Sound impossible? Hardly. According to an investigation by the Institute of Medicine, such a scenario happens about once every minute in the U.S., and while not every case ends up with a dead patient in the back of an ambulance, the statistics are a sobering wake-up call concerning the state of our hospitals, health care, and ability to react to disaster situations.

This is just another piece in the mounting pile of evidence that America’s health care system is not the finest in the world, at least not in terms of accessibility or preparedness. The report makes some fine recommendations, but unless lawmakers hear from the citizenry, the issue of national health care is going to keep getting pushed to the back burner.

What matters more to your life? Burning flags or closed hospital doors? Same sex marriage or dying in the back of an ambulance? To me it’s an easy choice. Time to put some pressure of politicians to work on something that really matters to all of us, our quality of life, and yes, our national security.

(originally posted at Bring It On! )

Purely by accident, I was born in the good old U.S. of A. From my first breath, I already held an advantage over two thirds of the planets human population. I did nothing to deserve this; my eventual skills played no part in my good fortune. It just was.

But rather than assume that the advantage of birth is a foregone conclusion, entitling me to all the good things in life just because, I came to realize that success, whether individual or larger scale, is built on the backs of those who came before us. I was lucky to be born in a country that was technologically advanced, democratically governed, and financially affluent. All of these things contribute to my present condition, and they were fought for and won by those who came before me. So despite my own hard work to prop myself up, others paved the way, created an environment for me to excel, and defended the rights of the common man as described in our Constitution.

Yet with so much in my favor, with so much good fortune on my side, why is it that I am so angry at what our country is becoming; at what it has become? This is a question posed often in various ways by conservative commenters and writers who fail to see not only what is changing in America, but also how it is that we got to be so advantaged in the first place.

“What are you whining about?” they say snidely. Or, “Why should I care about that?” in response to some social or foreign policy issue. For someone with limited ability to see beyond one’s own good fortune or pleasant circumstances, the question may seem valid. And try though I might to illuminate my displeasures, the moat of selfishness is often too large to breach. Yet for the sake of trying, I will make another attempt, in statement and response form.

“Why do you always blame everything on Bush?”The president is a categorical liar, beginning with his self-description of “compassionate conservative” to his rationale about Iraq through to his false refutations regarding foreknowledge of the potential damage from Katrina. And these are just the big ones. He has a proven record as a failed businessman, a proven record of unbridled cronyism, and an unhealthy love affair with corporations. He distorts spirituality and cheapens religious beliefs by using them as cynical political ploys. And, he and his administration are responsible for the policies and actions that have gutted decades of environmental and social progression, lowered our reputation among the nations of the world, and squandered our tax revenue and our soldiers in pursuit of folly and a misguided sense of destiny.

“The economy is doing just fine. People who don’t make it are just lazy and expect handouts.”The economy may be okay in my house and in your house, but that could change in a heart attack. Even with my own great medical plan, one major situation and I’m in the hole. But I understand that my own good job is dependent on so many others. With increased outsourcing, there are fewer good paying jobs around. That means less money to spend or circulate, lower tax revenue, fewer public works and support, and on and on. The net effect of other people losing their jobs is felt by us all, and that concerns me, both on a personal level and from an empathetic point of view. Because I don’t just worry about myself. I care about other people too.

“There is no right to health care in the constitution.”There is no right to corporate subsidies either. To paraphrase an original American patriot, give me equity or give me nothing. The Declaration of Independence proclaims the right to life, liberty, and the pursuit of happiness. The Constitution declares government to provide for the general welfare of the people. I can’t seem to find the words corporation or lobbyist anywhere in these documents. I can more readily parse “good, affordable health care” from those documents than I can for corporate welfare.Yet aside from the human element, even corporations would benefit from a release of financial obligations for employee health care. It can be done and it should be done.

“Nobody cares about the wiretapping.”Aside from being patently false, the number of people who care is not the relevant issue at hand in the illegal wiretapping scheme carried out by this president. It was, and still remains, an illegal practice as performed at the direction of the president. He is not above the law. No amount of spin can change the facts. Most people don’t care about a hold-up at an obscure 24-hour mini-mart either, but we don’t stop arresting armed robbers. The issue here is not only did the president break the law, but we have men and women dying today fighting to preserve and spread our democratic belief in the rule of law. We’ve had men and women dying for generations to preserve the ideal. It is both a stain on their sacrifice and a spit on their memory to allow any public official, but especially a president, to get away with that kind of arrogance.

