Confusing Paid Health Services with Caring Muddles Thinking of Patients, Providers, and Reformers

Alternative healing traditions hold potential for lowering costs, improving treatment outcomes

The push is on to reform health services financing before the August Congressional break.   Will haste give us another problematic law like No Child Left Behind?  Or is it more important to pass something, anything, to get the ball rolling?

The other day I sent the following letter about health “care” reform to my Congressional representatives.  And please see below for a link to a July 10 Bill Moyers interview with a health industry exec who has changed his opinion on health insurance.

My letter:

Dear Senator/Representative ______________

I confess I haven’t been closely following the legislative proposals for health “care” reform because I really don’t expect anything very helpful to come of it…. Why?

1. We have a multifaceted health services industry whose intent and methods of operation are disguised by our cultural agreement to designate its activities as “care.” As health policy expert John McKnight pointed out decades ago, care is an expression of love and is given without compensation. The health services industry, however, is comprised of businesses that need to be run for-profit.

When for-fee services are confounded with care it’s not possible to discern dispassionately and realistically which services are reasonable and affordable and serve the best interests of both individuals and the overall system. Thinking that service providers are acting out of love, patients adopt an attitude of dependence and gratitude rather than one of questioning and personal responsibility; and service providers think they are responsible for every life saved or lost.

2. Medical education and services in the US are in thrall to the special interests of the pharmaceutical and medical technology industries. There is a bias throughout the US health services system, and in state and national laws, toward theories, research, diagnostics and treatment modalities which support the profitability of these industries.

For the most part, then, we’re in a catch-22 situation with little hope of actually reducing overall costs, expanding services, or improving treatment outcomes. But there is a way to interrupt this vicious cycle: It’s the availability of so-called “alternative” treatment modalities such as oriental medicine, homeopathy, naturopathy, midwifery and others.

Unfortunately, the 1910 Flexner Report, reflecting early 20th century prejudices of the AMA and the Carnegie Foundation, created a monopoly in medical education and treatment that continues to dismiss other modalities as “unscientific.” The fact is, these other approaches are often effective and are less invasive and less costly. Typically, these alternatives rely much more on establishing healthy life styles. They promote responsibility for personal and family health rather than dependence on expensive medical technologies and pricey drugs with costly side effects.

My one concern about reforming health services financing is that it should not limit the availability of treatments, compounded pharmaceuticals, and nutritional supplements that fall outside the bounds of the US medical-industrial complex. I’m not arguing for these alternative modalities to be covered by health services insurance, but only that they remain available to those who choose to pay for them out of pocket. This is, first and foremost, a matter of protecting the rights of individuals to determine their own health choices. Secondarily, it might eventually serve to put a brake on the continuing escalation of the costs of health services in the US.

Among various examples of misdirected spending on health services that could be cited, over-medicalized maternal and infant support services put the US in 8th place out of 9 industrialized countries in maternal and perinatal mortality. This low standing is due in large part to improper interventions in normal births and failure to adequately facilitate breastfeeding. And in my own family I’ve seen the lives of several elderly persons destroyed, and their need for health services escalated, by excessive interventions resulting in toxic drug interactions.

The biggest problem I see in US medical practice today is failure—through ignorance and denial—to adhere to the ancient precept to “do no harm.” The other healing traditions available to us have not been blinded by the glitz of drugs and technology. Along with what is effective in mainstream medical practice, these alternatives offer avenues to more effective and economically sustainable health services for all.

Thank you for your careful consideration of the rights of individuals and the value of minority views in your review of the pending legislation on health services financing. JN

Bill Moyers interview:

This is a sobering Bill Moyers interview with Wendell Potter who was a health industry executive at Cigna. He’s now retired and has changed his opinion on health care. You can either watch the video or read the transcript.

Write your own letter:

If you’re not in the habit of writing to your representatives, the website has info for getting in touch with them. The Friends [Quakers] Committee on National Legislation also has a good website for that purpose: If you click on the link “Take Action” it sets you up to write and send your comments from the website.

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