Thursday, October 1, 2009

Random Thoughts re: Health Care Reform - 2

In my childhood none of our friends – or my own family – had “health insurance”. Since those were the 1930s and 1940s there was no “shame” associated with being “uninsured”. The uninsured were the majority!

Being “uninsured” did not mean, however, we had no care for when we got sick:
I broke both arms three times by the time I graduated from high school. Five [5] of those were diagnosed and treated in our living room without any diagnostic x-ray.
My father experienced a myocardial infarct [heart attack!] and was treated and recuperated at home! The doctor made routine visits and dad “rested”. It must have worked as he lived 18 full and productive years afterwards.
My sister was treated for bronchial asthma – all via home visits.

Were we wealthy? No. My father was laid off twice during the depression – and never had any “health insurance” until he was past 55 years of age! The same was true for most, if not all, of our friends. There was this expectation that life occasionally confronted you with illnesses or accidents – and treatments were usually paid from ordinary income. That was possible because:
Most families had a broad spectrum of home remedies. We put Vicks Ó on our chests; drank a milk-vanilla-sugar mixture with up-set stomachs; wrapped sprains; etc.
Physicians made house calls.
Physician fees were usually less than $5.00 per visit.

Gradually, however, more and more citizens obtained “health insurance”. While there were many reasons for providing such coverage, the major factors were as ways for industry to grow wages during WW II when wages were frozen and later when they sought tax-free ways of increasing remuneration. This new “benefit” was not a response to the dictum in Matthew to care for the sick!

However – little effort was directed towards understanding what “health” means. “Home” and “Auto” insurance policies operated quite differently as they became directed towards the “unexpected” and/or the “catastrophic”. One did not ‘expect” the ‘Home” insurance policy to cover a periodic paid job because the old paint peeled or one’s spouse wanted the house to look differently. Nor, did one expect the “Auto” insurance policy to cover a lube or oil change – even though such would add to the ‘well-being’ of the auto.

Society has taken different approaches with their “Health” insurance policies. There was a gradual reliance upon them to finance such treatments and care that are, in any society, part of what is the norm! Instead, since we did not define “health” – then there is too often the assumption that “health” is the absence of disease. And, even more of a problem, “disease” too often comes to mean anything that causes a person to experience “dis-ease”!

It is my belief that unless we focus time and energy towards redefining what it means to be “healthy” or just what is “sickness/disease”, no “Reform” was have a chance of resolving the problems. Such a new “focus” will not be easy. It will involve persons from every walk of life – care providers, educators, religious leaders, economists and politicians.

We must also seek ways to contain, or even lower, the costs of such care! Those ways will, in most circumstances, be complex. There are, however, ways to lower costs that are not complex [or are at least less].
Is the value of a super-specialist 4 or 5 times greater than a primary care physician?
Does society truly need all the free-standing care facilities? The multiple, and expensive, diagnostic machines?
If computers were to initiate a paper-less business atmosphere, can’t we increase that function to avoid the time-consuming redundancies when seeking care?
If death is truly a “natural” event, is it necessary to make it a “medical” concern? If a person opts to die in her/his own home, the process becomes very complex. It takes physician to pronounce one dead. It takes a coroner to make certain your death did not result from foul play.
Just some thoughts!

In the 3rd installment of these Random Thoughts, it will be my goal to explore how some of the resources of religion can also play a significant role in these efforts at Reform. Stay tuned!