its foundations in being legally bound to put its shareholders first (i.e. in front of the patients). Maggie Mahar says that in healthcare, this is akin to the Swahili saying that "'when the elephants fight, the grass is trampled'; - the patients are essentially the grass."

Concerned citizens and patients are not the only ones who have an issue with our sick-care system (as that's what it really is). Many physicians have expressed frustration with not having enough time to spend with patients, and feeling that they are being told what to do although that may not necessarily be the right thing to do. They fear that the quality of care they are providing for their patients is diminishing. There's not just one blameworthy party here - the failing system is a product of the clash between the free market economy and the need to provide healthcare. It's a shame we let it get this far, with nutrition-related healthcare issues spiraling out of control and doctors not even being taught sufficiently about nutrition during medical school. I often wonder why med students take the Hippocratic Oath to help their patients, and yet don't follow Hippocrates' mantra "let food by thy medicine and let thy medicine be thy food." At least physicians are starting to band together for Physicians for a National Health Program and the Physicians Committee for Responsible Medicine. Given the incredible debt most medical students find themselves in due to med school tuition and malpractice insurance costs, in addition to an institutional emphasis on "more, more, more" tests and procedures, many med students are taking the more lucrative path of specialties, instead of the much more needed, much less respected and underpaid primary care physicians - but not all of them. One medical student at SUNY Downstate Medical College who has not yet been discouraged from primary care has started a blog and Primary Healthcare Discussion Group. He understands that doctors need to focus more on preventive strategies such as nutritional interventions. In regards to our healthcare system, he says we must hope that "US health care gets some form of huge overhaul for the better in the next year(s), otherwise Healthcare itself may become the cause of morbidity and mortality not only on the growing uninsured, but also on all other sectors of American society." According to the Money-Driven Medicine documentary, the corporate healthcare model cannot be sustained because eventually, only the extremely well-to-do patients will have access to it.

We also need a more patient-centered model - and I believe we should use the model that Dr. Neil Calman, the President of the Institute for Family Health, has been using since 2002. He uses EPIC, a Health Information Technology (HIT) system that involves the patient in every step of treatment, from the physician going over charts with a patient and determining a present state of illness, to deciding what the plan of treatment will be and ensuring the information is easily understandable and accessible for the patient to take home after the appointment is over. Dr. Calman explains that the HIT he is such a proponent of (he's on President Obama's HIT advisory board) is that of a "myChart" system where the patient records are available to the patient, and the patient is able to access their medical records online from home as well as send secure emais to their provider. HIT does not refer to a network of information to be shared in between different healthcare institutions for the case of patients who move from one hospital to another - that he refers to as Health Information Exchange (HIE).

I had the opportunity to attend the healthcare rally in Times Square on Saturday Aug. 29, where three thousand people showed up to express their desire for a public option in healthcare reform. There's a lot of confusion as to what a single-payer healthcare system or public option would entail, and if it would cut benefits etc etc. But as discussed in my last post, there's no need to worry about what would happen if (God willing) we can pass a public option plan. There are several really good resources you can check out for more information - "Reality Check" put out by the White House, Tim Foley's healthcare blog, and the House Committee on Education and Labor's website on America's Affordable Health Choices Act.

It doesn't end here, though. Corporations such as the pharmaceutical industry and medical product makers aren't the only ones influencing the healthcare industry. Corporate sponsorship is a huge issue for many organizations, and one I have struggled with as a member of the American Dietetic Association. ADA corporate sponsorship has led to many dubious nutrition recommendations and there are many people who do not respect dietitians and the ADA because of this influence. The ADA supports the use of the USDA's food guide pyramid recommendations, which is influenced to a large extent by lobbying from the dairy and beef industries, according to Marion Nestle's book Food Politics. This understandably has led to a lot of confusion among the general public as to what should be regarded as a healthy diet, which logically is a partial contributor to the upsurge of obesity, diabetes, and heart disease epidemics. (There are other issues, of course - such as corporate advertising of unhealthy food, as well as unsanitary and dangerous chemical treatment of foods - but you can read about these elsewhere on this blog.)

Fortunately, there is a progressive group of dietitians that belong to a subgroup called the Hunger and Environmental Nutrition Dietetic Practice Group, which has some pretty strong advocates who are on the verge of making a taskforce to take on the corporate sponsorship issue within the ADA. The importance of changing to sponsors who are more concerned about public health should not be underestimated. It's embarrassing that I have a bag from an ADA conference that has a logo proudly announcing its sponsorship by PepsiCo.

1 comment:

Kelly said...

Sen. Kennedy wrote a letter to the Pope before he died, in which he mentioned his valiant effort to pass a productive health care reform bill. Here's an excerpt:

"I also want you to know that even though I am ill, I am committed to do everything I can to achieve access to health care for everyone in my country. This has been the political cause of my life. I believe in a conscience protection for Catholics in the health field, and I'll to advocate for it as my colleagues in the Senate and I work to develop an overall national health policy that guarantees health care for everyone."