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Healthcare problems and ideas
So I got this E-mail from the Obama campaign... Time to brain storm ideas for Healthcare!
Dear People of the forums
Over the coming weeks, thousands of Americans will be leading Health Care Community Discussions -- small local gatherings in which Americans are sharing thoughts and ideas about reforming health care. President-elect Obama and Health and Human Services Secretary-designate Tom Daschle are counting on Americans from every walk of life to help identify what's broken and provide ideas for how to fix it.
You can help shape that reform by leading your own Health Care Community Discussion anytime between now and December 31st.
Secretary-designate Daschle recorded a short message about these important discussions. Watch the video and sign up today to lead a discussion in your community:
Secretary-designate Daschle is committed to reforming health care from the ground up, which is why he won't just be reading the results of these discussions -- he'll be attending a few himself.
When you sign up to lead a discussion, we'll provide everything you need to make your conversation as productive as possible, including a Moderator's Guide with helpful tips. All you have to do is reach out to friends, family, and members of your community and ask them to attend -- and, when it's over, tell us how it went. The Transition's Health Policy Team will gather the results of these discussions to guide its recommendations for the Obama-Biden administration.
No transition has tried something like this before, and your participation is essential to our success.
Thank you,
John
John D. Podesta
Co-Chair
The Obama-Biden Transition Project
What's broken in the healthcare system and what needs to be fixed?
Dear People of the forums
Over the coming weeks, thousands of Americans will be leading Health Care Community Discussions -- small local gatherings in which Americans are sharing thoughts and ideas about reforming health care. President-elect Obama and Health and Human Services Secretary-designate Tom Daschle are counting on Americans from every walk of life to help identify what's broken and provide ideas for how to fix it.
You can help shape that reform by leading your own Health Care Community Discussion anytime between now and December 31st.
Secretary-designate Daschle recorded a short message about these important discussions. Watch the video and sign up today to lead a discussion in your community:
Secretary-designate Daschle is committed to reforming health care from the ground up, which is why he won't just be reading the results of these discussions -- he'll be attending a few himself.
When you sign up to lead a discussion, we'll provide everything you need to make your conversation as productive as possible, including a Moderator's Guide with helpful tips. All you have to do is reach out to friends, family, and members of your community and ask them to attend -- and, when it's over, tell us how it went. The Transition's Health Policy Team will gather the results of these discussions to guide its recommendations for the Obama-Biden administration.
No transition has tried something like this before, and your participation is essential to our success.
Thank you,
John
John D. Podesta
Co-Chair
The Obama-Biden Transition Project
What's broken in the healthcare system and what needs to be fixed?
Comments
Oh yeah, and if we take all the money we spend on fake medicine and use it on real medicine, that would help a lot also.
So, basically, educational reform is needed. Nothing new.
I second the NO FAKE MEDICINE stance. Get that shit out of my hospitals.
I found this write up of a congressional Panel on alternative medicine... And found that Congressman Waxman once again comes off looking awesome
" There is no denying the growing popularity of alternative medicines. They constitute a rising proportion of our healthcare expenditures. The number and diversity of alternative products and services in the healthcare marketplace are increasing dramatically.
Today's hearing is focused on the right questions about alternative medicines. It is important that we seek information about therapies that can help improve our well being and to encourage access to safe and effective treatments. At the same time, we must promote thorough testing and review of therapies to prevent unnecessary harm and expense to consumers.
I believe that a quote from a recent editorial in the Journal of the American Medical Association provides the appropriate framework for today's discussion. The Journal of the American Medical Association recently wrote ''there is no alternative medicine. There is only scientifically proven evidence-based medicine supported by solid data or unproven medicine for which scientific evidence is lacking.'' This is the test to which we must hold alternative medicine. Medicine of any kind must undergo the crucible of scientific investigation from clinical trials to publications in reputable peer-reviewed journals before it can gain a place in routine practice. We must place our trust in credible evidence and not mere speculation, or tradition, or popularity when we decide how best to care for the sick.
The Federal Government and others have invested millions into research on alternative medicines. Some research has had promising results. For example, the Journal of the American Medical Association recently reported on a preliminary study indicating that yoga stretching can relieve some symptoms of carpal tunnel syndrome.
