Tell-A-Vision for the 21st Century
Analysis & History Relevant to HealthCare Reform
Suzanne Arms et al
Overview & Vision: America can’t afford not to reform the way we provide and pay for healthcare. What we need and want is a system that our nation can be proud of – one that is fair and affordable, that preserves individual choice and reliably delivers healthcare that is as safe and cost-effective as any other industrialized country. This laudable goal can be achieved without taxing the middle class, rationing medical services for the elderly, limiting the advance of medical science or turning healthcare over to government bureaucrats. Two trillion a year is more than enough money to treat everyone and compassionately meet every genuine medical need. All that is missing is the right expenditure of our plentiful resources.
Money that is currently being spent unproductively (or unwisely) can be redirected. Forward-thinking reform can introduce science-based changes in how health and medical care is provided and financed, while allowing for scientific innovation and new technology. DNA-based diagnosis, genomics, and the new science of epigenetics will reduce future health care costs by dramatically improving early detection and pre-determining the best drug treatments. To the great joy of many families, stem cell therapy, gene-splicing, and yet to be invented treatments will eliminate many previously untreatable diseases and debilitating conditions.
Health Care is not the same as Medical Care: However most Americans, including many elected officials, don’t understanding the important difference between health care and medical care. On a policy level, we have to acknowledge the distinction between health care and medical care and capitalize on the difference. Health care is a prevention-based model while medical care is a system for after-the-fact intervention. The purpose of health care is to preserve, protect and maintain the health of the already healthy, reduce the incidence, duration and severity of disease, prevent suffering and prolong healthy function during the normal human lifespan. Healthcare includes and appreciates medical services, but is organized around the preservation of health and the prevention of disease.
In sharp contrast to a health-based model, what we have now is basically and primarily a medical system developed to intervene in the course of an already established disease and preventable injury has occurred (diabetes, cancer and drunk driving accidents). Only after a patient’s health has seriously deteriorated or a medical crisis occurs does this system of medical intervention come into its own. While modern medicine offers some preventive care, such as prescribing cholesterol-lowering drugs, the 8 -12 years of medical training and reimbursement for a medical doctor’s professional services are neither one organized around the preservation of health or prevention of disease.
In the US, we neither teach or pay MDs to provide ‘health’ care.
When crisis-intervention medicine is compared to the top 5 causes of mortality, it is easy to see the unproductive expense and other problems caused by not having a health-based model of care. The 5 most frequent causes of death in the US are all preventable diseases or avoidable accidents associated with smoking (lung cancer & heart disease), alcoholism (liver disease and fatal car accidents), complications of obesity (diabetes, ), drug abuse (overdose, murder) and exposure to toxic substances and poisons, including air and water pollution (fatal asthma attack and death from acute toxicity).
One measure of the medical costs of untreated mental illness comes from a study of 120 homeless alcoholics living on the streets of Boston who collectively chalked up a staggering 18,000 EMS calls-ER visits and 900 hospital admissions over five years – 150 per alcoholic. Costs to the county for emergency medical services were estimated at $26,000 each year for each alcoholic, but until such a time as these alcoholics get liver disease or hit by a car, that $26K worth of repeat ER visits did nothing to successful treatment of their basic mental health problems, but it did add over $3 million to the ‘health’ care bill sent to the taxpayers of Massachusetts or $15 million over the 5 year course of the study. [NPR story 08-04-09]
Best Practices and Comparative Effectiveness: Our medicalized health care system is also illogical in regard to clinical effectiveness of customary treatments. The current standard of care does not require that medical treatments or surgical procedures be the most clinically effective or “best practice” or that patients be informed of their ineffectiveness. Recommended treatments also do not have to be cost-effective. For many decades, studies have identified a high ratio – upward of 80% -- of customary medical practices to lack any compelling evidence of effectiveness and many treatments are known to have serious side-effects that significant cause harm. Care for the same medical problem is also different in different parts of the country. For instance, surgery rates for the same diagnosis are dramatically different depending on of the region of the country and the size of the city one lives in, ranging from as little as 5% in the northeast to more than 40% in the southeast. Obviously human biology does not differ by a factor of eight based on geographical latitude or population, which means that illogical criteria are being employed in an irrational system.
