Tell-A-Vision for the 21st Century
I wrote this essay in 2009 during the year-long debate in the US Congress over the Affordable Care Act.
As a web post, it was long with a lot of moving part and a ton of details, which made it a daunting read.
It was also daunting to research, organize and write, so you’ll run across several typos, as well as a few missing or misspelled words. Also the political information is 12 years and 3 presidential administrations old, so some comments are no longer germaine.
faith gibson, People Farmer, Webwife, Writer, Childbirth Activist, former L&D and ER nurse, currently a California Licensed Midwife, Executive Director, California College of MIdwives
Epilogue: We have a ‘medical services delivery system’ (MSDS) that masquerades as “health care”
My goal for this essay was to provide an overview and in-depth examination of what Americans call our “healthcare” system. This requires uncovering important historical information about the political manipulation of medical practice in the US . In the earliest part of the 20th century, the general manager of the AMA (“Doc” George Simmons, concluded that the ‘secret’ to control the number and type of doctors allowed to practice in the US was to control medical education at the national level and have control over the state licensing of doctors att he states and regulating the by organized medicine. As a result, “health care” in America is legally controlled, by the allopathic medical profession.
Allopathic medicine is generally defined as the use of prescription drugs, surgery and ionizing radiation. In the 21st century, allopathic medicine has devolved into a “medical services delivery system”.
Usually the medical care for hospitalized patients is ordered by the patient’s doctor — someone they personal know and have some kind of relationship with. However, 99% of this “care” is actually provided by dozens non-doctor hospital employees that the patient has no direct relationship with, never met before and often will never meet again. These “healthcare workers” provide all sorts of support services, starting with typing up admission papers, moving the patient by wheelchair or stretcher to other places in the hospital, drawing blood, taking x-rays, delivering food trays, and a wide variety of nursing services provided by different shifts of nurses who provide bedside care, give regular doses of drugs and medical procedures.
For the last one hundred-plus years, the United States has been locked out of a health-oriented system, while being locked into system that waits until people become ill or injured, pregnant, newly born or elderly, and then performs a battery of diagnostic tests and treats these “patients” with drugs and surgery. In many ways, this medical services delivery system (MSDS) is modeled on Henry Ford’s assembly line and the system currently used by McDonalds’ kitchen — people as replaceable parts that have no personal relationship with the “customer”. Even this little bit of humanity is being rung out of these systems as these jobs are automated and performed by computerized programs.
@I hope my readers (all 7 or 18 of them!) will understand why a our so-called “healthcare”system is systemically dysfunctional. This is in stark contract to the vast majority of other wealthy developed countries have far better outcomes for far less money.
Unlike many comparable Western European countries, our allopathic-orientated “healthcare” system (HC) is not organized around keeping people healthy. From the standpoint of a doctor’s “usual and customary” professional fee, time spent keeping patients healthy would not generate enough income to pay off student loans for medical school, office expenses, employee salaries, malpractice premiums, etc. and still have enough left for doctors to make a decent living.
This “style” of medical care directly back to interference for organized medicine, most especially the AMA, in the early 1900s.
However this essay “long read” also includes the kind of granular details that allow people to understand both what happened and WHY our current system doesn’t work for so many Americans, even those with “good health insurance”. Surprisingly, that includes a lost doctors and their families who had (or are having) the same frustrating and often heartbreaking experience as the “lay” public.
For those 3 or 4 people who wants to read the original “all in one” post, here is the URL from my “HealthCare2point0.com” website
https://healthcare2point0.com/PseudoJournalism_1Colnm_Jun21_09.htm
So I decided t
o make this important story much easier to read and digest by reposting it in 6 parts.
Obviously this is post #1.
I hope you enjoy it, benefit from what you learn, pass it on and come back for more. Also spread the word — tell you friends and tell them to tell their friend — it’s that important!
NOTE: the links below take you to the original (very long) post. I will be copying all of the original material to this website (faithgibson.org), so it may be easier to read in this WordPress format than original FrontPage web application.
June 21, 2009
PDF version to print, send to your Kindle or read on a smart phone as a PDF
See Table of Contents & Links to each specific topics (separate page)
Five-Point Wrap Up:
The ABCs of a Political Action Plan
Excerpts from background materials:
Short-cut to: part 2, part 3, part 4, part 5, part 6, Wrap-up, references & background material
The Bad & Sad News
The American healthcare system is failing all of us in one-way or another.
In 2007 we spent an average of $7,900 on health care for every person living in the US, or 16.4% of our total Gross Domestic Product (GDP). Every other developed country spent far less per person, had better outcomes and devotes only 9% to 12% its GDP to healthcare.
As an insider in the field, I’m all too familiar with the problems of the current system – lack of access and poor quality for the uninsured, unproductive expense, procedure-intensive care and over-treatment for the insured.