On the other hand, other therapies have proven ineffective or dangerous. For example in 1997, the deaths of three cancer patients were linked to a Manassas physician who had been treating them by injecting them with concentrated aloe vera, a treatment that is not approved by the Food and Drug Administration. Patients reportedly had learned about this physician's treatment through the internet, word of mouth, or an aloe vera supplier.
In highlighting ongoing research, examples of scientifically validated forms of alternative medicine and positive personal experiences with alternative treatments, today's witnesses will help sift through the positive and the negative aspects of this area of medicine.
I join my colleagues in welcoming the witnesses here today and I just want to comment on the fact that we have a change of the list of witnesses and their order which we were never advised of until the very last minute. Not only were we not advised, but the Government witnesses—and it would have been helpful for them to know when they were to appear—were suddenly put on a third panel. And, I think for the record, I want to point out that we ought to be courteous to all of the witnesses try to accommodate them and also discuss with our colleagues, if we are going to have collegial hearings, how we're trying to treat the witnesses so we can get the opportunity to hear from them and not have them mistreated by having the schedules changed on them.
Thank you very much, Mr. Chairman. I do appreciate the hearing. I think the hearing is a worthwhile one and I will try to be here as much as possible, but I certainly will review the record for those witnesses where I am not present in the room because of conflict of schedule."
Then of course Kucinich, approves of the alternative treatments and wants government funding.
Mr. KUCINICH. Thank you very much, Mr. Chairman, Mr. Waxman, fellow committee members, and members of the panel. I appreciate the opportunity to participate in this hearing on complementary and alternative medicine. I applaud the chairman's willingness to address this issue and I thank him for providing us with this forum.
As a witness to the theories and practice of alternative medicine, I support the committee's efforts concerning this issue. With this in mind I look forward to exploring opportunities that will advance medical care and expand the treatment options afforded to today's doctors.
I think that all of us in Congress are fully aware that our healthcare system is on the verge of radical change. The direction that we are going remains to be seen, but with rising costs, with more and more Americans not having access to adequate healthcare, and with more and more Americans questioning whether they have any availability to healthcare, I think there is becoming a greater and greater interest in alternative methods.
This, in no way, is an attempt to denigrate allopathic practice because I think that, at a minimum, many allopathic practitioners would agree that alternative healthcare methods and therapies are a proper adjunctive theory. I have great respect for allopathic practice, but at the same time, I think that you will find that allopathic practitioners who are candid will admit that there are limitations to their own practice.
I think that we are fully aware that the United States enjoys some of the most advanced health care in the world, but yet we are unable to provide relief for a number of common ailments. The current standards of practice occasionally fail to recognize that medicine is an ancient art that encompasses all methods of healing. Somewhere along the road to advance medicine we sometimes forget that there are methods of treating those who need help. It's time to help widen the vision of modern medical doctrine and explore alternative medicine. We have to let go of the fear that alternative medical practices will replace and endanger standards and instead embrace the idea that any method that is proven a safe form of treatment ought to be available to the people.
American citizens have a right to health care and as Members of Congress, we have a duty to ensure that they have every available proven treatment option. Complementary and alternative medical care encompasses numerous forms of studies and tested procedures and practices and it is gaining support from mainstream medicine. Unfortunately, there is some unwillingness to support its practice and research. We must ensure nonprejudicial disbursement of research funds to all disciplines of medicine, including alternative medicine. We must utilize this research not only to educate practitioners and the public, but to provide them with access to proven methods of alternative medicine.
I hope these hearings will broaden our understanding of alternative medicine; will expose and end any bias that may exist within our current system of medical doctrine. All citizens deserve access to safe and proven methods of medical care and I thank the chairman and the panel for expanding our understanding of medicine that some would deem, unfortunately, the alternative.
Finally, Mr. Chairman, these hearings present a wonderful opportunity. We have to think creatively about healthcare; to think dynamically; to draw new worlds toward us using a higher consciousness of the potential we have within us to make this a better world. I think that we need to urge Government officials to keep an open mind on alternative therapies. Anyone who is watching or listening knows that once an individual has experienced a profound shift in his or her health as the result of a new approach toward health care, it is important that the story of the miracle of an individual's transformation be available to study, certainly, and also to share.
