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Part 136: Reforms in Medicine:
January 10, 2005:
In essay 134 I promised to discuss additional items that need to be cleaned up in the healthcare industry. Lets begin with the attitude of HMO's about what they are doing. The very names they assign and use can tell us a lot about them. For hospitals, clinics, and doctors they assign the name provider. Well, a vending machine is a provider. A doctor is a human being, in most cases a dedicated caring human being. There is no way a doctor should be called a healthcare provider anymore than a friend should be called a friendship provider.
The same nonsense applies to us, the patients. We are called subscribers. In healthcare I do not want to be a subscriber. I do not want to receive a magazine in the mail. I do not want impersonal routine things. I want to visit my doctor and be treated and cared for as a valued human being, a patient of the doctor. I do not want to be a patient of just any doctor. I want to be a patient of my particular doctor with whom I have an ongoing relationship.
A relationship is the key to this. I think there is covert intent in these naming games the HMO's play. The intent is to destroy that personal ongoing relationship between the doctor and the patient. The intent is to depersonalize the relationship. Then, any doctor they decide to provide is the same as any other doctor. It's just a routine machinelike situation. Subscribers come in, subscribers get processed, subscribers get dismissed and it's all automatic and mechanical. There is no consideration for the differences between people or their medical problems. A certain number of subscribers must be processed by each provider on any given day. That is the routine Julie Elgas was following when I was her subscriber. That is why I almost died in her care.
The solution is obvious. The healthcare insurance companies must have serious direct government supervision. They are inherently dishonest and always will be. They must be firmly and directly regulated like any other public utility. Their income and prices must be regulated by law. They must give up control of claims management. But, more importantly, they must be forced to give up control of the doctors and the healthcare facilities. Doctors must be free to treat patients according to their needs rather than by routine. Doctors must go back to being doctors rather than routine healthcare providers. Perhaps Hillary was right about this.
While I am about this, I want to look at the history of this situation. The reason HMO's came into existence was to offset the bad behavior and high costs of the Blues. The HMO's were supposed to provide an alternative. The idea was they would concentrate on preventative medicine. It should not take an Einstein to notice that preventative medicine is most ethical and, in the long run, less expensive. That was the goal.
Now we know the HMO's are just as bad if not worse. We find case after case where people have died because the HMO's refused to pay for preventative procedures. We find other cases where people have died because HMO's have refused to pay for necessary lifesaving procedures, In addition the Blues have reverted to the behavior that caused the HMO's in the first place. The entire industry is involved in deceit and stonewalling. These people must be exposed and brought down. They have proven they won't behave without direct supervision.
I will just outline other things I think are necessary. For one, I think we need to get a great deal more proactive about preventive medicine. Regular medical checkups and screening are the key to this. We cannot lay this all on the industry. The patients are culpable in many cases. We cannot check a patient for cancer if we don't see him. Of course, the HMO's like it fine if the patient does not come in. They can sign up a subscriber and get paid without providing any care. It saves a bundle all down the line.
So the government and employers need to get involved in this. When employers pay all or part of the cost of a plan, they should insist that the employees do their part. There should be company wide campaigns to see that workers make appointments and keep them. The government too should make a real effort to get people to pay attention to their health. Paying attention is the key. No one can cure you if you are unaware of your medical condition. In many cases, particularly cancer and heart problems, the killer can be a silent stalker until it is too late.
Along those lines, there are many things that should be routinely tested for. For example. all women should be screened from puberty for breast cancer. In addition, we need a better method for detecting the disease. Mashing a woman's breast in a vice is uncomfortable and embarrassing. We need research into that. All adult men should be routinely screened for prostrate cancer. And all adult patients should be routinely tested for heart problems. Let's deal aggressively with our number one killers. Then we can look int other things.
In the area of other things, we need a comprehensive program of funded research into causes of diseases. At this time, the main avenue for that approach lies in stem cell research. It is not just unconscionable for our government to oppose that, it is evil. Millions of people will die needlessly, sometimes in extreme despair and agony, if we do not act. If our government will not do that, we must get rid of the scoundrels. This is just one more reason for Groundswell to step up.
Much of what is needed in healthcare and other areas will require
profound changes in the way our government operates. I could go
on forever with essays about wrongdoing in our corporations and
the collusion of our government. There is a great deal more material,
but I have covered enough here to show the pattern. There is a
very obvious need for a new approach. I choose to call that new
approach Groundswell. Call it what you wish, but let's get started.
As to the additional material I will get to some of those issues
in essays on the Forum. For now, it is time to get on with the
remaining issues of this philosophy series.
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