its broken -lets fix it
It's easier to criticize what's wrong than to figure out how to solve just about any problem -- let alone one as massive and messy as our healthcare system. So, it seemed a pretty good idea when President Obama's Health Policy Transition Team asked for input on how to heal our sick system -- urging everyone with ideas or interest in the topic to host grassroots sessions in their own communities. Thousands of people in all 50 states volunteered. James Gordon, MD, former chairman, White House Commission on Complementary and Alternative Medicine Policy, and founder and director of The Center for Mind-Body Medicine in Washington, DC, was among those who accepted the challenge."
Prevention must become the new primary care. Dr. Gordon said this means that the "true primary care" should be a focus on wellness through the use of nutrition, exercise, stress management and mind-body approaches before resorting to symptom-suppressing tactics like drugs and surgery. As one participant, a mother of three, put it, "breathing, moving, learning how to shop [for healthy products]" should be mandated as primary care. With better wellness strategies, the cost of illness management naturally declines.
Retraining... for everyone. The group recommended lots of role-shifting and retraining in integrative approaches to healthcare in order to change the paradigm from disease-focused to wellness and prevention. They also recommended adopting a view of healthcare that combines treatment modalities for better outcomes. "Nothing will change if people remain stuck in the old model that no longer works," Dr. Gordon told me. "Surgeons ought to understand the role of self-care and group support -- people will always need surgery, but we also need to emphasize how to prepare for surgery... and how to recover in a more healthful way."
Mitigate the influence of profiteers, most notably pharmaceutical companies. The group supports banning direct-to-consumer drug advertising.
Free education, strings attached. A plan for transforming the system for the selection and education of health professionals should emphasize ideals, not economics, a "primary devotion to science in the service of people, to patients, not profits," said Dr. Gordon. The group proposes free education for healthcare professionals -- and in return, requiring compulsory public service from all physicians, nurses and other health professionals.
Change starts with children. The Department of Education should become a central agency in health promotion and disease prevention, teaching kids how to be healthy. Dr. Gordon pointed out that at present, health education to children is "largely negative -- don't smoke, don't drink, don't have sex -- and largely ineffective." Parents' responsibility to act as good role models should be reinforced.
Stop the malpractice insanity. We need a new "sane alternative to the current overpriced, counterproductive, indeed destructive system of malpractice insurance." The group proposed a national fund to fairly compensate patients in a way similar to workmen's compensation. "The practice of defensive medicine has been destructive to the delivery of quality healthcare," Dr. Gordon said.
Write a new research agenda. Expenditures for medical research should be reallocated to serve different priorities -- the budget should set an agenda for true health, rather than one that advances profit potential. Specifically, the group recommended that the $30 billion-plus budget of the National Institutes of Health be reconfigured, dedicating approximately 20% to studying the effectiveness of prevention, self-care and wellness... 20% shifted away from the single-intervention studies that now predominate and toward the study of comprehensive, integrative and individualized programs of care (e.g., mind-body therapies, nutrition and exercise interventions for arthritis and heart disease) for the chronic illnesses that beset our population (and consume healthcare dollars)... and 10% allocated to single-intervention studies for research on non-patentable approaches, such as herbal remedies and musculoskeletal manipulation. The remaining 50% would be spent, as it is now, on basic science research and the study of single interventions.
Aim higher. Healthcare should be envisioned as promoting personal, emotional, social and spiritual fulfillment -- programs should be designed to manifest this perspective.
Hire a boss. Dr. Gordon told me he believes this last recommendation is particularly urgent, and will facilitate all the others and help ensure their sustainability. A small, but powerful agency, a White House Office of Health and Wellness, should be established to ensure the government continues to respond to the ongoing and changing health needs of Americans. The mandate would be to enforce accountability of governmental bureaucracies to a vision of real healthcare for all Americans.
WHAT CAN YOU DO?
As the discussion moves into legislation, with debates already underway on what specifically needs to change about our current system, it presents an opportunity to get things right. You may agree with these ideas or not... you may have heard other plans you think are better... or you may have ideas of your own you believe strongly in. Now is the time to speak up. If you like these ideas, Dr. Gordon asked me to ask you -- readers of Daily Health News -- to pass them along to President Obama (1600 Pennsylvania Avenue, NW, Washington, DC 20500 or at www.whitehouse.gov/contact or by fax at 202-456-2461) and to Ezekiel Emanuel, MD, PhD, special advisor for health policy to the director of the Office of Management and Budget at eemanuel@omb.eop.gov or at www.fedspending.org/contact.php or fax at 202-395-1005. You can also contact Senator Tom Harkin at harkin.senate.gov/c/ and Senator Barbara A. Mikulski at mikulski.senate.gov/Contact/contact.cfm. He also asked that you forward him a copy of your communications at jgordon@cmbm.org. "If even half the people who read this do something, we can make change happen," he said
This US approach has equal merit in Camada and the world-QJ
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