Also, if people want to use fake medicine, I don't give a crap. That's Darwinism at its finest. However, I don't want my tax dollars paying for it. We should pay for tested treatments that have been evaluated and approved by our designated organizations. Give them a choice between approved treatments if there is more than one, but if they want to go see a chiropractor instead of a physical therapist, let them do it on their dime.
The same thing goes for any situation in which a person needs help that requires knowledge they do not have. When you go to get your car fixed, but you know nothing about mechanics, you are in a position to be easily swindled by lies. When your computer breaks, and you go to get it fixed, you are in a position to be easily swindled. When your body breaks, and you need to get it fixed, you are in a position where you are easily swindled.
Even if everyone in society were super smart, we would not all be medical, mechanical, and computer experts. There is just too much specialized knowledge for even the smartest human beings to have sufficient knowledge in multiple areas. Most people are not the smartest human beings.
I don't really mind if they sell fake medicine. I do mind when there is false advertising and misleading journalism on the subject. I also believe that without that false advertising and misleading journalism, fake medicine would be far less popular.
Take for example this bullshit. I heard a commercial on the radio for this yesterday. It claims to be able to treat almost everything including kidney stones, the common cold, almost all physical pain, varicose veins, cold sores, ear infections, foot fungus, and more. If this product wants to make these claims on their packaging, then they should be regulated just like every other drug, like Tylenol and such. The other option they have is if they want to be regulated like food. In that case, they won't be allowed to make any medical claims whatsoever, but they will have to be tested to make sure they aren't harmful.
All this trouble with fake medicine is primarily because Bill Clinton signed the Dietary Supplement Health and Education Act (DSHEA) into law in 1994. Notice how it was only a small problem before then, but has since blown up into a big problem? The DSHEA allows products to be regulated as dietary supplements. Thus, they aren't allowed to make a claim such as "cures flu", but they are allowed to make structure/function claims. That's why bullshit you see in the store will say something like "helps with flu symptoms," "boosts immune system" or "for healthy joints."
The Internet has also not helped in this. Even if we prevent the products from falsely advertising on packaging, television, radio, print, etc. it is impossible to prevent them from falsely advertising on the Internet. I'm not suggest we should try to prevent these people from falsely advertising on the net. What we should do is ban the sale of any products that are found to falsely advertise on the net. The wild west of free information and free speech has made regulation of advertising all but impossible, and it will only become more impossible. Thus, the only way to protect the vulnerable populace from scam artists is to block sales of all products.
Normally I'm anti-consumer protection. Do we really need to put warning labels on hair dryers that tell you not to use them in the shower? Do we really need to make all go-karts super safe so that nobody can hurt themselves? Do we really need to make playgrounds so safe that kids can't have fun? No, not really. The reason we don't need protection there is because the dangers are common sense. You don't need to go to medical school to know that a hair dryer in the shower will kill you. It's common sense. We don't need protection from common sense. You do need to have advanced knowledge to be able to tell that a box in the store is lying to you. Thus, for the benefit of the entire society, we need the people who do have that knowledge to regulate the industry and protect those who do not.
You should ask someone who has medical training when making a decision about medically impacting your body. You CAN expect the average American to know that they should consult a doctor about medicinal things, even if you can't expect them to have advanced medical knowledge. If a medical professional recommended it, then that's different. People don't generally second-guess their doctors about treatments, but I know very few real doctors that would prescribe a non-FDA-approved treatment. Exceptions would be things like marijuana usage for stress and pain relief...but that's not fake medicine. It works...it's just illegal. In any case, doctors should not be putting people on treatments that are fake or untested...I believe there's some things called informed consent and ethics that are supposed to come into play there. If a doctor tells you, "You can try this, but it's not tested or verified that it actually works," and you chose to try it anyway, then whatever happens your own fault. If the medical professional leads you to believe that a fake treatment will definitely work, then that isn't your fault. You did your due diligence, and you were screwed by the doctor.
Anyway, if our health care plans would stop PAYING for fake medicine, then perhaps it would not be recommended as a treatment alternative to the people who don't know any better.
To drive home this point, let me use myself as an example. Let's say I am sick for three days straight. I go to a perfectly normal physician in the city. I ask them what they think about chiropractic and other things, to make sure they aren't a quack. They say that it's all bullshit, so the doctor isn't a quack. The doctor says I've got pneumonia, and prescribes an antibiotic. Let's say it's penicillin, and we know I'm not allergic to it. I go to the pharmacy, get the drug, and take it according to the directions. Seems ok right? But is it really?