The only way our healthcare system can be built on “best practices” is by scientifically analyzing all health care models, methods and products for effectiveness and ranking each one in comparison to other models or modes of treatment for the same mental or physical condition. For example, the Veterans Administration’s clinical policy is to only use ‘best practices’ -- models of care proven effective based on their own internal review of treatment outcomes. Using 294 measures of effectiveness and patient satisfaction, researchers rate the VA is far above that of every other healthcare system, including private facilities with a world-class reputation. The VA’s healthcare system has the lowest per patient cost of care – one-third less than Medicare, which is already a third less expensive than care in private institutions. This means the VA is effectively treating people for 2/3s less than any other segment of the health care system while earning the loyalty of its patent based. If this is what ‘government-run healthcare’ can accomplish, maybe we should reconsider our prejudices against bureaucracy.
An example of what happens when evidence-based ‘best practices’ are not used is the current treatment of diabetes and its complications, which is the single biggest item in the healthcare budget. At present, one-third of every healthcare dollar is spent on diabetes, which is the number one cause of all blindness, limb amputations and kidney failure. That’s bad news. The worse news is that only 8% of care provided by our current system is treating diabetes effectively as judged by patient longevity and prevention of these complications. Data on kidney dialysis from Medicare shows that annual patient cost ranges from $65,496 to $488,360 -- an average of $129,090 per year. If the scientific principles of comparative effectiveness already being used by the VA were widely applied to the treatment of diabetes, it would reduce the complications of diabetes by 80%. That’s a ten-fold reduction in the horrific, disabling and expensive complications of blindness, amputations and end-stage kidney disease. State-of-the-art analysis of comparative effectiveness (ACE) gives modern healthcare providers the tools to ‘ace’ the system in every way – truly a win-win solution. When it comes to 21st century health care, ACE should be the American standard of care.
The Other Pillar of a Cost-effective System – Primary Care: Clinically effective health care starts with a robust primary care system. This improves health outcomes and lowers cost by preventing the incidence of disease, reducing the health impact of chronic diseases and by extending the healthy lifespan. It’s ever so much cheaper and more humane to prevent hip fractures that it is to treat them.
At the turn of the 20th century, primary health care was provided by medical doctors, non-physician practitioners (including midwives) and non-allopathic physicians. In 1910 the traditional multidisciplinary pool of practitioners was replaced by an MD-centric system. This means that primary care is essentially provided by MDs. However, the interest and enthusiasm of MDs for primary practice has fallen steadily over the last hundred years. Now days 75% of MDs choose specialty medicine, with fewer than a quarter of new graduates becoming general practitioners. Of the 25% who start out as GPs, poor reimbursement rates and inability to meet office expenses (or paying down $140,000 in student loans) forces a large proportion to close their doors within a few years and retrain into a better paying specialty.
Last year there were 902 million doctor’s office visits in the US, the vast majority for routine healthcare needs. Approximately 90% of all office visits are for self-limiting conditions and other types of non-urgent or preventive care. Self-limiting conditions includes mild illnesses, minor injuries and other conditions that heal spontaneously or resolve by themselves. This kind of care consists of routine checkups, health education and information, monitoring normal biological states such as pregnancy, healthy newborns and well-woman gyn visits, refilling prescriptions, concerns associated with normal aging and support for people with stable or chronic diseases.
For the last century our medicalized model of health care has been spending the incredibly expensive time of MDs to provide routine primary care that actually does not require the education of an MD to accomplish safely and efficiently.
This category of care is vital to the health and wealth of the nation and yet we do not and cannot compensate MDs at the level their education and training requires. Clearly the majority of self-limiting conditions and preventive healthcare should be handled by someone other than a medical doctor. MDs are specialists trained to handle acute and life-threatening medical emergencies and to diagnosis and treat diseases that require pharmaceuticals and surgery. Since most primary care visits are for problems that don’t need or benefit from medical technology, drugs or surgery, this is an unfortunate mismatch of resources. The same 8-12 years of post-secondary training as an MD so crucial to emergency intervention and brain surgery is neither necessary nor cost effective when providing routine health care.
