Health Care for the Masses:Health Care for the Masses:
Ignorance as a Leading Cause of Death...
Those of you who are not old friends, probably are not aware that my variegated occupational background includes 35 years of work as a cardiovascular technologist and nurse, both within the USA and abroad. There was a time in my life when I felt that the provision of health care was a satisfying and honorable trade, but that was before I entered an undergrad program in Health Services Administration back in the 70s and was introduced to theoretical philosopher-economist Ivan Illich and his brilliant insights into the guts of the modern health care establishment.
It was Illich who first focused my awareness on exactly what I was co-dependently helping to foster, as a minor practitioner of medical technology and as a "low-grade" nurse (LVN). Illich managed, through the facilities of Antioch University (that wonderful, quirky "touchie-feelie" institute of higher learning), to help strip away all the layers of my own naive ignorance of functional health care systems and reveal the modern medical establishment for what it actually is: simply another consumer arena in which human illness and suffering is capitalised upon by powerful private and corporate interests. [Before I go any further, however, let me say that there are honest souls who truly believe that they are practicing medicine purely from a desire to help their fellow human beings; regrettably, there are many far more well-suited ways to do this than by first graduating with a medical degree and practicing 'western' medicine. Having said that, fasten your seat belts.....]
An understanding of the historic background of our present system of finely tuned medical care exploitation is, however, first in order. Even more helpful as a precursor background would be a basic understanding of the traditional European academic processes, through which higher levels of learning were rewarded by the award of advanced degrees (i.e. "Master", "Doctor", etc.) that certified the expertise and understanding of the recipient in his specific area of knowledge. Unfortunately, this would take far too long to expound upon and suffice it to say that originally (back in the medieval era) a Doctor was simply a learned scholar who happened to complete the highest curricular requirements in some academic discipline or another; being a "Doctor of Medicine" did not necessarily imply skill at being a 'healer' in and of itself, but merely identified a graduate student who had achieved a somewhat more than rudimentary understanding of physical human anatomy and physiology.
In the United States of the 1800s, so lax were the standards governing education in America's era of 19th century frontier expansion, that more frequently than not a "Doctor of Medicine" had obtained his academic certification from a diploma mill, rather than from a legitimate educational institution. Partially as a result of this fact, the town's friendly "Doc" was, in most Western communities, regarded only with slightly more regard than the town drunk, or the spittoon cleaner at the local saloon. Earning potential for such an individual was nominal, and payment for services was more often than not taken in the form of bartered produce or a dozen chickens. Clearly, the town's doctor was neither considered a leading member of most communities, nor was any special cachet of great respect accorded him for these occupational services.
This changed with the formulation, in the late 1800s, of a standard set of medical training and education criteria set forth by mutual agreement of prominent medical figures associated with leading universities in the larger urban areas. These individuals, recognizing the need to elevate the status and prestige of their calling (hence their income, as well), whilst helping to eliminate quacks and other diploma-mill doctors, put in motion the groundwork that would ultimately result in more or less standard curricula for medical education study and training on a graduate level. This was the first and earliest achievement of the new founded American Medical Association.
While this
act did in fact result in the institution of uniformly high standards of education for
medical doctors, it also began the escalation of the status, prestige, and income earning
potential of medical doctors to the highest levels of the professional classes. By the
early 1900s, the power of the American Medical Association was already formidable. By the
1940s, medical doctors were capable of making some of the highest incomes to be found in
entire spectrum of American Middle Class occupations. As costs for medical care rose even
higher, with the happy embrace by the medical establishment of the latest advances in
medical science and technology, it was soon clear that before too long that costs for
individual health care would entirely outstrip the ability of most American citizens to
pay for medical treatment entirely out of their own pockets. At this point, the third part
insurance companies stepped in with a solution that would both allow doctors to maintain
their high income expectations AND allow the average person of humble means to pay his by
then already quite expensive medical bills. This was the start of the Health Insurance
Industry's rise to dizzying heights of importance in the American economy. Physicians as a
class, meanwhile, had become one of the top 'feeders' on the income and social prestige
food chain hierarchy for professional classes in the United States.