“Criticism only emboldens the terrorists. I guess you love al-Qaeda.”And I guess you are a complete idiot. Anyone not thoroughly brainwashed by neo-con, ultra-evangelical ideology can see that it is my deep love of the good fortune I now have that causes me distress over the course this country is on. I see an unsustainable federal spending spree forcing generations to pay for today’s errors, ultimately driving down our country’s economic stability and superiority. I see social programs, designed to uplift those among us who haven’t the money to become educated or get a doctor check-up or eat three squares a day, being systematically cut down or farmed out to religious indoctrinators. I see a hyped up “War on Terror” that expects no civilian sacrifice or participation other than to keep spending those dollars while the tax revenue gets funneled to corporations who don’t even perform the work they were hired for. My criticism is not given blithely. It has been well earned by this administration. And were I not to criticize, were I to remain silent and mute my free speech, only then would I be emboldening the terrorists. For it is that kind of society, one where self-censorship predominates all public discourse, that they embrace and thrive in.

“Why do you hate America?”Why haven’t you been listening? Really listening. Just as no one is perfect, neither is America. Yet in normal times, it is her imperfection that gives her charm and strength. But in times of duress, which is what we entered when planes were used as cruise missles and our government decided to go all squishy while the POTUS had one to many Napoleonic dreams, we can not simply sit back and marvel at our own good fortune. For as government becomes more and more separated from the people, our individual good fortunes will eventually falter. Our collective good times will end if this path is not altered. If you really love America, you wouldn’t sit by and idly accept every lame excuse from the mouths of liars. You wouldn’t profess admiration or fealty to men and women who discard our most important secular documents of all. If you really love America you
’d be right here beside me too.

So as I wrap up another day in my fortunate life, as I get ready to crawl into a warm bed, I realize that for too many in America the good times aren’t real. The struggle is constant. The relief is fading. And I know that if I do not speak, if I do not empathize, I am no better than those who actively fuel their downfall. Out of honor for those who have come before me I will speak for those who fall beside me. Out of respect for the sacrifices of our forbearers, I will fight to preserve the freedom they died to give me. And so long as I have the ability to vote, I will insist that those who speak for me really speak for me.

As many know, the infant (no pun intended) science of using stem cells to create human tissue shows promise for medicine because stem cells can be stimulated to grow into new human tissue, giving doctors the ability to treat organ disease with greater chances of success. One of the earliest researchers of stem cell development, James Thompson, showed a line of stem cells that had been transformed into human heart cells. The belief is that these cells could replace damaged heart tissue in patients, offering better chances for recovery, lower the chance of tissue rejection, and reduce overall chances of death due to heart injuries. This example is just one of many possible futures for medicine through stem cell research. And embryonic stem cells offer the best opportunity to tailor tissue for a specific purpose. Such scientific advances would seem to promote life for already living humans, or cure humans who are hanging to life in precarious medical situations, something that Bush and his party seemed eager to advance during the whole Terry Schiavo grandstanding last year. So, according to their actions in the Schiavo case, it would seem logical to assume that Bush would support this research.

But as with many things from the Bush administration, logic is not at the forefront of their decision-making processes. Despite the president’s desire to see things as either black or white, right or wrong, the fact is that the world is seldom that accommodating. Because in this case, in order to support the measures that would promote life for the living (or in the case of Schiavo and others like her, the lingering), advancing the research of embryonic stem cell research requires the destruction of the embryos themselves. The question then, is whether these embryos are really life, in the sense that we know it.

According to Robert George, a member of the Council on Bioethics, the president’s position is that an embryo is human life, with all the same rights and dignity of a fully developed, fully formed human being. And to destroy one for stem cell research is the same killing a person walking down the street.

George says, “The principle that the president laid down and which I support is one that says all human beings, irrespective of age or size or stage of development or condition of dependency, possess the same human dignity, because human dignity is inherent.”

Yet, instinctively we know that Bush does not believe this, or else he would not have signed a law while governor of Texas that allows family members to decide when to pull the plug on life support measures for patients who can’t make the call themselves. We know this because recent congressional investigations into the Hurricane Katrina response by the government shows a lack of effort to save as many lives as possible. We know this because of the signing statements Bush made regarding the use of torture. And with regards to frozen embryos, we know that this “inherent dignity” is little more than talking points to drum up support from his religious base because laws allow the destruction of thousands of frozen embryos each year when couples decide they are no longer needed.