The most appropriate and cost-effective choice for primary care are non-physician healthcare professionals -- nurse practitioners, physician assistants, professional midwives, naturopaths, etc. Each of these professionals is trained to provide primary care in areas of routine and preventive care. Ordinary health-related complaints include mild illness and psychological issues such as anxiety or mild depression; normal biological states, life-style issues (diet, exercise, contraception; questions about sexual topics); health histories and students physicals; vaccinations or testing for STDs; managing a stable chronic disease, and more.
What each of these conditions and health concerns share is that they are not medically complicated. However they are frequently time-consuming and certainly take more than the 6 to 10 minutes allotted for the typical non-urgent medical appointment. What people seeking non-urgent health care most want and need is a relationship with an unhurried primary-care practitioner who is able and willing to be empathetically present, to listen, talk, ask questions, sympathize and make helpful suggestions. Primary care practitioners help each person they see stay healthy, become healthy or lessen the impact of a chronic disease. They achieve this important goal by taking the time to educate the patient (or parent/ guardian) in the best strategies for managing their health or that of their child or aging parent.
This personalized form of care reduces the need for expensive testing and invasive procedures while improving patient outcomes. High-quality primary care is the most effective way to prevent the systematic overuse of drugs and surgery. Since the number of primary care visits in the US is expected to increase 42 % by 2025, this kind of relationship-based care is ever more important. The growth in US population includes an increased proportion of children, retired baby-boomers and patients with chronic diseases – the very categories of patients that benefit most from the coordination of care and continuity of care provided by primary care practitioners. [Am College of Physicians - White Pager 2008]. Reducing rate of obesity, diabetes, osteoporosis and many other chronic and expensive diseases eliminates the great volume of expensive and invasive procedures currently driving up the cost of health-related services.
Logically, the services of allopathically-trained physicians are to be reserved for patients that require medical services or intervention. This ‘right use’ of an MD’s time is a far more appropriate from the patient (and taxpayer’s) standpoint and a more profitable use of medical training and talents. The idea of the right practitioner for the right problem saves the health care system vast sums of money that can be redirected to improved health care coverage and to eliminate any need to ever ration medical care for the elderly, disable or terminally ill. Instead of fighting against the tide of MD specialization, this frees up funds to pay for the kind of advanced care that only MD specialists can provide.
MDs who are currently providing primary care and want to stay in general practice medicine would become the invaluable hub of a primary care system, providing consulting services for non-physician practitioners (NNP) and non-allopathic physicians who would be on the front lines in large numbers. Physician GPs are needed to take referrals from NPP whenever a patient’s condition required allopathic medical services or if the patient simply preferred to see an MD practitioner. Regardless of the category of caregiver, quality primary care always preserves and protects individual choice.
A cost-effective system must rely first and foremost on non-physician, primary care providers. This is made possible by having timely access to medical doctors, hospitals, and surgery to be used in event of a serious or urgent medical situation. Fortunately the U.S. has created a rather good system of emergency, “at-the-scene” care, stabilization and transport, via our “first responders”, ambulances and fire department teams and transport by helicopter and plane. This shows that we do know how to create a cooperative and collaborative model for health care for everyone, which is so necessary in creating a system that focuses its resource on prevention! It is also how to stem the overuse of prescription drugs and medical tests and procedures, each of which carries risk of harm to patients, even when they are used appropriately.
Why don’t we have a system that facilitates instead of impedes this common-sense approach?
How did this lopsided state of affairs come about? In the early 1900s, organized medicine successfully lobbied state legislatures to outlaw the traditional multi-discipline form of health care and replace it with an exclusively medical model. This decision to switch to MD-only care made no distinction between routine care for self-limiting conditions and urgent medical intervention for serious and acute problems that requires a medical doctor to diagnosis, treat and coordinate care. The determination to abolish the traditional practices of non-allopathic physicians and non-physician practitioners of midwifery, naturopathy, homeopathy, osteopathy, chiropractic, and oriental medicine, etc) occurred without any scientific research showing that this was wise, cost-effective or safer.
