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





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