The news story went on to report that there are over 400,000 frozen embryos currently in storage in the U.S. Many will never be used for pregnancy, and in fact will slowly deteriorate if kept in their cryogenic condition indefinitely. Many others will simply be discarded. Some will make their way into privately funded research programs, but none will be eligible for federally funded research that could ultimately increase the quality and ‘dignity’ of life for the living because of Bush’s ban on such studies.

To insist that frozen embryos are indeed human beings at all is a stretch. Most scientists and medical professionals do not consider an embryo to be viable until it passes 22 weeks of gestation, and even then could hardly be expected to grow into a successfully functioning human being if brought out of the womb. The Catholic website, www.newadvent.org says that viability is not safely presumed until the 8th month. Clearly, there is some contention about when a fetus becomes a human being with the inherent rights of a born person, but few disagree that a frozen embryo is about as close to being human as a cup of freeze dried coffee would be. Sure the potential is there, but unrealized potential is just that- unrealized.

In his 2006 State of the Union speech, Bush proclaimed that, “Human life is a gift from our Creator — and that gift should never be discarded, devalued or put up for sale.” Yet when it comes to frozen embryos, this is hardly true. In fact, such embryos are created in a petri dish in a laboratory by human scientists. And they are discarded with regularity. And the president knows it. Why then can they not be used to advance the science of medicine that would better the condition of human life? For a man willing to sacrifice the living in poorly thought out wars, why the hesitation to use that which will never be life to help heal the sick or cure the diseases that plague humanity?

There is no rhyme or reason to this president’s policies, no logical strain to follow. Instead, what we get are inconsistent ideas that make good sound bites but fall apart when examined as a whole. When it comes to stem cell research and frozen embryos headed to the scrap heap, the only sane choice-the only humane choice- is to use what we have to make life better. After all, isn’t that what pro-life is all about?

This is the America they have brought to reality today:

Education is falling farther behind the rest of the world, including some third world countries. Science and math scores are at all time lows. Education costs are at all time highs. Cuts to student grant and loan programs for higher education leave many out of luck. The average reading comprehension ability among adults is judged to be at a sixth grade level.

Health care has become so expensive that many citizens go without, causing preventive care to be ignored at the peril of national health. Hospitals are overwhelmed with uninsured and illegal immigrants and are closing their doors. Seniors are having to go without vital medicine in the wake of a “new and improved” Medicare prescription benefit. The average bankruptcy is due not to reckless, wanton spending, but to unexpected, catastrophic medical costs.

Energy costs have skyrocketed, but energy providers and others in the energy industry have seen their profits explode. The average person has to choose between filling up the gas tank or buying new clothes for the kids. Home heating bills are even worse. Yet the answer from Congress is not to aggressively explore new energy resources, but to offer tax cuts to the industry as they attempt to gut wilderness areas in the quest for more non-renewable energy sources.

Employment is being sent overseas as companies seek to improve their bottom line at the expense of the people they want to buy their goods. For every middle wage job that leaves, a new Starbucks opens so net job loss is negligible. Net income is going way down though. And as inflation rises along with the federal interest rates, average Americans are being squeezed by the financiers and credit companies. Bankruptcy is also tougher to access for those in real need, but companies can shift their obligations like pensions and health care off on the government while receiving subsidies and bail-outs and tax cuts.

Prisons are expanding in both population and power as more citizens are targeted in the worthless war against pot users. Meanwhile, child rapists and convicted murders are paroled and let loose on an unsuspecting society to make way for the dangerous dopers. We have nicer prison complexes than schoolhouses, which is okay since so many will end up there now that they can’t get a good education or a good job anyhow.

Domestic security is a farce with our unsecured borders, unprotected ports and transportation systems, and concern with taking nail clippers away from the elderly and infants. Regular Americans are kept off of airplanes by a “no-fly” list while we look the other way as violent gang members sneak across the border. But at least the president is spying on average citizens to make sure they aren’t calling terrorists abroad. After all, better to monitor the phones than stop them at the border.

Our environment is being assaulted by corporations who continue to ignore regulations and get away with it. Reducing greenhouse gases is just too darn expensive. Ensuring that water is clean takes too much time, and besides, we soon won’t have any scientists to monitor this stuff anyhow.

