This Diary was originally a comment on a thread about a story on 60 Minutes about an organization that travels around providing health care to indigent or uninsured people. It was heartbreaking to see people who have been completely defeated by our system. It spurred me to think about my 21 year history in the healthcare delivery universe.
The following is a fairly comprehensive look at how I see it....
I'm an Optician by trade. I work for an independent Optometrist in Iowa. The woman shown in the 60 Minutes segment had a prescription, based on my observation of her glasses on TV, that is so near-sighted that it is almost certainly associated with other serious physical problems. I suspect that's why she got in, despite being too late to be seen. The fact that she simply described problems with her vision, despite the very strong prescription she was wearing, is a sign she had lowered her expectations to an abjectly fatalistic level.
The saddest part of that report, and I'm as mad as hell about it, too, is that we see these people all the time in our office.
I remember a 5 year old boy, functionally blind due to a retina problem, who was denied contact lenses by Medicaid because they were considered cosmetic. Well, no; the combination of contact lenses and glasses were the only way for him to be mainstreamed in school, instead of being shuffled off to an institute for the blind. It would have taken the first 9 weeks of the school year to fight the State for payment, and probably not get it anyway, so we gave the boy the contact lenses, and the all of the followup exams to make sure his condition was stable and that the lenses actually worked.
This boy had been through several eye surgeries to improve his vision, but none of them had worked well enough for him to attend 1st Grade. By the time I was given the task of teaching a blind 5 year old to insert and care for contact lenses, he wouldn't let me near him. He was afraid of any medical people.
He told me he would teach himself to put the lenses in. The Doctor and I reluctantly agreed.
This kid DID teach himself to manage his lenses. This was 21 years ago.
I saw him for the first time in 15 years a month ago. He's a graduate student.
Here's the problem. Very few people are as extraordinarily strong as that young man. Most are like the woman in the 60 Minutes piece, not weak necessarily, but defeated by a health business system that is designed to defeat patients.
Although I'm an Obama supporter, none of the health insurance plans proposed by any major players in the Presidential race, nor in Congress, are sufficient to solve the problems of the people in the 60 Minutes report, all of whom have been bulldozed by the system we have now.
So, it's really gonna be up to us to make it clear to the next President and Congress that freakin' tax breaks or business mandates are NOT gonna work. As long as the problem is looked upon as an "insurance" problem, we're screwed. It's a health-care accessibility problem. Dennis Kucinich has been right about this forever, but the message needs better messengers. I hope that the netroots can help force the debate towards a solution over the next few years.
My fear is that whatever system is devised, it will be designed to keep costs down based on ability to pay. That means that millions of mentally ill, indigent, illiterate, preschool, orphans, and anyone else who can't understand or fill out the paperwork correctly will fall through the cracks, just as they do now.
If we are going to fix the problems in our current health business system, we need to change four things that will be extremely difficult to address:
Patients...
must be educated that doctors aren't magicians, and they're not mind-readers. Also, patients need to be educated to understand that many common health incidents are normal and benign - like bad colds, scraped knees, and shyness. They must be educated to expect to wait out problems that don't commonly last more than 4-5 days. They must understand that some problems cannot be solved, or that the best treatment only will manage the problem and not cure it. They must learn to understand that age destroys a lot of bodily functions, and that this is often irreversible. Patients should understand that they are finally responsible for their own best health, and that their health providers can only make twinky-gulping obese people thin (for one common example) with non-insured procedures.
Doctors...
need to be freed to treat patients the best they can, no matter how long it takes and no matter how difficult it may be to do so. A system that allows this (see "Sicko" for the French approach to this) will allow patients to begin to trust good doctors. This will improve care. Doctors need to learn to admit mistakes. This has improved care and lowered lawsuits in places where this policy has been instituted (I read this in another Diary, and I apologize for not being able to find it now for attribution). Doctors need to readjust their expectations of compensation to be more in line with other professionals. Believe it or not, other professions deal with life and death issues every day, too! Health care isn't magic, and therefore isn't necessarily worth whatever a frightened patient population can be held hostage to.
Insurance...
needs to become a non-profit business. That doesn't mean it goes away, or that it has to be single-payer, but that policies that cover everyone, as Obama likes to suggest, for the same things Congressmen are covered for, are the bottom rung of the insurance ladder. Any system that can succeed must quit paying for health insurance agents' lake homes. I admit to not knowing enough about the costs of research and development in drugs and other medical therapies to suggest an ultimate solution to the problems in that area, but one thing is certain. It should not be possible for prescription-only medications should not be advertised to patients. We don't allow tobacco commercials, on the basis that they are counterproductive to smoker health. Any product that can cause medical emergencies associated with erections should be understood and prescribed by doctors, not the marketing wing of some international conglomerate.
Government...
must figure out how to override industry intentions to keep things basically the same as they are now, and then create a politically possible solution that puts health care back into the hands of doctors and their patients, and puts health care costs behind patient care in priority.
Whatever the solution turns out to be, it needs to address these four issues, or we'll just have a shiny new coat of paint on the old broken plan.