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Fixin' Healthcare

Wednesday, January 03, 2007

The Lifestyle Chronicles - Join Your Neighbor, Raise A Barn

Does the health care system contribute to poor health?

That question has troubled me for over 30 years. Initially, my concern centered upon errors of comission and omission. The incorrect diagnosis, the drug reaction, the complication from surgery, inappropriate therapy, incorrect triage. Mistakes that are the nightmares of healthcare providers.

On the other hand, the limits of capability, experience and knowledge are reached all too soon. There is more to know than is known. One of the prices to be paid is the current limitation upon the science and the art of health care. This is reality and the challenge is to determine where and how to push the frontier to improve health status.

During my lifetime health care has been transformed into medical care. And, medical care has become a business. Medical care is focused upon illness, disease and injury, and the process is refined and expanded by business. Middlemen, highly specialized practitioners, peripheral practitioners and technologies abound.

The medical care system finds and treats an expanding array of diagnoses, often without definitive or favorable outcome. Panels of experts change the standards and up the ante for more diagnostic screening and additional therapy. "New and improved, the best in town, we treat more of these than anybody else." Additional medical care opens the door for more mistakes.

The public is focused upon complaints, ailments, illness and disease. Everyone wants their share of individual attention, which includes the most advanced diagnosis and therapy available regardless of cost. The medical care consumer almost always expects more than can be delivered. Furthermore, no individual ever believes they should pay for the bad luck of being sick.

The majority of medical problems are not the result of bad luck or faulty genes. The majority of medical problems are preventable and they cannot be cured by means of medical therapy. Welch, Schwartz and Woloshin are correct when they describe sickness as an epidemic of diagnoses.

Yes, the medical care system does contribute to poor health. Medical care is a process and like the MTA of Kingston Trio fame, you can never get off. That is, unless someone remembers the objective is improved health status. Evidence based medicine is an oxymoron.

Forget about reforming medical care and pursue a transformation of health care. When medical care is the junior partner in the health care system, health status will improve and the financial crisis will have passed.

Let's keep an eye on the West Virginia Medicaid project. They may not be right on all accounts but at least they are doing something. This will take time and it will undoubtedly require mid-course corrections. Meanwhile, other models such as the project for prevention in Rhode Island will come along, and please don't forget Mike Huckabee and Healthy America.

America needs to go to boot camp. Americans need to be inspired to a higher cause. Drawing and giving strength to the community is the most productive pathway to improved health status. It is time to take control of life. No more victims.

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