On the foreign front, we’ve managed to piss off most of our former allies and made some new, duplicitous ones in the process. The “War on Terror” has been turned into a war on innocent foreign citizens while the real dangerous people are left to plan another battle for another day. And let’s not forget about the fact that we’ve hocked the future of the next two or three generations to foreign countries to pay for all of our misdeeds. The mortgage on America is held by everyone but us, and when the bill comes due, it will be our future generations who are left holding an empty purse.

Throw in an assault on the Constitution by a power hungry president and administration, fueled by a religious ideology and sense of American superiority that does not exist and the very tenets of freedom are on the block.

And what has your congressperson or senator done to prevent any of this? The Republican party in congress has created many of these program policies and championed them through couched as family values or moral certitudes. The Democrats have sat idly by and let it happen. Both want only to remain in power and get richer while the average citizen withers away. They are paper tigers and corrupt pawns of corporate hegemony and religious zealotry and neither will help us regain what used to be a given- namely, American freedom, prosperity, integrity, and pride.

Sure, some politicians are trying to do what is right for America and Americans, and by extension, the other people in this world. But the majority are careerist hacks, bent only on their ability to get power and keep power. They’ve made politics a game of partisan bickering without benefiting the taxpayers who keep them in office. They’ve turned us off on politics by their own ineptitude. They’ve made the job of governing so meaningless that we’ve stopped participating. And now they can do as they will, not to make life in this country better, but to keep the people out of the way.

So I ask you again, Why do you support a system and a politician who would sacrifice you and your children’s future freedom and peace? Is it because you believe the rhetoric you read in the paper or the sound bites you see on TV more than you believe what your own experience tells you? If I kick you in the head and tell you it doesn’t really hurt do you believe that too?

There is another way. In America we are allowed, no, we are required, to choose who will govern us. And when those who are in the chair of power do not do their duty, we are supposed to get rid of them. If the Democrats and the Republicans won’t take this country to a place it should be, a place where our tax dollars fund the people who pay them instead of the bureaucracy that has no common sense, then we must find people who will. We must choose to elect people who are like us. People who suffer the inanity that we all endure and want to change it. People who grow weary of the rhetoric and seek to speak the truth. People who will work towards a common goal of returning America to the land of freedom and fiscal sanity and lawful rationality that it was meant to be.

If the two party system has become so corrupt that it cannot right itself, and I fear that it has become just that corrupt, it is time to move away from it to an era of citizen legislators. Don’t be fooled into thinking that we need two parties to move America forward. They obviously have done nothing but move us backwards. We could do better without them, and our very way of life may require that we do just that.

Solving the problem of access means we have to acknowledge that our current health structure is inadequate to modern society. Increased knowledge should have led to a more efficient system, but instead has given rise to ever increasing numbers of treatable conditions, driving us to our doctor’s doors at the first sign of illness. With an increasing population on top of that, doctors are finding themselves facing more patients with marginal health concerns, leaving them less time to address more serious health issues. Just as emergency room nurses prioritize incoming patients according to their injury, it is time our entire health care system performed triage on itself, establishing a system that addresses different levels of health care at different levels, and differentiating between necessary and elective medical procedures.

Suppose that the first line of health care treatment was a neighborhood clinic. Staffed mostly with novice doctors and nurses, but led by a seasoned doctor, these primary care clinics would be an integral part of the community, dispensing first aid, vaccinations, minor stitches or casts, caring for sprained muscles, colds, flu’s, and other lesser medical problems. One clinic per thousand residents (an admittedly randomly chosen number, for illustrative purposes only) would almost assure quick care when needed, and easy appointments for the rest. The facilities would be owned and administered by the public, and the doctors and nurses could receive tuition credits and on site housing options to accommodate a lower salary commensurate with their experience level. While working in the neighborhood clinics, doctors and nurses could continue their education towards a specialty, at no cost, and after a certain number of years experience and specialized training, could move into the next career phase of medicine, the Specialized Care Practice. Patients would utilize their neighborhood clinics as their first resource for the aforementioned medical needs. If their illness exceeds the level of primary care, patients would be sent to their specialized care doctor, who also would be their primary personal physician.