It was however accompanied by a PR campaign by organized medicine that portrayed MDs as the only ‘scientific’ source of care – modern medicine at its best. While allopathic treatment was described as the best choice for all health-related needs, non-allopathic practitioners were all simultaneously depicted as dangerous quacks. People (especially legislatures) were convinced that it was in the public interest to outlaw all non-allopathic and non-physician forms of care.
The AMA’s efforts focused exclusively on the education of medical students as the foundation for a truly ‘modern’ medical system that encompassed all aspects of health care as well as medical treatment. In 1905 decisions were made by AMA insiders to close half of all medical schools in the US -- virtually all the programs that included the traditional models of what were called the “healing arts” in their curriculum and/or accepted women and minorities. Not only were women and other ethnicities eliminated from the medical profession, but all non-allopathic healing arts were dropped from the medical school curriculum. This included the use of medicinal herbs and physiological management of normal birth (midwifery-based care). For the next 50 years, the only form of health care education that was funded by the Rockefeller and Carnegie Foundations was medicalized treatment by drugs, surgery and other medical interventions.
Despite the fact that it was not “evidence-based”, the MD-centric model of health care was rapidly adopted across the country without any scientific facts or other proof that MDs were the better choice for routine health care than the multidiscipline category of practitioners they displaced. This unscientific monopoly also went against hard-won democratic principles and the belief by most Americans in the value of fair competition and the importance of personal choice.
The Consequences of 19th Century Ideas in a 21st Century World
Over the next hundred years, the MD-centric model has increasingly involved pharmaceutical drugs and hospitalization and these 2 powerful and wealthy industries rapidly grew. When medical insurance entered the scene in the middle of the century, physician organizations – again with the help of legislatures – made sure that only physicians could be directly reimbursed for primary health care. Organized medicine sees the practice of non-physicians as unwanted competition in a field they wish to dominate and remains vigorously committed to the MD-centric system they put in place in the first decade of the 20th century. Political pressure on state legislators continues to make it illegal in 28 states for non-physician practitioners (such as nurse practitioners and professional midwives) to provide care unless they work under the control of a physician or are employed by a hospital. In these states, it is the doctor or hospital that bills for care provided by these other professionals and it is physicians and hospitals that are reimbursed for these professional services, not the practitioner who actually provided them.
Despite this vigorous opposition, laws in 22 states recognize that it is in the public interest for non-physician practitioners to practice independently and be directly compensated by third party payors (private insurance or the government). But this little bit of movement in a positive direction has triggered a powerful backlash by the American Medical Association. The AMA’s 2006 “Scope of Practice Partnership” is a large and well-funded campaign to keep all non-physician health care practitioners under the control of MDs as employees. The Scope of Practice Partnership (SOPP) is a coordinated plan to eliminate the independent practice of non-allopathic primary care providers in all 50 states by blocking attempts to change the law in the 28 states where it is illegal to practice independently and repealing the authorizing legislation in the 22 states where non-physician practitioners are currently able to practice unencumbered.
Many physicians heartily disagree with the AMA’s SOPP campaign, but nonetheless it and many other policies they object to go forward unimpeded. The AMA is actually a publishing empire that makes its fortune by selling advertising space to drug and medical device manufactures in JAMA (Journal of the American Medical Association) and its ten other professional journals. The Association has recently expanded its publishing business to include on-line data services for MDs and to gather, archive and sell statistical data on health and medical practice to corporations. In addition to advertising revenue and selling very pricey subscriptions to its professional journals to libraries and educational institutions, the AMA also sells malpractice insurance and receives many generous corporate grants. As a result it does not have to rely on its membership for the $300 million a year that currently fuels it’s aggressive lobbying activities. Within the world of special interest groups, the AMA reflects the very specialized corporate interests of the organization itself, rather than the medical profession per se or any public-spirited advocacy for national health care policy.
The health care industry is reported to be spending 1.3 million a day lobbying the Congress in an effort to influence healthcare reform legislations. The organizations and individuals spurred on by them have recently claimed that the House of Representative’s Affordable Health Choice Act (HR-3200) was purposefully designed to “kill off senior citizens”. Anyone who reads HR 3200 will discover this false claim to be a total fabrication. But it’s interesting to note that in 1910, when organized medicine first took over control of health care by eliminating non-physician practitioners, they claimed that midwives were “killing babies”. While nouns have changed over the last century, the verbs used to manipulate people thru fear stay the same.
