Tuesday, November 23, 2010

Medical Self Care Has Its Time Come

What do you do when you find some greatness in an article but cannot agree with most of its prescriptions?  I rewrote it into my own piece leaving out what I thought was pure nonsense. Below is my version of the article:

1. All health insurance plans promote irresponsibility to some extent. People begin to believe that their doctor is responsible for keeping them healthy, not themselves.  It might be good to not carry insurance at all but I recommend very high deductible insurance. Some might choose to go without insurance as they can pay after the treatment, most hospitals will set up payments. 

2. Health insurance is a scheme, with the healthy paying for the old and chronically ill and those with poor health habits, though I should add that smokers actually cost insurance plans less money over the long haul since they die sooner.  Clearly by logic more than half of people will pay less for health care if they do not carry insurance. 

3. With a large pool of money available, the insurance pot gets raided and doctors and hospitals overcharge since there is no market control. There is nothing the plan won't pay for, no matter how expensive, because the desperate public will demand it. You learn your mother has breast cancer. You will stop at nothing to see she gets the most advanced care, and the more her disease progresses, the more you will demand something be done, even unproven treatment.

4. High-tech care caused Americans to falsely believe their healthcare system is the best in the world, and they want more of it. Fancy imaging technology (cat scans, MRIs), unproven but less invasive particle beam radiation treatment, robotic surgery – all are in huge public demand. A Rand Corporation study showed high-technology is the main driver in the high cost of health care.

We are living a fantasy to believe American government can provide all the high-tech medical care that is available (example: latest New York Times article suggests $5000 disease gene testing for all).

5. About 85% of Americans have health insurance. To provide insurance to the remaining population, largely illegal immigrants, places financial and manpower strains on the delivery of health care that the industry is not prepared for. It was Winston Churchill who said: "The inherent vice of capitalism is the unequal sharing of the blessings. The inherent blessing of socialism is the equal sharing of misery."

6. Because other countries provide universal health insurance is only to say the bills are paid. This represents provision (welfare) for doctors and hospitals. The system rewards treatment, not cure. Modern medicine has substituted markers of poor health, such as cholesterol, PSA, blood pressure, rather than true end points, such as survival or being drug free.

While many Americans envy countries that offer universal health care, most universal health care plans will soon fail. The National Health Service in Britain is about to implode.

The day is fast coming when health insurance schemes collapse and self care becomes the order of the day. But many Americans aren’t ready for this.

Certainly many Americans are angry at the passage of Obamacare. But a man I met at a Postal Annex store said he needed the insurance coverage and welcomed it, as he has problems with his joints and diabetes. He wanted the medicines that only the insured can afford.

However, Obamacare, or even the pre-existing healthcare system, would not make him any healthier. But this man, along with many other Americans, has no perception of this.

Drugs will be prescribed for him that calm symptoms but never restore health and in fact may create new diseases. Some drugs cause the very disease they are intended to treat.

Obamacare pays more doctor and hospital bills, but it will also increase utilization and overall costs and it burdens the economy with higher health insurance premiums. AT&T reports Obamacare will cost them an extra $1 billion a year. For the 85% of Americans who were already covered by health insurance, Obamacare is a step down in availability of care. But recognize, the system is collapsing and unaffordable regardless of the insurance scheme in place.

Obamacare only adds to the nation’s growing healthcare bill. Medicare is not only insolvent, but it has $60 trillion of future obligations it cannot meet. The day is fast coming when health insurance cards will be worthless. American government will have to default on its promise to provide health care for all, especially its retirees, Obamacare or not.

Yes, other countries provide universal care, but they aren’t facing a population bulge of Baby Boomers now entering Medicare age, nor do other countries have so much unnecessary care (estimated $700 billion of needless care in the Medicare system, the Congressional Budget Office estimates). For example, PSA tests, mammograms and coronary angiograms have recently been reported to be of marginal value or over-prescribed.

Private practice American medicine can’t be compared to other countries that provide universal care. In those countries, their doctors on a fixed salary. More and more US doctors are now opting out of private practice and taking a salaried job.

However, the American public mistakenly believes their insurance companies are holding out on them and they are undertreated and deserve more care, not less. With Obamacare, Americans will experience more rationed care.

7. Waiting lines for care will predictably lengthen as there simply aren’t enough primary care doctors to handle the increased patient load. Americans are going to have difficulty getting used to delayed care instead of the accustomed care on demand.

Wait-a-while medicine is part of most universal health insurance programs worldwide. For example, in Canada, once target budgets are expended, patients wait months for a cataract removal/lens implant operation. During that wait time, if you fall and break your hip because you couldn’t see a step while walking in the dark, and then you succumb to pneumonia while laid up from the hip surgery, no one will blame it on delayed care.

8. Universal care just delivers more needless and ineffective care. Americans involved in the healthcare debate are arguing over the wrong issues. Americans want freedom to choose their health plan, their doctor, their hospital. This is not the problem. If you have no money, you can no more have the freedom to choose your doctor and health plan than to choose whether you would like to buy a Chevy or a Cadillac at the car lot. You can’t have these freedoms when treatment is no longer affordable. And why does the American public keep clamoring for care that doesn’t work and is even harmful?

The only three proven medical technologies are vaccinations, antibiotics, Trauma care like  mending broken bones; replacing cloudy cataracts;  repairing decayed teeth, drugs for the mentally ill. The rest are questionable.
Forty years of telling the cholesterol lie makes it difficult to undo the false cholesterol phobia. For example, eggs, loaded with cholesterol, have not been found to raise circulating cholesterol levels. For the majority of U.S. adults age 25+, consumption of one egg a day accounts for less than 1% of coronary heat disease risk. Health insurance pays for many false cures and unproven medical technologies. Universal health care seeks to pay for more of the same.

Americans have a knee-jerk reaction when they hear of panels who will decide whether your loved ones receive care in the last days of their lives. But Americans fail to realize hundreds of thousands of old and dying Americans are prescribed medicines that reduce pain but hasten death.

9. Self care is an underutilized option. However, Americans have been trained to run to the doctor when anything ails them. The typical senior American is taking a number of inappropriate medications and afraid to stop taking any of them.

Self care is not something doctors and hospitals want to promote. One would think managed care plans would promote self care because they would theoretically get to keep more per capita money that way, but they want to keep costs high so their cut of the financial pie remains lucrative.
Even in countries which provide universal payment for health care, there is increasing awareness that self care is a better route to take. One consultant in Britain says "the time has come to break the national dependency upon the National Health Service….. which denies the confidence to take control of their own and their families’ health."

Costa Ricans and Jamacans are almost as health and long lived as Americans with far less medical care.  In the medicine vaccination yeild, I would guess, over 90% of the benefits.  The rest of care helps here and there but if you have been vaccinated you got most of it.  That is why Costa Ricans and Jamacans are almost as health and long lived as Americans

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