Each person, or family as the case may be, would have their own personal physician to turn to in addition to the neighborhood clinic. This would be the doctor you went to see for more serious medical problems like prolonged pain or if you needed diagnostic tests like blood tests or x-rays or MRI’s. This doctor would also perform comprehensive annual physicals for you as part of a preventive medical plan. Your dentist and eye doctor would fall into this class of doctors too, working in conjunction with your medical doctor to provide the patient with overall health care. Your primary doctor(s) would also be able to refer you to another specialist when necessary to help determine the course of your treatment. As with the neighborhood clinics, primary care practices should be developed to ensure adequate doctor-patient ratios in the communities they serve. Various specialists could reduce the overhead costs of separate facilities by creating community specialist clinics, larger versions of the neighborhood clinic due to the greater number of doctors and diagnostic tools. Unlike the neighborhood clinic, these facilities would be owned or leased by the doctor groups themselves. Another difference between the neighborhood clinic and the specialist clinics would be the matter of choice. With the neighborhood clinic, patients would have a designated clinic based on their home address. But your personal physician could be entirely up to you. Because this doctor could potentially manage your health care for your lifetime, it is important to choose someone you feel comfortable with, and different people have different health concerns. Since these doctors are specialists too, what you may need from a doctor could be different from what I need, but only you and I can make those choices for us. Doctors and nurses at this level of medicine would also have continued education requirements and testing levels before becoming eligible for hospital staffing, the final layer of a reorganized system.

Hospital care was designed for serious injury or illness, or birthing, or prolonged care and treatment. But hospitals today have become a catchall for anyone with anything who can’t see a regular doctor. With the institution of neighborhood clinics, coupled with annual preventive care and diagnostics from a personal physician, it could be possible for hospitals to return to their intended tasks. Barring an actual emergency situation, patients should need a personal doctors referral, or a referring doctors AND personal doctors referral, before being admitted. This would not apply to actual emergencies, severe trauma, or life-threatening conditions. But except for these types of patients, any person without a referral for hospital care should be sent back to their personal physician for care. This would have the effect of ensuring that hospital staff could better address critical patients instead of worrying about keeping the peace in the waiting rooms. Doctors would refer patients to hospitals for conditions requiring surgery, chemotherapy, radiotherapy, and childbirth, to name a few. Again, hospital size and number should be in a direct ratio to the populations they serve. Hospital wards could be divided into multiple building complexes too, to better prevent internal spread of disease, and to concentrate specialists together to provide better patient care. Like the neighborhood clinics, hospitals would be public owned and administered, allowing costs to be accountable and removing the “profit versus care” conundrum.

I mentioned the necessity earlier of differentiating between necessary and elective medical procedures. Elective medicine has recently become a boon industry as scientific advances extend beyond simple health concerns and embrace the cult of youth, self-image, and behavioral control. Elective medicine would include any procedure that is primarily intended to combat the visible effects of aging. But it could also include juvenile behavioral medications used to control a child’s attentiveness or aggression in place of parental guidance and discipline, or adult medications intended to increase certain physiological capabilities. Since the nature of these practices is not usually necessary for good health, they would fall outside the realm of the public health system. While doctors specializing in these areas of care would still need to be licensed and have completed the same initial training steps, they would not be eligible for public health dollars to cover their fees. And prescriptions for elective medications would not be regulated as far as costs were concerned. The only exception could be a patient referred by their primary physician for a medical necessity (read burn victim to plastic surgeons for example).

While this structure leaves out areas such as hospice care and assisted living care, I think that these could be considered lateral elements of the second tier of
health care. At the heart of such reorganization is, of course, public education. Ensuring that the public knows where to go for each level of illness would be vital to keeping facilities and doctors accessible. Just as important is letting people know that they will always be able to choose their personal doctor for their overall care, despite using neighborhood clinics for the minor problems. This stratification only helps ensure that doctors responsible for your total care have taken the time to learn their specialty and have been tested and licensed for your piece of mind. Such measures alone could lead to fewer misdiagnoses and hospital screw-ups, not only providing better access, but better care in the process.

Of course at this point it becomes incumbent upon me to provide the means and methods by which we pay for all this health care, because health care affordability dwarfs access as an issue of contention, and access is a pretty big issue. In my next essay, I’ll offer this final element of health care reform that, along with the cost saving measures already discussed in “Your Money or Your Life-The Costs of Health Care,” should provide an affordable, equitable, and more efficient means of paying for our good health.

