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Portland, OR, United States
I am finishing up my midwifery apprenticeship and plan to be a real midwife early in 2014!

Friday, February 15, 2008

The Health Care Issue

While you're considering political issues and who to vote for, read my friend Monica's excellent and common-sense approach to what we all need.


architect said...

I read the article, and I must admit that I agree, as long as I'm the one to determine how to keep everyone healthy. =) However, our society believes in vaccines and anti-biotics and many other interventions which I believe causes ill health.

To me a commonsence approach would be: good nutrition through sound agriculture practice (think organic, with quality compost,) good information on how to treat common diseases without a need for doctor intervention (ie: vit c for pertussis, colds, flus; selenium for viruses; vit a for measles; etc,) and then have full blown research on the proper use of herbs. I would keep doctors around to deal with high trauma injuries, and that is about it.

But as I said, our society believes in the wrong thing, so if collective health became our system's healthcare choice, we would all HAVE to be vaccinated, and be FORCED to take abx, and have to SUBMIT to numerous tests, so I won't commit to Monica's idea.
Fun thoughts though.

architect said...

Oi, I just noticed that my dh totally changed his information. Ah well, you know it is me, right?

Elizabeth said...

Ha! Yes, I know it's you, Cuz! ;-)

I think the issues you're bringing up are a whole 'nother issue. Coverage for health care and how that health care should be implemented are two separate things. I think all these things start with good prenatal care, a good birth (you and I think alike on that one) and breastfeeding (another area where you and I agree). Good nutrition is a must. And then all the other issues kind of fall into place.

But there are times when medical intervention is necessary. Monica's little boy, Simeon, was born with a malformed ear. (She goes into more details on her blog.) Through no fault of her own or anyone else's, Simeon was born with health problems that need attention. She's honest in saying that we ALL need to take responsibility for our health issues, not just make it one party's "fault".

I agree with everything you said in your second paragraph. But I don't agree necessarily with the Big Brother scenario that you present in your third paragraph. I think safeguards would need to be continued to ensure that we all have choice in our own health issues.

Anyone familiar with how things are done in countries with socialized medicine? Are vaccinations and tests forced there? (More than vaccinations are forced here, hmm?)

ElizO said...

I agree with you, Elizabeth, that coverage for health care is mostly a different issue from what preventive and treatment measures are used. People may disagree about the optimal treatments for various conditions, but if people at least have access to something that has some evidence for effectiveness, that is a big improvement from where we are now.

I'm sure I don't need to rant here about the poor job our system does as a whole (e.g., see http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=640980), at higher cost ( see http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=362803). I also agree that our food policies are heavily stacked against optimal health, with lower-income folks bearing the brunt of the flood of cheap, unhealthy food in country.

The place where I do see a risk of increased pressure for mandated preventive services and treatment (where coverage and treatment approaches may overlap), is with the movement for "pay-for-performance" approaches, where providers are rewarded financially when they meet certain goals. All the research I've read on this so far is in non-profit systems that are making strenuous efforts to figure out which services have the strongest evidence base and the potential for the greatest good. Pay-for-performance that I've read about has involved things like screening X% of patients for high blood pressure or cervical cancer, and assumes that it is not feasible and/or appropriate to screen everyone, so they set the percentages somewhere below 100%, which gives patients the ability to opt out without undue pressure usually.

However, I do worry that this could be a slippery slope, and that if electable government officials got into the business of setting performance targets, then this system could be really, really vulnerable to $influence$ from lovely things like the pharmaceutical industry, who only have our best interests at heart, right? Nevertheless, I believe universal health care coverage is absolutely vital as a first step for improving the health of this nation. I do think that the fight won't be over if we get it, though.

architect said...

Oi! How many elizabeths do we have here? lol

Thank you for spelling out our agreements so nicely - so I won't bring those up, just want to start the subject, knowing we are on the same page.

Right now in my state (California) medical intervention is based on what the CDC recommends. If I took myself in to a Dr, the only information that he can LEGALLY tell me, is what the CDC says is appropriate treatment (drugs or surgery,) even if people using alternative methods have better results. If my child needed some intervention, for genetic reasons or whatever, I would want a health care practiner who has evaluted all treatments including homeopathic, herbal, chiropractic, accupuncture, drugs, surgery etc, and then allow me and the child to decide the best plan for us. Right now this isn't happening, and until it is, I don't want to pay for it.

Since our medical system is currently owned by the CDC and FDA, there is not much freedom for alternative methods, although, as a fringe group it is thriving because it works. If I told you, straight out, to eat ginger for your cough, you could easily get me in big trouble with the gov't for offering medical advice without a license. You laugh - but something similar happened on the mothering.com discussion boards.

If health care is given to every one, there is always someone who has to pay. Right now, I'm in the group who pays, but I refuse to utilize the service it gives because the whole health care industry is rotten to the core. So, while I strongly desire to live in a country of healthy individuals (those who feel right, will act right) I don't want to have to pay for a corrupt health care system that makes everyone sick!

We really can't compare our country with other countries, because of how much $$$$ the pharmacetical companies pour into electing our so called representatives. Since our officals are pretty much owned by the drug companies, I don't see any reason to hope for positive change in the future.

btw, fun discussion!

ElizO said...

I'd say that neither the FDA nor the CDC are funded well enough to own the health care system--I think you'll have to look to the pharmaceutical, device, and insurance industries for the real drivers of health care policy!

Honestly, I've worked with quite a few people at the CDC in the course of working on health services research projects, and found them all to be intelligent, hard-working, and well-meaning people, though usually frustrated by the unwieldy bureaucracy of the place.

Here's a little tidbit about the FDA I only recently learned about. They are too poorly funded to be able to complete reviews for new drugs quickly enough, so they charge companies submitting drug and devices users fees to do the reviews. In other words, the FDA depends on the pharmaceutical and medical device industry for funding in order to do its basic work. Is this not a conflict of interest??