POLITICS. We have a tacit understanding to exclude politics from the blog, but current events are pushing the borders. It’s not our fault, other forces are on the move. At the border last year was the Iraqi civilian body count issue precipitated by articles in The Lancet. That’s when politics intrudes into medical research and literature.
Other borders are matters of licensure, and of permitted and rejected methods and materials, encoded into licensure, food and drug laws, and a myriad of administrative edicts and court decisions. One can’t escape the politics of those, especially when Congress and states start to control as commercial entities, areas that historically belong in culture: professional behavior codes, codes of traditional relationships between physicians and patients, for instance. These are under further pressures of conformity and legal sanctions enforced by the power of central government.
Steve Salerno (web site: www.journalismpro.com, blog: www.shamblog.com), author of the WSJ article on “CAM” and the NCCAM last December that precipitated the Chopra, and Co. responses, brought to attention a recent House hearing at which Congr. Riley (D, Ohio) queried Sec. Sibelius whether she was aware of “mindful meditation” as a cost-saving method that should be included in any federal health plan.
Here we go again. Ten to 15 years ago it was Sen. Harkin legislating research and practice from halls of Congress resulting in the Office of Alternative Medicine and NCCAM. That legislation resulted in financed medical school courses, multiple more lectures and demonstrations, and now med school divisions with endowed chairs, scores to hundreds of employed associates, and with little to no scientific feedback or oversight.
The sectarians are on the move again to be included in a prospective national health insurance scheme. The politics is inevitable, not because of us, but because of the economic push by sectarians. Here in Northern California we saw two acupuncture articles – one in the SF Chronicle, the other in a hospital and practice journal – within 2 weeks of each other. Content was no different from the puff pieces in the 1990s.
I wrote both authors and editors, asking if the articles were generated by the authors or by “someone else”. I got one response (the hospital journal author) stating the reporter thought it up herself. I then asked to speak to her by phone and got no response.
And from the SF Chronicle came no response at all. I’ll be working on it the next few weeks.
The first bit of good news (in my view) came through an LA Times article yesterday that Ted`Kennedy had removed from his version of the bill, the federally funded choice option. A few words about that. Many observe a federally run health insurance option as the camel’s nose under the tent, the end to private medicine in the US, and the takeover of medicine by government. The prediction was, that like Medicare and Social Security, the cost could not be funded by a set-aside funding mechanism, but that the inevitable cost over-runs would be financed by – of course, federal taxes and deficit spending, increasing the national debt. The federal plan would be cheaper and unfair competition. The Feds would never increase the premiums to cover the cost of a federally sponsored plan because it could not be competitive, and would break its own financial setup – just like the rest of federally funded undertaking. The costs would probably be greater than privately run plans or else care would have to be rationed more than would happen on the private side. Nevah hoppen, GI.
Besides, legislated general medical care would be open to being amended at first or later to include your “mindful meditation” fees that advocates and sectarian are sure to request. Then start adding and multiplying from acupuncture and chiropractic on down.
So removal of the federally funded option was good news indeed – if it remains out. There is no assurance it won’t reappear. If people want insurance to cover such electives and personal and philosophical fulfillments, be my guest. Just allow them to pay for it themselves, and not take my taxes to pay for it like the NCCAM has.
I was asked by a prominent physician with entrée to the Administration for my view of an ideal “reform plan.” I stated the above and then some; mainly that the feds have no business expanding their role. Bug out. Leave “reforms” to the states and individual choices. Why? Once the feds approve for payment sectarian and implausible methods, extracting them for payment is harder than “pulling teeth.” Once the camel’s nose…
WHAT’S A REFORM? As for reforms, look at history. Our medical system works well for most people, and I’d say, better than in most countries, no matter what the critics and malcontents say. I’ve worked both privately, in the armed forces, a university hospital, in safety net county hospitals. They all work as a system despite their separate subsystems. And the most efficient and cheapest is the private system, and it’s the freest. .
The present private insurance system can be reformed. It began in the late 1930s-40s, tied to employment because large firms though it a good idea to keep good employees by including medical insurance as fringe benefit. There was no other reason. A good idea, but with unforeseen consequences. It introduced the third party, the problem of systematic abuse (in addition to two-party abuse) and the concept of approved and disapproved methods – a generally good idea, but… Medical insurance also should bug out of employment agreements, and be completely portable (another suggestion.)
The second development was the takeover of medicine by the business community (The Business Roundtable) in the 1970s-80s. Medical professional organizations just rolled over and had tummies scratched by the false offers from business, HMOs, and organized insurance to guarantee income. It was a disgrace at the time. Many of us complained but so many bought into the “system” promises as did state legislators, that we lost our choices, and professional freedom. A bad idea with bad consequences. It was the genesis of the 10 minute visit, lack of listening, and the host of modern criticisms.
Any reform must keep medical care as a primary relationship between patient and professional (physician and nurse, dietician, etc.) because that is the human nature of the matter, and anything interfering with it will be dysfunctional, and not correctible, period. Quality review has to be limited to opinions of other – peer and expert – opinions. Government plans inevitably encode pseudoscientific methods and practitioners because the plans are not insulated from politics and economic pressures.
Private insurance would be functional and affordable with co-pays, and only partial outpatient coverage, and with insurance mainly for expensive disasters. Expensive drugs can be made more available through economics if the market could be freer to operate. “Safety net” clinics and hospitals would still exist. That which does not respond adequately to the market we can still work on without discharging the entire US medical system. Or even a single payer – my idea of another nightmare.
As for the concept of the system being in crisis, I dealt with this previously. It’s a conjured myth; hyped by people who want a say in controlling the present status. The word crisis goes back as far as the 1950s. That is no crisis. We have a correctable situation, but not a crisis. There is no epidemic of deaths due to lack of insurance coverage. And no need for a takeover of medicine by a central government.