Once upon a time, medicine was about healing people, or at the very least, easing their suffering. The role of doctor was a respected position in a society, and the doctor could always be counted on to come to ones aid any time, day or night. Sometimes you would heal, sometimes you would die, but always, the doctor would be doing what he could to help. Many doctors were not rich people, for the people that they served were not rich people. Money and medicine were not incompatible; they were just not synonymous. There were no pharmaceutical companies, no hi-tech equipment, no real overhead at all. You went to the doctor, told him your ailment, and he fixed you up with what you needed right then and there. Quick, cheap, and sometimes it even worked.
As such, a doctor’s payment often depended on two things: the effectiveness of his cure, and the relative wealth of the patient. In many cases, in-kind trades often replaced cash payments, which the doctor kept or sold for cash, as he needed to.

But the advancements in both medicines and knowledge merged with an increasing, then aging population. As our ability to actually cure diseases or operate on injured people became more adept, and as procedures became more standardized and effective, medicine shifted away from a service-oriented industry into a profit driven industry. It was discovered that people would pay good money for a treatment that really worked. Doctors could now heal more people with less effort, prescribing the perfect pill to fix your ill. And when there’s money to be made, everyone wants a piece of it. So let’s look at some of the costs of our health system, and see if we can cut those down using the service-oriented mindset and a healthy dose of Common Sense.

Let’s start with the costs of medical school. In 2004, the average debt a medical school graduate received with their diploma was between $105,000 and $140,000, depending on whether you went to a public or private university. Compare that to the graduating class of 1985 whose debt was $22,000 to $26,500. This debt represents the unpaid portion of their education only, with total 4-year costs of medical school topping out at $225,000 for a private university. With costs like these, it’s no wonder that doctors now try to get in as many patients per day as they can. There’s just no time for personal care when you’ve got a loan balance that large hanging over your head. The result of such high costs is a decreasing number of practicing physicians in this country. The solution? For starters, put a cap on public university tuition for doctors. Then offer a tuition trade-off program that would allow qualified students to receive free medical training. In return, the student would sign an agreement requiring them to work as a primary physician, at a greatly reduced fee, for the same number of years that they received training. For those students not taking advantage of the free tuition program, we could institute a graduate mentoring program that provides an opportunity to reduce costs of support staff at schools by pairing recent graduates with upcoming students and reducing the amount of their school loans proportionately. Finally, we develop national training and licensing standards for both general and specialized physician degrees that ensure a consistent level of knowledge and care. This would also have the effect of standardizing licensing fees paid by doctors, reducing the overall costs of becoming a doctor.

The costs of medical training are only the first drop in a very large bucket. Consider malpractice insurance premiums for doctors and hospitals. One of the unintended results of our increased medical knowledge is our assumption that doctors can cure anything. But for many diseases, doctors can only try certain treatments, offering no predictable or promised outcomes, only doing the best they can. In cases where there is no proven treatment, it is incumbent on a doctor and patient to have a clear understanding of the course of action, along with the possible outcomes, and as long as that plan is followed, no suit should be brought against a doctor. In instances of actual incompetence though, lawsuit awards should be commiserate with actual harm, meaning that non-life changing mistakes do not always amount to million dollar judgments. Mediation should precede any court activity, leaning towards non-cash restitution as often as possible. Again, if these or other measures result in decreased insurance costs for doctors, those savings can be passed along to the patients, lowering the costs for all.

What about administrative costs? Doctors and hospitals spend a whole lot of time and money keeping track of patient records, dealing with insurance companies, processing billing forms, and the like. Eliminating medical insurance as we know it would save millions in reduced manpower alone. Simplifying billing procedures through the adoption of a new way of funding health care will save even more. (In a coming essay, I’ll present my idea for funding medical care.) We could also adopt computer technology to manage the problem of keeping patient records private while eliminating the need for a large paper database. Imagine an encrypted computer disk in two parts. The patient keeps one of the pieces and the doctor keeps the other part. The patient’s piece would contain all of their personal medical history in an encrypted form that could only be decoded with the doctor’s piece. The doctor’s piece would be like a universal code breaker. Both pieces would have a randomly encrypted pattern to prevent accidental data exposure, but upon joining together would become readable to both doctor and patient. To further protect the patient’s information, the system could even require a biometric indicator, like a fingerprint or DNA sample before proceeding with the decoding. The information would remain private and in the hands of the patient, preventing any kind of data theft. With the increase of computing power coupled with the decreasing cost of computer technology, such reduction in administrative costs would further streamline the whole system, again reducing overall costs of health care.