Medical politics continues to masquerade as science, when in fact the great majority of customary (and frequently expensive) medical treatment were never scientifically established to be clinically effective, despite the fact that for more than 25 years people and organizations have been looking at research to see what “good” evidence shows. Both fiscal responsibility and informational transparency are lacking in this medical monopoly.
This, in brief, is the sad history of the expensive health care problems we are saddled with today. It is a deadly combination of lack of treatment and overuse of expensive tests, drugs and surgery, depending on whether or not you have health insurance and whether the physician or facility is paid per procedure – billable units -- for providing care. For people with ‘pre-existing’ conditions or diagnosed with an expensive condition (or terminal illness) and those living in rural areas and inner-cities without access to care, this is a constant nightmare that ends in preventable death tens of thousands of time each year.
While the number is big, it must be remembered that we die one by one by one. Each death leaves grieving parents without a beloved child, a husband without his lifetime partner, a wife who is now a widow, children without a parent, sibling without a sister or brother. It leaves big medical bills for the family, with no one to earn an income or pay taxes. No matter why someone dies, each loss is a personal tragedy. But preventable death that is the result of a health care system that puts corporate profits or professional prestigious ahead of the welfare of its patients, it is a betrayed trust that makes survivors bitter and the loss so much harder to bear.
On September 11th, 2001, the loss of 3,000 American lives was seen as a tragedy of such magnitude that we went to war to be sure it didn’t happen again. However, every year we quietly accept a death toll from a broken health care system that is 73 times greater than the 9-11 disaster. In the eight and half years since that awful day, toxic healthcare system syndrome has caused the death of almost 2 million Americans or to be exact 1,870,000 men, women and children. Toxic healthcare syndrome is a condition marked by medical errors, hospital-acquired infections, over-treatment and ineffective treatment for the insured and under-treatment, mistreatment, poor treatment and no treatment for 47 million uninsured.
One of those fatalities was an extremely talented healthcare professional who practiced midwifery flawlessly for 30 years. However, the respect of her patients and colleagues could do nothing to help when she was repeatedly turned down for health insurance because of a treatable but potentially expensive medical condition. Without access to preventative care and necessary medical services until it was too late, she died tragically and unnecessarily, one more statistic in the collateral damage of a health care system that is neither healthy nor caring.
A 21st Century Vision of Reform ~ HealthCare_2.0
Between the last decade of the 19th century and the first of the 21st century, our health care system has evolved thru a number of distinct stages that have brought us to a place that is both filled with promise and fraught with political danger. In the Chinese language, for the word “crisis” is a combination of the calligraphy characters for “danger” and “opportunity”. Whatever else may be said about our health care system, the word ‘crisis’ surely would apply -- predicament that also provides us with unique opportunities.
As depressing as the stories and statistics are, the real news is that we have the money, talent, technology and other resources to develop and maintain a system that is fair and affordable, preserves individual choice and reliably delivers care that is as safe and cost-effective as any other industrialized country. This can be done without taxing the middle class, rationing medical services for the elderly, limiting the advance of medical science or turning the healthcare system over to government bureaucrats. Two trillion dollars a year is twice as much as any other country spends per person. That’s more than enough money treat everyone and compassionately meet every genuine medical need by creating a model of care that works at every level.
In keeping with the idea that fools rush in where angels fear to tread, we boldly call this vision “HealthCare_2.0”. HealthCare_2.0 takes the best of all the available options, acknowledges future contributions from science and technology, and coordinates all these elements into an effective and efficient system that all Americans can be proud of.
The idea of a “2.0” system obviously comes from the world of computers. Software developers believe that computer programs should be improved by every person who use them. This 'second generation' effect is both an ideal and a practical strategy that includes a feedback mechanism that changes the relationship between the developer and the user. In a 2.0 system, people using a software program are no longer just passive recipients of a finished product, but active contributors. It is this feedback loop that completes the circle and ultimately improves the system. Developers are no longer flying blind or limited by their own small set of ideas. When experience and ideas are shared in a mutual relationship of respect, it maximizes creativity, efficiency and cost-effectiveness and produces a superior product. During the 1980s, software programs that met these goals were known as “user-friendly”.