Conveniently, the rise of health insurance systems also solved the other major problem posed to pharmaceutical companies: how to preserve or even increase their share of the medical practice wealth generated by physicians, through their increased use of and reliance upon modern drugs and medicines. For a time, all was quiet on the health care front. Physicians were happy because they could allow the costs of technology assisted medicine to continue to soar to the Stratosphere without concern on their part, and the other two legs of the medical economy's Unholy Triad (the Pharmaceutical Companies and the "third-party" Insurance providers) would be able to continue to share the excessive wealth created by the powerful professional medical establishment (much like Remora symbiotically coexist with Sharks).
Unfortunately, as might be reasonably expected under such a careless and basically unconscionable system of mutual wealth enhancement and escalation, something had to give. In time, the amount of out-of-pocket money owed for health care by the patient rose so drastically that it became obvious even to the greediest and most self-serving members of the professional medical establishment that an overhaul of the system was in order. In the finest crisis-management tradition, this eventually took form in the shape of today's managed health care (epitomised by the HMO, or Health Maintenance Organisation), much to the alarm of the AMA. The AMA's fears were well-founded, regrettably, for in the proliferation of the managed health care system several effects obtained. Chiefly, the immense power formerly wielded by the professional physician elite passed firmly over into the hands of profit-seeking corporate interests. This understandably resulted in 1) a marked diminishment of the power and wealth formerly wielded by physicians, and 2) eventually created today's emerging crisis in the provision and maintenance of satisfactory standards of health care for patients that are able to exist independent of ordinary cost of care considerations.
At present, the whole health care scene in the United States has morphed into the unhappy set of complex problems that is today's health care status quo. Not only have doctors been taken down a few notches in terms of the power they exert over our lives, the standard by which medical care is rationed is now firmly (and seemingly irrevocably) tied to profit/loss considerations. When you factor in the additional nuance of ever-increasing need for health care created by burgeoning immigrant and lower-class ethnic populations, it suddenly becomes painfully clear that we now have a monster loose within the health care setting: grossly inadequate and unaffordable care resources availability.
Causing still further alarm is the awareness that probably a full third of the whole population of our nation has no medical or health care plan (in terms of health insurance); sadly, it is now purely and simply impossible to seek even basic, perfunctory medical care without some form or another of this subsidized third-party cost assistance. Thanks for all of this present mess is largely due to the short-sighted, spiritually impoverished, and traditionally self-serving interests of our vaunted American Medical Association (who along with their equally guilty partners in social crime, the immensely wealthy pharmaceutical firms and the health insurance 'industries', richly deserve the lion's share of blame for our present health care crisis).
I had the opportunity, after spending many years working mindlessly in the private medical sector, to join the Kaiser Permanente Group (the first HMO, which began as a factory worker health plan for war workers in the 40s, and that later became the bellwether for all HMO development that followed) as a nurse, some years ago. I was working in a major Kaiser pulmonary clinic for a little over half a year, during which time I was absolutely aghast to discover that each patient seeking care for a pulmonary problem is allotted exactly 15 minutes on the daily clinic schedule. Ironically, a full 5 minutes of that sparce time is consumed by medical minions (such as myself, in taking vital signs and putting a few basic complaints on the medical record for the doctor to use as a starting point), which effectively leaves the patient with 10 minutes or less in which to communicate his concern and undergo a cursory exam by the specialist clinician. It doesn't take long, given the inability of the typical patient to verbally express his concerns effectively and concisely, to realise that this is not anywhere near an acceptable system within which to achieve an adequate level of responsive, appropriate medical treatment.
In fact, if the average patient had more than a few functioning brain cells (and was less in awe of the intimidating 'presence' that status as a "Doctor of Medicine" bestows) for reflectively applied thought, he would quickly realise that this is not just an inadequate system, but a scandalous one as well! Fortunately (for everyone involved in the health care scam that we are all dependent upon), the average patient is still so much overawed by the 'Wizard of Oz-like' status of the professional care-giving provider, that he (or she) hesitates to accept that intuitive feeling that truly, something stinks in this modern medical Wonderland of ours!
Regrettably, it is far too late to effectively turn this galloping monster back towards the corral. We are now stuck with a system that is clearly inadequate for the needs of most middle-class people and completely out of reach, whether a good system or bad, for a large percentage of the lower economic classes of our entire population.
