Tell-A-Vision for the 21st Century
HealthCare_2.0: A Transformative Vision for the 21st Century
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 for our current system 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 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 of a 21st century system “HealthCare_2.0”. HealthCare_2.0 takes the best and leaves the rest. This includes the best of currently available options and future contributions from science and technology -- all these elements coordinated into an effective and efficient system that all Americans can be proud of. This forward facing upgrade changes in how health care and medical services are provided and financed, while incorporating the benefits and cost saving of scientific innovation and new technology. DNA-based diagnosis, genomics and the new science of epigenetics will dramatically reduce future health care costs through early detection and improved treatment. Gene-splicing and yet-to-be invented treatments will eliminate many previously fatal or expensive diseases. HC_2.0 reflect a can-do attitude supported by the right expenditure of our plentiful resources.
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, these ideas offer a unique way to think and talk about a positive vision that might also be called “user-friendly”. Here is the story in geek-speak of how our health care system evolved from 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’. AMA sanctions extend to other MDs by prohibiting them, as a mater of medical 'ethics', from referring their patients to other physicians or non-physician 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 modern example of the perpetual turf wars generated by this antiquated system was recently provided by the New Jersey Board of Dentistry. A New Jersey 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. How this makes the rest of us safer is unclear.
A HealthCare_1.0 - a retrospective look: Historically, 20th century medical care has been never focused on prevention. When you factor ten-plus years of medical school into the equation, it's obvious that it will never be profitable for MDs to provide "health" care. The allopathic model portrayed in the movies and television shows such as Gray's anatomy is last minute emergency care that requires sophisticated technologies and highly- interventive and invasive procedures. At any one time, this type of care is only needed by a small percent of the total population.
However, for those people with urgent or potentially-life threatening medical problems, HealthCare_1.0 brought us many medical miracles. This is a long and impressive list that includes drugs such as insulin for diabetics, antibiotics to cure infection, medical procedures such as safer blood transfusions, safer anesthesia, and kidney dialysis and life-saving surgery such as organ transplants and operations to cure cancer. These abilities have extended the human life span and dramatically improved quality of life for many millions. Many of us owe our own life or that of a loved one, to the skill and compassion of the 1.0 system. For this, we are all profoundly and eternally grateful.
Unfortunately, HealthCare_1.0 also replaced common sense and patient choice by inappropriately excluding non-allopathic models and methods of care and non-physician practitioners and gave rise to a medical monopoly. HC_1.0 is responsible for a hyper-medicalized syste, with 75% of its MDs practicing specialty medicine. This sucked all the oxygen out of primary care and put preventive healthcare at the end of the line.. HC_1.0 sent us on a hundred-year detour around universal coverage, eventually produced the medical-industrial complex which is increasingly burdensome and expensive.
HC_1.0 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. What we need is an upgrade that will transform HC_1.0 into a 21st century that we can all be proud of.
Health Care 2.0: By taking the best of all the available options and innovations in health care and coordinating all of these 'best practices' into a single unified system HC_2.0 will be dramatically different. Freed from the legal and financial limitations of 20th century medicine, we can take advantage of many other effective health-based methods of dealing with physical and mental well-being. Of course there will always be medical emergencies, but there are ways to deal with the human health and that are far more successful than the ones that we use today -- less expensive, less invasive, less painful, less restrictive, less tied to large institutions in densely populated urban areas. Another dimension of an upgraded model of health care is MaternityCare_2.0, which applies a more appropriate, less expensive, less restrictive model to normal pregnancy and child birth that produces better outcomes at much less cost.
Aceing the system is the antidote for system that for the last century hasn't used a rational process to determine clinical effectiveness. Upgrading to a HealthCare_2.0 system begins with the scientific analysis of comparative effectiveness (A.C.E.) 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. This an evolving model will include smaller, better and more affordable imaging technology, diagnosis through DNA and other genomics discoveries including gene-splicing and epigenetics. In the not-too-distant future, we'll be upgrading again to HealthCare_3.0 and beyond.
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 Medical Association (or AM2A) which welcome include all non-physician practitioners and non-allopathic physicians as associate member of organized medicine's must influential representative.
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