How do I even know I really had pneumonia? The doctor could have been lying. Plenty of things have similar symptoms. The test they ran to see if I had it was done in a lab, and I didn't examine the results myself, nor could I understand them. The lab work could have gotten messed up, and I would have no way of knowing. Maybe the doctor is an ass and lied to me. Maybe amoxicillin would have been a better choice than penicillin in my case, but the doctor was getting perks from the penicillin company. Maybe I would have been better off with a different dosage.
Even being a smart and well-informed person, I am completely at the mercy of the doctor. I have to fully rely on them because I myself am not a doctor, and never will be. I also have very few means at my disposal to tell if a particular doctor is legitimate or not. Even researching on the Internet doesn't turn up very much. Anyone with a white coat and a diploma on the wall is going to look like every other. And yes, even real doctors are supporting the fake medicine. I knew a guy who took the homeopathies because his Harvard medical school graduate doctor told him to.
Letting Darwinism have a go at it is fine when it comes to common sense. If someone doesn't know something so simple as to not drink gasoline, light themselves on fire, or horseplay on a cliff, then so be it. But when it comes to things like medicine, even incredibly smart and well informed people are completely helpless. You really have no choice but to completely trust that the person is a real doctor, and knows what is best. You have to completely trust that the mechanic isn't ripping you off. You can get second opinions, but that doesn't really solve the problem.
This is why we need the government to protect people in these situations. When people are in a vulnerable position, and it is unreasonable to expect even a very well informed person to be capable of fending for themselves, that's when you come in with the regulation. If we have the means available, how can we not do it? That's one of the main purposes of our society, defense. We have a military to defend us from foreign militaries which we can not reasonably defend ourselves from. We have the FDA and such to defend us from fake medicine, which we can not reasonably defend ourselves from.
Government must protect those who cannot protect themselves, but should not protect those who will not protect themselves.
Also, altering the label isn't going to stop someone from taking fake medicine that their doctor recommends. The only way to stop that is to ban the medicine.
You also said this. Sadly, this is not the case. There really is no way for people to know a real doctor from a quack. Also, terms like "FDA Approved" get thrown around too much to be meaningful. For example, chiropractors will use a machine called the DRX-9000. It's FDA approved. What is it? It's just traction. It can't do any of the things chiropractors claim, like help you avoid back surgery, but it is an FDA approved medical device that has a use, just not for what chiropractors say.
Normal people can not tell a real doctor from a fake doctor. Look at that site I linked to before, with the bullshit panacea thing. It says it was created by a doctor. Apparently he's a real doctor who has been practicing for many years. He's just also a scam artist, or a true believer. There's no way to tell which without meeting him.
When I was little, I had a family doctor, that I grew to trust. Of course, he was a pediatrician, so he can't help me now. Nowadays I would like to pick a primary care physician, but how do I pick one? How do I know the good from the bad? There aren't exactly doctors on every corner who have skeptical evidence-based medicine blogs. NY state has a web site that helps me figure out if a doctor has a history of malpractice. That's a little bit helpful, but not really. The vast majority of doctors have clean records, and there is little other information in there other than what degrees they hold, their area of expertise, what hospitals they work at, etc. Basically, I have to pick a general care practitioner in my geographic area somewhat randomly from the list provided by my insurance. I can do some questioning when I get there, but that's the limit of my evaluation abilities.
Because of this, I think the government regulation should go as far as arresting anyone who even presents themselves as having any medical authority who does not work in strict accordance with evidence based principles. It should also completely ban all pharmaceutical "bribery" of doctors, and remove licenses from doctors who accept gifts and such. The problem with that is we will have even fewer doctors when we clearly need more.
And this is the fundamental problem with health care. There is more health care needed than we have. In the meantime, we need a fair way to decide who will get the health care resources that are available, and who will not. Not everyone will get what they need, and that is the sad reality of the situation.
If you have a good research facility (grad school/etc) in the area chances are that someone is collecting all the bacteria samples from the labs/hospitals/doctors and compiling all this information. This then gets published and passed around so that doctors know what to prescribe for UTIs vs sinus infections. Taking an antibiotic just because a doctor hands it to you is just as bad as getting an antibiotic as a placebo.