While computer analogies cannot be applied directly to health care, they do offer a unique way to think and talk about a positive vision that might also be called “user-friendly”, so here is the story in geek-speak of how we got from the late 19th century to 2009.
Traditionally-based Health Care: In geek terms, the ‘beta’ version of healthcare in the US was the traditional model in place at the turn of the 20th century. Prior to 1910, healthcare in the United States was not systemized – no government program, single philosophy or profession controlled health services or defined medical care. In this naturally inclusive model, care was provided by ‘regular’ MDs, naturopathic physicians, osteopaths, homeopaths, midwives and a category MDs known ‘eclectics’, who created a hybrid form of care by taking what they believed to be the “best practices” from each of the different healing arts. While health care included medical doctors and treatments such as drugs and surgery, it was not limited to MDs or allopathic ideals. The result was a broad-based, multidisciplinary free market process that offered patient choice and controlled costs thru competition.
HealthCare_1.0: The first systematic program for health care in the US was orchestrated by the AMA between 1901 and 1912, when they replaced the traditional multi-disciplinary form of care with an all-allopathic medical system. Organized medicine successfully lobbied for state laws that granted an unlimited licensed scope of practice to medical doctors. This gave MDs exclusive and permanent control over all human “mental and physical conditions”. Ever since HC_1.0 has organized around an artificial chokepoint which identifies MDs as the exclusive gatekeeper for all health-related care. Every patient must first see and be seen by a medical doctor before any other aspect of the health care system can be accessed.
Since the passage of these laws a hundred years ago, the legal scope of practice for all other professions that provide care to human beings for any mental or physical condition has been determined by the MD lobby. This lists includes dentists, pharmacists, optometrists, midwives, nurses, dietitians, physical therapists, and many other occupations. The unopposed political power of organized medicine was used to legally limit the type of health care available to the public and the manner and circumstances that care could be provided by all categories of non-physicians.
Early in the 20th century organized medicine also used its power to sanction ‘eclectic’ MDs who used any non-allopathic treatment or traditional ‘healing arts’ and to prohibit MDs from referring their own patients to other practitioners who used ‘alternative’ methods (such as chiropractic, acupuncture, herbs, Chinese medicine or midwifery). A medical doctor who ignored the stern warnings of the AMA’s 1912 Committee on Propaganda risked becoming a pariah among his physician colleagues. After being put on the AMA’s black list of quacks and non-compliant MDs, other doctors would stop referring patients to him and in many cases, the unfortunate miscreant would also lose his hospital privileges and be put out of business.
A 21st century example of the turf wars generated by this antiquated system comes from the New Jersey Board of Dentistry. Recently a NJ dentist complained that someone not licensed to practice dentistry (perhaps a dental hygienist) was helping people apply the same tooth whitening strips that we can all buy in the grocery store. The Board ruled this to be an unlicensed practice of dentistry punishable with jail time. Apparently its OK if you put teeth whitening strip on yourself, but anyone who helps you risks criminal prosecuted.
A HealthCare_1.0 Retrospective: As a purposefully programmed system, HealthCare_1.0 brought us many medical miracles such as insulin for diabetics, antibiotics to cure infection and organ transplants to save lives. It has extended the human life span and dramatically improved quality of life for many millions. Many of us owe our own or our loved one’s life to the skill and compassion of the 1.0 system, for which we are profoundly and eternally grateful.
Unfortunately, HealthCare_1.0 also replaced common sense and patient choice and gave rise to a medical monopoly that is increasingly burdensome and expensive, propagated the medical-industrial complex and sent us on a hundred-year detour around universal coverage. It improperly excluded all non-allopathic models and methods of care and all non-physician practitioners. It sucked all the oxygen out of primary care and put prevention at the end of the line, while developing a hyper-medicalized system with 75% of its MDs practicing specialty medicine. This offers nearly every aspect of medical treatment and technology known to mankind except for the unfettered time of the physician. Since the physician’s time is the most expensive element in the medical care equation, it becomes easier or more profitable for a physician to order a another blood test or write a prescription than sit down an ask detained questions or quietly listen to the patient describe his symptoms or concerns.
