Wednesday, March 10, 2010

The Elephant in the Health Care Room

It's the topic that's been dominating the evening news for years: How do we fix our health care system? The responses to this question have run an emotional gamut similar to the Elisabeth Kubler-Ross stages of grief. The first stage is denial. We've seen that in truckloads from certain protesters inside and outside of Town Hall meetings last year, wailing desperately to preserve a status quo which in their skewed view of reality means keeping the government out of Medicare. The most popular stage all across the ideological spectrum seems to be the second stage: anger. Anger at President Obama for trying to institute socialist health care. Anger at President Obama for not trying to institute single payer universal health care. Anger at insurance companies for their usurous rates and pre-existing condition exclusions. Anger at the government for inaction, proposed action, imaginary action, ad nauseum. There's been a lot of bargaining, the third stage, as the compromise between the House and Senate approaches its conclusion on the bill for proposed health care reform. These responses have ranged from, "Well, if they can just squeeze the public option in, then I'll support it" to, "If they pass this socialist bill, then I'll get my health care in Costa Rica". (Real smart, Rush, Costa Rica has universal health care!) Then there are many in the fourth stage, depression, who don't believe anything will change, or that any good will come from this current effort at reform. I believe that the fifth stage, acceptance, is that whatever form the bill ends up in, this is the way the system changes within the context of our current paradigm. Slowly, incrementally, shaky enough to rock the boat for some, but never radical enough to flip it upside down. Every change, big or small, must fit into the Infinite Growth Paradigm.

But what happens when the paradigm collapses? This is the proverbial elephant in the living room where real health care reform is concerned. When our economic infrastructure predicated on infinite growth collides with the physical limitations of our planet, that infrastructure is toast. How will that collapse affect our health care system? That is the subject of a wonderful article written by Daniel Bednarz published in the July/August 2007 issue of Orion magazine. Just the first two paragraphs spell out the connection between Peak Oil and pharmaceuticals and how dependent our health care system is on oil and natural gas:

Medicine After Oil

It could be distributed a lot more democratically

by Daniel Bednarz

Published in the July/August 2007 issue of Orion magazine

The scale and subtlety of our country’s dependency on oil and natural gas cannot be overstated. Nowhere is this truer than in our medical system.
Petrochemicals are used to manufacture analgesics, antihistamines, antibiotics, antibacterials, rectal suppositories, cough syrups, lubricants, creams, ointments, salves, and many gels. Processed plastics made with oil are used in heart valves and other esoteric medical equipment. Petrochemicals are used in radiological dyes and films, intravenous tubing, syringes, and oxygen masks. In all but rare instances, fossil fuels heat and cool buildings and supply electricity. Ambulances and helicopter “life flights” depend on petroleum, as do personnel who travel to and from medical workplaces in motor vehicles. Supplies and equipment are shipped—often from overseas—in petroleum-powered carriers. In addition there are the subtle consequences of fossil fuel reliance. A recently retired doctor informs me, “In orthopedics we used to set fractures mostly by feel and knowing the mechanics of how the fractures were created. I doubt that many of the present orthopedists could do a good job if you took away their [energy-powered] fluoroscope or X-ray.”

What I love about this article is that the author doesn't give into despair and say, "We're doomed!" There will be options. Here are some:

At present we have a tiered health-care system. At the top is a Ferrari model of care that reflects our affluence, fascination with technology, and extravagance. Ferrari care has made possible the treatment of rare life-threatening diseases and expensive procedures like organ transplants, but it has also been used for esoteric and often redundant testing and vanity procedures such as botox injections. At the bottom is a jalopy model serving over 50 million un- and underinsured Americans who very often receive no treatment, defer treatment until their condition cannot be ignored, or face economic ruin when they seek adequate care. If the two tiers persist after peak oil, they will eventually be preserved by force—armed guards at gated medical facilities—for the few able to pay, while the rest of Americans are relegated to the jalopy and faced with overt rationing, triage, and curtailment of medical care. Such an outcome would be an overt contravention of democratic values—most Americans tell pollsters they believe that health care is a human right, not a privilege awarded those with higher income.
What then should we do? The best democratic option is to replace both the Ferrari and the jalopy with a Honda. The post-peak Honda health-care model will of necessity operate with fewer overall resources and less energy than today’s health-care system, and at lower cost. But it need not result in poorer quality of care. Although the United States spends more on health than any other nation—per capita health-care costs in this country are three times those in Great Britain and more than twice those in Canada—we do not have the best health outcomes. A study in the Journal of the American Medical Association in 2006, for example, reported that “white, middle-aged Americans—even those who are rich—are far less healthy than their peers in England.”
The commonsensical Honda model will emphasize public health—the prevention of disease and the promotion of health within the population as a whole—over treatment medicine, which focuses on restoring health to chronically or acutely ill individuals. Typically accomplished through the diffusion of information, low-cost therapies, and the promotion of healthful nutrition and lifestyle, preventive medicine allows people to avoid or postpone disease, and to stay clear of the costliest and most energy-intensive sectors of the medical system—doctors’ offices, pharmacies, and the hospital. In the Honda model, treatment medicine would continue, but its role would be brought into better balance with the vastly more cost-effective and energy-efficient mode of preventive health care.
The public health system arose in the early decades of the last century as a response to fears of infectious diseases in our country’s crowded cities. Its outlook is inherently egalitarian—if the entire community is not protected, then no one’s health is assured. Public health is no longer the force it was when it sent “ladies in white uniforms” into communities to preach the Gospel of Germs, explaining the relationship between hygiene and disease prevention. Today, public health is overburdened and underfunded, receiving about 5 percent of health-care dollars, with the balance going to treatment medicine and to biomedical research.

This is what I consider a great example of optimistic practicality. If only we could come to a consensus within our country now that this should be our moral outlook within our health care system: "if the entire community is not protected, then no one’s health is assured."
Please read the entire article at the link in the prior blog entry today.

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