I didn't say you had to tell the difference between a non-quack doctor and a real one. If a medical professional is misleading people, then that is fraud on their part, not stupidity on the patient's part. (Well, to a point...of the doctor tells you to think really hard about puppies and rainbows, and you will get better, then you should be questioning his judgment.) If the doctor tells them to take X supplement, even if the supplement makes no claims to fix the problem, they will take it. Once again, the packaging making or not making unverified claims is NOT going to stop people from taking fake medicine if their doctor recommends it. Taking the claims off the package won't help in the case of fraudulent doctor quacks.
Perhaps, as Scott suggested, doctors should be required to work from evidence-based medicine, and strict penalties should apply if they do not. Technically, if there is a real treatment and they lead a patient to fake medicine and the patient gets worse, the doctor has violated the Hippocratic oath, so there may be some grounds for this kind of regulation. I don't think there will be fewer doctors...just fewer quacks trying to get rich off of exploiting people.
You're never going to get rid of the people that want fancy new age treatments, but you can at least make it illegal for doctors to recommend the ones that have no verified benefits.
Think about the right to free speech. It's not really something that scales situationally. There are clear rules as to when you have free speech, when you don't have it, and how much you have.
The same is not true for health care. If there is a flu vaccinne shortage, do you have a right to it? If 1,000 people have cancer, and the treatment costs $1,000,000, yet there isn't a billion dollars available, do all of the cancer patients have a right to the treatment? If a company spends $100 billion to invent a new treatment that can save lives, do you have a right to that drug just because you need it? If the company never makes their money back, they will have no incentive, or means, to continue the research.
If you are a doctor, and someone comes in with a heart attack, you have a moral imperative to treat them as best you can with the resources available. Thus, it could also be said that if you have a heart attack, and you see a doctor, you have an entitlement to the treatment that they can provide. In that way, health care can be viewed as a right. That is to say that health care is a moral or legal entitlement to the degree that the practitioner of the health care is morally or legally required to dispense it.
The fundamental problem with health care in the US, and everywhere in the world, is that people are concentrating on fixing "the system" of insurance and all that other bullshit. I've said it before, I'll say it again. Nothing will ever be fixed unless you solve the two fundamental problems.
1) How do you allocate the available health care resources? Who gets what? Not everyone can get the maximum level of available treatment. There aren't enough resources for that. So we need a fair way to divvy up what we've got.
2) How do you pay for it? Pharmaceutical research is insanely expensive. Think about how much money has been donated by people to various charities over the years for so many different ailments. Cancer research alone gets insane amounts of money allocated towards it, still we're probably not even halfway there yet. It's nice to want to give health care to all the people who can't afford it, but it simply costs too much. You have to decide a point at which you deny treatment.
I think the PR problem with health care is that we are dealing with a situation of a cruel world. Diseases suck. Treatments suck. There isn't enough to go around. It's all very expensive. This isn't the fault of insurance companies, doctors, hospitals, or pharmaceuticals. It's just the reality of the world. Sure, those companies are not without their faults, but you can't blame them for the state of reality. You can't lay blame on other people for a tornado, so why do we do it for health care? There needs to be a lot of PR work done that makes people realize that the reason health care sucks is because it has to suck, not because of evil insurance and drug companies. Once people realize that, maybe they will start to take a different approach and try to solve the fundamental problems.
When I lived in Boston I worked for a Print Shop that offered several health care options. One of those was the Harvard Health Care (group/plan/can't remember). I belonged to that one and they had their own clinics that you could go to. They also had a very heavy emphasis on preventive maintenance.
I think one of the biggest problems with the health care discussion is that there is too much focus on fixing people who are broken and not enough of a focus on preventing people from becoming broken in the first place!
Offer wellness programs and nutrition programs where they are needed. I have no problem paying for a program that goes into a community and helps people help themselves. I do have a problem paying for a program that repairs people whose health care problems are brought upon by themselves.
If you are still smoking (or are a new smoker) I feel no obligation to help you pay for that new lung you need. Nor do I feel any obligation to pay for your new liver after you pickled the last one from drinking too much. If you are involved in a car accident that was not your fault then you should be repaired as best as modern medicine can. If you caused the accident I do not feel nearly as charitable...