I also know that a wealth of definitive information about our and health and medical care system is just waiting for someone to connect up the dots. This is the only way the public and the policy-makers can understand what makes our current system so dysfunction and why doing more of the same won’t fix it.
An exercise in Pseudo-Journalism
So far this week I’ve heard a dozen different speeches and interviews on the pros and cons of national health insurance. According to the political pundits, the next few weeks are critical to the success or failure of the Administration’s plan for legislative reform. Media coverage is plentiful and includes persons of great influence: no less than President Obama himself, elected officials, talk-show hosts, and healthcare experts. Unfortunately, this mile-wide coverage is only 1/8th of an inch deep, with the most vital facts consistently absent from the public discourse. This leaves citizens with no reliable source for factual information of the quality necessary to make important personal or political decisions.
“When you don’t know where you’re going,
every road takes you there!”
Policy decisions this important should be the subject of hard-hitting investigative journalism. But the corporate structure of newspaper journalism is so tied to advertising revenue that controversial topics are an economic liability. Given the long lead-time in the publishing business, books about current events rarely make it into print while the topic is still hot. For instance, the present crop of books on health care reform was published during the Bush administration.
What we need is the quality and quantity of investigative journalism that would allow us to formulate a rational national policy. What we are getting instead is pseudo-journalism — what looks like a good faith effort to inform the electorate is little more than infotainment or dumbed-down journalism. While there are lots of reporters, most of them are failing to do their home work or pulling their punches for some unstated reason.
The Information Gap
Many people believe they already know all they need to about health insurance reform. Public dissatisfaction is widespread, many businesses can no longer afford to cover their employees, groups formerly opposed to reform have grudgingly admitted its necessity. On the political side of the equation, and the administration has a voting majority in the Congress that supports incremental reform.
People expect these favorable conditions to generate an overwhelming political momentum that will prevail where earlier attempts by Presidents Roosevelt, Truman, Kennedy, Carter and Clinton all failed. But the political and financial matrix of organized medicine, investor-owned corporate medicine, lobbies for big pharma and 1,300 private health insurance companies have hired the same PR firm that produced the Swift Boat ads during the 2004 presidential campaign. Sooner or latter, the gloves will come off and the fight will get dirty.
None of the usual sources of public discourse, including the administration, have been able (or willing) to provide factually-rich background information on health care policy reform. For ardent supporters, this is not such a problem. But for many others, the gap in understanding will be left to the special interest groups to fill. This makes us vulnerable to fear mongering, as few people have the necessary facts to correct a campaign of misinformation or disinformation funded by special interest groups and politicians who oppose health care reform. Confusion is the surest way to sabotage democracy.
Failure is not an option. Our current system of highly medicalized health care is unsustainable, not to mention unsatisfactory and increasingly unstable. A 2009 PBS program on the national debt by calculated that current levels of healthcare spending had already outstripped the cost of both foreign the wars (Afghanistan and Iraq) and is projected to be greater than the entire GDP by 2050.
This level of unbridled spending is stealing money from everything else we hold near and dear, sucking all the economic oxygen out of efforts to prevent global warming, improve our schools, modernize our public transportation system or develop the infrastructure needed to respond to a natural disaster, pandemic or an act of bio-terrorism.
Were this profoundly dysfunctional system forced on us by a foreign government, Americans would rise up in rebellion.
There’d be marching in the streets in protest, willing to go do anything necessary to get out from under its tyrannical grip.
In a recent PBS interview Wendell Potter, retired head of CIGNA’s corporate communication department for 15 years (4th largest health insurance company in the US), acknowledged that unethical practices and skewed priorities are the industry norm. As a former insider, he identified the preoccupation of the health insurance industry to mirror those of Wall Street, with its focus on ever-rising quarterly profits. CEOs truly believe their first responsibility is to shareholders and not to the people they insure. [Bill Moyer’s Journal – PBS ~ 07-10-2009].
In testimony before the US Senate Commerce Committee this summer (2009), Mr. Potter said: “Recently it became abundantly clear to me that the industry’s charm offensive, which is the most visible part of a duplicitous and well-financed PR and lobbying campaign, may well shape reform more in ways that benefit Wall Street far more than average Americans.
The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable public health care option as “government-run health care”, but what we have today Mr. Chairman, is Wall Street-run health care that has proven itself an untrustworthy partner to its customers, doctors and hospital who deliver care and to the state and federal governments who attempt to regulate it.”
While reforming health insurance policy is vitally important, particular the issue of pre-existing conditions and rescission (dropping insured people when they are diagnosed with an illness or need surgery), it is just one aspect of a much bigger problem.
