Advising the Obama team on healthcare

28 12 2008

The Obama transition team asked for community input on healthcare reform. Here are the questions they were asking, and my responses to them:

1.   Briefly, from your own experience, what do you perceive is the biggest problem in the health system?


      Healthcare is currently based on the treatment of symptoms, usually through pharmaceutical methods. The model should be moved in the direction of finding root causes of illness, and focusing on the root cause rather than focusing on symptoms. That is a matter of education, primarily. Also, people should be rewarded for proactively preventing illness, since prevention reduces dependence on the healthcare system. 



2.   How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers?


      I choose by asking others who they go to and who they would recommend. I rarely see a “gatekeeper” physician, preferring to take responsibility for my own health.


      Public policy should reward physicians who successfully move their patients to individual responsibility rather than rewarding those who see the most patients, because the “quantity, not quality” paradigm encourages the use of pharmaceutical fixes of symptoms, which eventually leads to more prolonged and burdensome end-of-life illnesses. Policy should also look at redefining laws regarding “practicing medicine without a license” to allow traditional naturopaths and health coaches more latitude in their work with clients, since they can successfully help their clients reduce their reliance on the healthcare system.



3.   Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem?


      Haven’t yet experienced difficulty keeping up, but anticipate the possibility in the future due to family members with expensive dental problems and degenerating vision problems.


      No specific ideas on this one other than the obvious ones:  put a cap on medical expenses, with the cap reduced for early childhood and people on permanent disability or social security; make a higher percentage of medical expenses tax deductible and/or tax free; and provide a predefined and guaranteed level of care for all individuals (e.g. UK’s National Health Service).


4.   In addition to employer-based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?


      Yes, especially to help the unemployed, self-employed, and part-time workers.



5.   Do you know how much you or your employer pays for health insurance? What should an employer’s role be in a reformed health care system?


      In my home state, employers are required to pay for health insurance. This keeps wages lower, makes it harder for small businesses to survive, and is a burden on all employers. I would like to see the expense spread out so that the burden is shared by all, rather than being solely the responsibility of employers.


      With an insurance pool, employers could be rewarded by encouraging healthy lifestyle habits among their employees, since they could purchase health insurance at a lower premium. In other words, they could buy primarily accident and emergency insurance, and would not be forced to pay for expensive medical treatments for those who should share responsibility for illness developed due to lifestyle choices (e.g. most heart disease due to poor dietary choices, lung cancer and emphysema from smoking, diabetes from poor diet and lack of exercise, some forms of arthritis, etc.) In other words, if somebody wants to smoke, drink, be obese and not exercise, they should expect to pay a higher medical premium, and if someone wants to consciously live a healthy lifestyle, they should not have to subsidize the insurance for those who do not make healthy choices.


      Also, insurance coverage should include a broader recognition of alternative therapies, and should include dental and vision care as a part of basic coverage.



6.   Below are examples of the types of preventive services Americans should receive. Have you gotten the prevention you should have? If not, how can public policy help?


      I have gotten the screenings and preventative measures I felt I should have. I have not had a flu shot and do not intend to get one in the foreseeable future, but I do use a variety of public service screenings to monitor my health and fine-tune my lifestyle choices to stay within healthy parameters.



7.   How can public policy promote healthier lifestyles?


      I have mentioned several items above, and have included others below:


·         Reduced insurance costs for those who elect healthy lifestyles

·         Remove or reduce legal restrictions on traditional naturopaths, nutritionists, health coaches and others who offer alternatives that keep people from having to rely on allopathic medicine

·         Reward physicians who wean their patients from reliance on the healthcare system

·         Do not allow pharmaceutical companies to patent natural medicines

·         Develop a creative commons for researching new medications

·         Ban public advertisements for pharmaceutical products

·         Ban payments to physicians for prescribing certain drugs


      Going outside of the healthcare arena:


·         Automobile disincentives to reward alternative means of commuting

·         A Healthy America campaign, with participation in the campaign being recognized as a form of public service




20 12 2008

An audience of dandelion-blowing kids gathers around to see what is so curious. They have spent part of the summer morning chasing through a field playing tag, sending dandelion umbrellas floating into the sky with a single breath, collecting ladybugs, tentatively tasting a wild berry that was not yet ripe … but now, they gathered around a new curiousity.

Stooped in the middle of the group, on center stage as it were — although the setting is in a meadow — a young girl no more than seven years old reaches out to touch the leaves of the plant she just discovered.

“Watch,” she said.

As her finger neared the leaf, the leaf quickly closed itself by folding the edges into the middle.

The other kids in the group abandoned their dandelions to look for more of the same kind of plant. Their attention did not move on to other magical bits of the day until everyone had their fill of the mysterious leaves that seemed to shrink shyly away from human contact. It was a sensitivity plant, or sensitive plant, they soon learned.

That moment had many echoes throughout the years. There was an echo when walking through a thick patch of ice plant … the polar opposite of the sensitivity plant. That was on the seashore, where the sea anenome makes a very similar gesture to the sensitivity plant as it captures food carried on the tide, closing itself upon its unsuspecting prey — as well as closing at the touch of a child’s finger. There was a strong echo of the sensitivity plant when picking a basketful of fiddle-head ferns for a salad. They had to be picked at the right season, and the right time of day, before they opened their leaves for the day. And there is a faint echo of the sensitivity plant every year as the seasons change and different facets of the natural world go into dormancy, pulling back to a protective stance.

Years later, the thread that started that day in the meadow would be revived for one of the students when he learned in a botany class that the mimosa pudica was a carnivorous plant, and when the leaves closed, the plant was hoping to enfold an insect small enough to ingest for a bit of nutrition. A magical moment of childhood resolved by finding a scientific explanation. The moment from childhood was no less magical, but the universe was one step closer to having a comfortable explanation.

Discovery seems to satisfy a deep urge in people. Something as simple as the sensitivity plant may already be known to millions of other people, but the moment when one particular child reaches out a finger for the first time and sees the plant respond to them … that is always magical, no matter when and no matter where it takes place.

That sense of wonder, that awe, is repeated in a kaleidoscope of different situations for children who are just discovering the universe on their own. The magic eventually evolves into a structured way of looking at the universe, a way of explaining away the parts that are not yet understood, or that have not yet been discovered. The world view evolves into a familiar structure, but that does not mean that there are no more surprises, no more discoveries to be made.

It just means that the way one’s mind understands the universe is sufficient at the moment. There are no overwhelming mysteries, no anomalies so obvious that they cannot be ignored.

That is not to say that there are no anomalies. It’s just that the mind has a way of ignoring what it doesn’t understand … ignoring the unknown until it is impossible to deny its existence. The proverbial “elephant in the room” that may be obvious to most people, but is invisible to anyone whose view of the universe has not yet discovered a rational explanation for elephants.