Very few people who are also not evil have the courage to admit that we simply can not provide optimal health care to everyone in the United States, let alone the world. Every possible solution will involve some manner of suffering and death for some people. We will be forced as a society to decide who lives and who dies when treatments are too expensive. We will be forced to decide how much each of us is willing to sacrifice for all of us. Greed pulls us in one direction, fear in another, and ignorance in yet a third.
Sadly, I do not believe that we will see any meaningful change in the next several decades.
Think about how hard ti was to get insulin back in the day. Nowadays we can make insulin thanks to genetic engineering. Being diabetic now still sucks, but it sucks less than it did even a few years ago thanks to improvements in blood sugar testing devices and such.
By pushing science and evidence based medical research, we can generate more medical resources, and discover new ways to use existing resources more efficiently. We should also make more incentives for people to become medical professionals, as perhaps the resource that is in the lowest supply are good doctors.
Also, I at least partially agree with Steve's point. If you do want to start discussing a system to allocate health care resources fairly, you definitely must take into account which afflictions are the result of negligence or self-infliction when allocating said resources. I think the almost all people will agree that you treat someone who got cancer "randomly" before you treat a chain smoker who eats every meal at McDonald's.
To Scott's point: we can generate more sophisticated medical solutions to illnesses, which would lead to better patient management, but that would not necessarily improve access to said treatment. Research will probably result in expensive treatments, which will make them less accessible to the general population. It's a fact all over the world that if you want the best of the best in terms of healthcare, you have to pay for it - or someone has to pay for it.
To the point of allocation of resources: when I completed my internship here, I had to do a year of mandatory community service - meaning I had to continue working for a government hospital for a year even though I was legally qualified to move into private practice if I wanted to. From a doctor's perspective, government hosptials offer far more of a challenge - the cases are more interesting and you can make more of a difference. What are the feasibility implications in the States, and do you have such a thing? If not, it's something to be considered.
To the point of trusting your doctor: you should, but do not assume that doctors are infallible. Here the degree is six years plus internship, and over there I believe it comes to eight years in total? I expect a doctor with over ten years of actual practical experience to know a lot, but I wouldn't expect him to never make a mistake (or to never have made a mistake). You guys are lucky, because you can sue the living daylights out of a doctor over there and hold them accountable - here if a patient has an allergic reaction to medication, you basically say "Whoopsie!" and re-prescribe. Do make every effort to take the responsibility of your health into your own hands - I would suggest that when you receive a diagnosis, read up on it and ask questions. I used to love it when my patients came to me with questions! It was one of the best parts of my day, it forced me to challenge whether or not I was correct or not - and that is a very humbling experience!
To the point of illness prevention: my stock phrase when working at the hospital was that 80% of the surgery patients who came through the clinic (because I worked in the Surgical Dept for almost a year) were there because of things that they had caused themselves. Yes, prevention is better than cure (plus it saved me having to do rectal exams for hemorrhoids if people just ate enough damn fibre) - it needs to be impressed on people that they can solve a lot of the problems by living right, eating right and taking care of their psychological well-being. Does that happen in practice? Nope. I had patients who had massive incisional hernias (that's when you've had an operation and you develop a hernia into the wound site - there is usually skin and muscle covering) who were massively overweight and who smoked 40 packs of cigarettes a day... yes, they had an iatrogenic primary cause for the hernia, but they aggravated the situation immensely by not taking responsibility for their health. Both factors also weighed heavily against them getting the surgery they needed to fix the problem (another discussion for another time), and the blame fell squarely on the shoulder of the doctor for "not being a good doctor" (side note: that was my "attending" as you call them over there). Similar cases/examples?
Lastly: I'm so glad that there are people in this world who have risen above the delusion of "equal and affordable health care for all". It is rampantly idealistic, and has been since the beginning of time. Unfortunately, you are absolutely right, people treat it as an emotional or ethical debate, when it boils down to practicality and feasibility. I think you should make suggestions as per the original comment, but whether or not they will be taken onboard is a whole different discussion.
Phew - okay, I think I'm done. I have had this exact same conversation with so many non-medical people over here who think I am pessimistic and cynical, and the fact is that reality is a bitch.
Wassup, doc?
Yeah, I actually try to keep quiet about it until someone says something about health care specifically (cause I don't practice anymore - long story). Hence my tirade above
So who wants to have a drinking game while watching it?