Whether we have a not-for-profit public insurance, or for-profit private system or a blend of both, how we pay for health care is less important than what we are paying for – whether the medical treatment is genuinely needed and/or effective. If not, no newly configured source of payment can make the current system affordable. It would be like pouring water into a sieve – no matter how much or how fast it’s poured, you still can’t make it hold water. It will be the ultimate bitter disappointment to us all to discover that reform legislation failed to fix the underlying problem.
National Healthcare Policy 2009:
If effective health care policy reform is to prevail in 2009, it must win against the same special interest groups that have always opposed these changes — organized medicine, investor-owned corporate medicine, big pharma, 1,300 health insurance lobbyists who are spending 1.3 million a day, plus the US Chamber of Commerce. That is a most daunting task in light of political history and the century long dominance of the health care system by organized medicine. Like the proverbial 800-pound gorilla, they are used to getting their way.
For health care reform to happen, people need to know the facts. Without an informed electorate, the Administration and the Congress would more likely convince the NRA to go along with a ban on assault weapons or Wall Street bankers to voluntarily give up executive bonuses.
Since 1920, a plan for universal health insurance has been introduced five times by presidents or the US Congress and five times it has been killed by organized medicine and its economic allies. They expect to use this same wellspring of political might and money to stop the 2009 legislative proposal for a public or non-profit health insurance even though a plurality of Americans support.
The AMA and National Health Insurance:
As a private corporation, the AMA’s website describes itself as “one of the biggest and wealthiest lobbies” in the US. With the extensive political and economic resources available to the AMA, its ability to promote, introduce, control or defeat government policy or legislation is unparalleled.
As of 2007, the AMA had a national staff of 1,121 full-time employees. Sale of advertisements in the Journal of the American Medical Association (JAMA) and the other ten AMA-owned professional journals topped $289 million. In 2007 the AMA enjoyed a net income of $50.3 million and income growth of 99.6%.
In addition to advertising revenue and subscriptions to professional journals from libraries and institutions, the AMA also sells malpractice insurance, collects membership fees from its 240,000 MD-members and receives grants money from its many corporate sponsors. It has recently expanded its publishing business to include on-line data services for MDs and to gather, archive and then sell statistical data on health and medical practice to corporations.
Given this depth and breadth of resources, it’s no surprise that the Association has achieved its insurance-related legislative goals 95% of the time – 1920, 1933, 1948, 1976 and 1993. Equally important, they got a self-serving provision inserted into the only major piece of legislation in the last hundred years to pass in spite its opposition – the 1965 Medicare bill for the aged, disabled and medically indigent. At the AMA’s insistence, a cost plus-fee-for-service reimbursement scheme was added to Medicare, thereby turning a potential defeat into an economic bonanza for the business of medicine.
Due to AMA’s influence over the Medicare legislation, medical providers retained their unbridled control over all treatment decisions – the number and kinds of tests ordered, drugs prescribed, medical and surgical procedures performed. This gave physicians and hospitals absolutely no reason to use cost-effective practices, since they self-defined the cost of care and billed Medicare for whatever amount they considered ‘customary’, plus setting professional fees for their services.
Cost-plus-fees is a straightforward economic incentive to do more tests and procedures (i.e., billable units), and refer more patients to specialists, who are paid nearly twice as much as primary care providers. Since this costly Medicare provision was first passed in 1965, it has been modified to reign in its most egregious excesses, but not nearly enough to keep the mounting number of retired baby-boomers from crashing the system. Unless corrected, the inevitable result will be insolvency.
Another contemporary example of what happens when health policy and legislation are controlled by corporate medicine and big pharma is the 2003 prescription drug bill. This legislation explicitly prohibits Medicare-Medicaid administrators from negotiating drugs prices –something the US military and Veterans Administration has always done — even though these purchases are being paid for by US tax dollars. Not even the Pentagon has this sweet of a deal.
A Real-World Study in Contrast:
According to the US Bureau of Labor Statistics, General Motors was the country’s largest employer in 1960s and1970s but sometime during the mid-1980s, health care took over as our largest industry. By 1993, the cost of health insurance for GM’s employees added $700 to the price of every car and truck.
In 2005, GM’s yearly spending on health care was $5.3 billion for its 1.1 million workers, families and retirees – slightly more than $5,000 for every GM-insured person. This added $1,525 to the price of every vehicle the company builds in the United States. GM’s largest competitor, Toyota, spends only $97 on workers’ healthcare for vehicles built in Japan [A Second Opinion; Arnold Relman, MD].
As could be predicted, the healthcare industry is thriving. With a projected 22% increase in its work force over the next decade, health care is one of the few growth industries in the US, along with banking and financial services. Meanwhile, GM was grateful for a government bailout in the fall of 2008 and was forced into bankruptcy by May of 2009.
Part 2: Title here
weblink, etc