As
for those Joan of Arc-like and loudly outspoken champions of health care, the professional
nurses (that is, those with an RN certification or beyond), it is well advised to take
their frequent and tearful public declamations of inadequate medical care quality and
'lowered standards of patient care' (their favorite catch-phrase motto) with a grain of NaCl.
Whereas the Registered Nurse was historically the chart-carrying hand-maiden cum
servant of the professional doctor 50 years ago, despite their progress in elevating their
professional status in recent years they have long resented the fact that they have not
been able to share the spoils at the top of the health-care provision pyramid on an equal
footing with physicians. They also resent the fact that they have traditionally had to do
all of the dirty work for doctors and hospitals, while the physicians have just as
traditionally received all of the glory and status of their 'noble' calling. It is just as
much this long-smoldering resentment over inequities, as much as legitimate outrage over
lowered quality of care standards, that is responsible for the monthly 5 PM TV news
spectacle we have grown familiar with, of nurses striking and boycotting health care
facilities. Despite all the emotional fireworks and breast-beating theatrics of
these Florence Nightingale surrogates, that the press so loves to capture on video clips,
these women (and men) are no dummies--they would like more money and status just
as much as they would like to see health care standards maintained. Don't think for a
moment that it is entirely or solely about patient care.....it's about money, power, and
professional status. Anyone who fails to understand this fact truly fails to exercise
intuitive intelligence adequately.
Of course, let's not forget that other horrible co-dependent facilitator of the modern health care mess we find ourselves in today: the legal establishment. Like so many nasty, snarling jackals, the lawyers have practically built up their practices on top of the whole process, quite eager and ready to suck the monetary flesh right off the bones of all involved: the physicians, pharmaceutical firms, HMOs, patients, and health insurance industries alike. Medical malpractice lawsuits (or the mere threat of one) constitute probably the single most formidable obstacle that keeps any reasonable or fair-minded solution to the current mess from being agreed upon and brought into being by all the players. Unhappy as it may be, in a nation that is reputed to purportedly contain almost 60% of the world's entire attorney population, we are firmly caught up in the remorseless jaws of these legal predators, bereft of any hope of ever getting away from them long enough to give the problems facing us some balanced, sane, and egalitarian, non-partisan consideration.
And there it is, folks. Ivan Illich saw it in sharp focus many years ago, while formulating his opinions in Mexico. Today, it is all very much as he postulated. 'Economic iatrogenics' indeed! In summary, I suppose one might say that any system that insists on tying every single aspect of contemporary life (society, art, morals, economy, culture, demographics, aesthetics, politics, etc.) to a hard, cold bottom line of dollar valuation, is ultimately doomed to a fall just as irrevocable as that suffered by all the late, great (and equally greed-preoccupied) civilisations of our world. We appear to be no exception, as unhappy as that may seem.
Hence, next time you have a strange or troubling suite of symptoms that have defied medical explanation, despite repeated trips to your local clinic shaman, and once again seek some sort of satisfactory resolution from a physician, consider this bit of wisdom: You have a choice of either staying home in bed for two weeks, or taking a 14 day course of snake oil elixer and sugar pills from your local health care provider; either way, the result will be the same (you'll either live or you'll die....).
Good luck on your next clinic visit, friends........as statistics appear to show, you'll definitely need it.....
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FOR AN EXCELLENT ARTICLE ON THE CURRENT HMO SITUATION, PLEASE DIAL UP THE FOLLOWING URL: http://www.msnbc.com/news/519868.asp
The happy crew in the photo at the top of the page were among my colleagues at the King Fahad SANG Hospital in Riyadh in 1994; contrary to appearances, they were a wonderful bunch of guys and I would not have hesitated to trust my life to any of them. A bit further down appears part of a cartoon series that I produced while in basic medical training as an Air Force medic in 1967--such was my impression of medicine at that time. Finally, the last photo is of me between PTCA procedures at King Faisal Specialist Hospital & Research Center in Riyadh, in happier times. Happy Western New Year and Gung Hay Fat Choi on 24 January 2000!