Hospitals and other treatment facilities are not required to make the record of outcomes available to the public, but many reputable sources confirm our worst fears -- health outcomes in the US are poor – 37th as measured by international data—and we are further burdened by such a costly and inefficient system that many physicians, nurses, midwives and other healthcare professions as well as a majority of citizens feel short-changed and unhappy. HC_1.0 program continues to dominate our national healthcare policy decade after decade to the detriment of the physical and economic wellbeing of the American people. Unless upgraded and de-bugged in the next decade, HealthCare_1.0 will crash the system.
Ace-ing the system ~ Health Care 2.0 is the opposite of 20th century chokepoint medicine and the antidote for system that has excluded a rational process to determine clinical effectiveness the last hundred years.
Health Care 2.0 begins with the scientific analysis of comparative effectiveness (ACE) as the foundation for all national health care policies. It quickly advances to a broad-based, 21st century model of multidisciplinary care that puts primary practice back where it belongs – the hub right in the middle of the health care wheel. HC_2.0 uses the second-generation belief that the more people who use a program/system, the better it should and can become. With this in mind, mechanisms for constructive-corrective feedback, coupled with the advancement of technological know-how, are core features of the upgraded 2.0 version of health care.
One of the delightful little secrets that puts success on our side is that physicians and other members of the medical-industrial complex all get sick from time to time. Newsweek had a cover story that asked the rhetorical question “What do doctors fear most?” The answer was “Being a hospital patient!” Whenever doctors or their family members require medical care or hospitalization, they are forced to use same dysfunctional system that we are all complaining about. Their hopes and dreams (and at times, their very lives) are equally dependent on fixing the system. A large percentage of baby-boomer doctors and nurses are trying to coordinate medical care for a disabled child or aging parents and discovering first hand how dysfunctional the current system is for patients and families. They readily admit that the system is hopelessly broken. As a result of these personal experiences, many physicians and other health care providers are both knowledgeable and outspoken proponents of effective health care reform.
The upgraded 2.0 version of health care greatly benefits from the conventional practice of medicine and recognizes that bio-medicine will always, and should always be a core pillar of the health care system. Nonetheless, the 2.0 system of health care is a naturally inclusive model that incorporates and benefits from independent practice by non-physician primary care practitioners, especially nurse practitioners and professional midwives) and non-allopathic disciplines such as Chinese medicine, naturopathy, chiropractic, etc. This acknowledges the social value of independent practice by non-physicians and non-allopathic practitioners and incorporated this wide spectrum into the health care program based on established clinical effectiveness.
Unhindered access to non-physician primary care practitioners and non-allopathic physicians is crucial to an affordable (and sustainable) health care system. This is where real preventive care begins and is the most dependable way to end the current epidemic of over-treatment and overuse of Rx drugs and medical procedures.
Only by taking the scientific best of both allopathic and non-allopathic traditions can we create an inclusive and affordable system. MDs will find themselves relieved and delighted by this newly functional system that also provides them with the most favorable circumstances for doing what they do best – practice medicine using their talents and training in drugs, surgery, and sophisticated medical treatments. For instance, obstetricians will partner with the professional midwives who staff labor and delivery units. All normal labors and births will be routinely attended by these competent midwives while obstetricians stay home and get a good night’s sleep in preparation for a long day’s surgery schedule.
Secure in their central position in the scheme of things, MDs will form a second-generation professional organization to be known as the American Multi-disciplinary Association (or AMA_2.0) which welcome include all non-physician practitioners and non-allopathic physicians as associate member of the organization.
A Happy Ending: By making health care effective, we also make it affordable. With an affordable system, universal access to money-saving, health-preserving care is not just economically possible, but an economic imperative. We can’t afford not to cover everyone! All that is needed is the courage and wisdom to make right expenditure of our plentiful resources.
Get a clue – get HealthCare2
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This website is dedicated to Baby Boy Lance Anderson and Donna Driscoll , LM