Another way to reduce the costs of health care is to control the price and advertising methods of medications. Pharmaceuticals are among the highest costs seniors face with regards to their health care. Profits are so great on these drugs, that four of the biggest makers of pills (Pfizer, Merck, Eli Lilly, and Bristol Meyer) had revenue in 2004 of over $100 billion. Only $17 billion of that profit was recycled into research and development of new products. And another chunk of change was diverted into liability accounts to pay for the inevitable lawsuits that come when a promised new drug fails to perform up to standards or start making people worse than they started out. The fact that these drug manufacturers push their pill on everyone for every possible ailment isn’t lost on many, but our own gullibility rewards their efforts by gobbling up whatever they peddle, often without regard for the long-term consequences associated with the latest magic pill. Instituting a minimum and maximum price range for prescription and over the counter drugs may reduce drug company profits, and restricting advertising o
f drugs to the medical industry instead of the untrained consumer may result in drug manufacturers spending more time and money in R&D to ensure safer products. Their reward for better products, though not realized directly in financial gain could come in the form of tax credits or special government grant programs. And they’ll still be making plenty of money to boot.

I know that cutting expenses up and down the chain is only one of the ways that we can reduce overall health care costs. There are other areas to look at too, from aggressively prosecuting fraud to allowing patients to rent or borrow equipment like crutches or wheelchairs instead of purchasing them at high prices. But even with the reduction of these structural costs, we won’t completely solve the problem of how each person pays for their health care or how we, as a nation, dispense our health care services. Those topics will be addressed in the next few posts.

In the last century, humans have made impressive leaps and bounds in medical science, providing us with more effective health care than ever before. From eradicating deadly diseases to performing heart surgery to curing infections, modern science has extended our longevity and increased our ability to remain healthier longer. Our continued research into how the body works and what creates sickness have led to the creation of life saving drugs, more effective diagnoses, and comprehensive treatments. Yet for all our advances, we still have much to learn. Modern medicine, much like predicting the weather, is still not an exact science.

Still, it would seem that from a health care perspective, we are living in the best of times. We may never eradicate injury or illness in their entirety, but we have the ability to diagnose and treat most problems and our knowledge increases every day. Yet as our technological prowess increases, and as our pharmaceuticals become more targeted, the costs of obtaining the benefits of our advances continue to skyrocket. In 2001, health care spending in America amounted to $1.4 trillion dollars. That number is expected to be $3.1 trillion by 2012. Double-digit increases in insurance premiums are now the yearly norm, and more people have to make the choice between paying for coverage or paying the rent. Employers, struggling under the burden of premiums for employees and their families are also cutting benefits and increasing co-pays in an effort to continue to offer benefits at all. And the giant pharmaceutical companies are pushing their latest designer pills on the public, promising a cure to every ill, but at a cost. Medical care seems to be all about profit these days and less about healing the sick and preventing illness.

If the high costs of health care were the only problem with our system, it would be enough. Unfortunately, the quality of our care, or maybe more accurately, the manner of our care, has taken a hit too. In an effort to make medicine more profitable for providers and more economical for consumers, the HMO was born. Not only has the HMO model failed to keep costs in check, it has removed the personal care by turning treatment into a fiscal matter instead of a human one. Doctors, with the ever-looming cloud of a malpractice suit over their heads, are less inclined to be decisive or even forthright with their patients about their conditions. Secure patient records, privacy, and confidentiality are a top concern, as consolidated databases offer fertile ground for identity thieves. Clinics and hospitals are overcrowded, understaffed, and often badly managed, adding long waits to the growing list of negative aspects of our system. In short, we have a real problem with the direction our health care system is going, and it doesn’t seem to be getting any better.

But unlike a doctor who must perform triage on a patient with multiple injuries and treat the most threatening injury first, we must look at our broken health care system as a whole and find a way to make the different parts more synchronistic if we are ever to create a system that embraces the ideals of good health care. We must examine the reasons for increasing costs and find a way to control them. We must develop better access to medical care. We must protect the privacy of the individual. And we must look at our own attitudes and assumptions regarding health care. We must make the choice that medical care is a right and not a privilege. And as a basic human right, we must create a program that offers each citizen a consistent level of health care and find a way to keep the costs in line. And we must recognize that public health care is a necessary component of a functioning society, preventing disease from destroying the population, thus keeping the society intact and growing. Because if we don’t have our health, what do we have?

The American Dream is a quest for personal happiness. In this quest, nothing can derail a person’s hopes and dreams quite like medical problems. The uncertainty of recovery is hard enough to get through. The added uncertainty of getting and paying for treatment only makes things that much harder.