Part 2: Health Insurance is NOT Health Care

I’m sure there are some pharmaceutical researchers who are interested in making life more livable for some, and extending life to a reasonable length for others. However, the seductive public advertising for drugs that is rampant in this country continues to demonstrate that the bottom line for the pharm industry is money, rather than health. Any lecturer or teacher of pathology will tell you that, as disease symptoms are described, a high proportion of listeners will acknowledge those symptoms in themselves. The next step of fearing that one has the disease itself is often close behind. Both students and teachers have to be on guard for this tendency. The non-educated public, that sees itself as being educated by the experts in the field, has no such guardian looking out for its interests. When they go to the doctor to ask “If this product might be right for me,” the doctor rarely demurs, as they are taught by the pharmaceutical reps and ads. Besides they would be remiss and delinquent if they didn’t supply their patient with what they need (or request).

When it comes to medical equipment and testing, as with pharmaceutical drugs, the bottom line seems to be making money. Even the insurance industry is now realizing that there is excessive use being made of high-tech medical testing equipment. Some attention is being brought to research indicating that CAT scans, mammograms, and other radiological testing may be injuring health more than helping diagnose it. Again, we, as a society, have allowed ourselves to be led to believe that more expensive, higher tech, is better.

The companies that make medical equipment have the sole responsibility for education about them. The research is stacked in favor. Who is to question…until they have been used for many years at a very high financial cost, and maybe health cost as well. But insurance has tended to pay and money is being made. Even small medical devices such as wheelchairs and walkers, crutches, slings and other easily cleanable, reusable products are prescribed for each individual patient procedure. There is little to no attempt to notify a patient with enough advance notice that they can obtain these devices from a friend, relative, church or community organization. Besides, it’s usually covered by insurance. So that means we don’t end up paying for it?

Hospitals are often considered sacrosanct when it comes to criticism. There is a lot of overuse, of resources, waste, and misdirection happening in hospitals. They are good for emergencies, but bad for health maintenance. It has also been demonstrated that hospital administration comes at a high price, often raising the costs of essential services provided by the hospital, but not trickling down to medical staff or, God forbid, patients. Hospitals are often sponsored by large corporations, or by schools that are large corporations. Often their mandate gets lost in that “corporate-ness”.

Medical schools are often involved in more politics than should be involved in teaching doctors. They too, have donors and sponsors that help to dictate who is taught, what is taught, what procedures, equipment and drugs are preferred. There is too much ego involved in who gets admitted to which schools. Medical school is really about how to treat sickness, disease and trauma. That is necessary.

Medical school is not about keeping people healthy, keeping people free of dependency on medications, helping people to take control of their own health. Medical students still receive less than one term of human nutrition in their years of schooling. That has not changed since the 1970s. Medical students are not taught how to interpret labels on food, but they are taught the brand names of preferred drugs to treat conditions brought on, at least partially, by the ingredients on those food labels, and often on those preferred drugs.

When those students become doctors, some go into research, some into general practice, some into specialties, some into surgery and specialties in surgery. Researchers may or may not do work with others, not in their field of specialization. A lot depends on who sponsors their research, who might publish the results of the research and, finally, what the results of the research are. There is not often respect for open-ended scientific, medical inquiry when it is being sponsored by special interests. That’s one way that the FDA gets skewed information – especially when it isn’t looking very intently.

Doctors who work with the public, especially in a more general practice, still get educated about drugs by the pharmaceutical companies and about medical devices by the device companies. Continuing education is very often sponsored heavily by these same interests. Sometimes these interests are openly acknowledged, sometimes not.

All physicians are affected by the insurance industry. Insurance companies are not made up of doctors. They are administrators and bookkeepers. They are executives and analysts. Yet insurance companies have as much as, or more, influence on our health care as any of the other pieces. They decide what health is. They don’t recognize good health. They define what care is, and who gets what care for which conditions. They determine what doctors and hospitals get paid for which procedures, for which patients, and sometimes for which results.

Recent research has shown that these demands, determinations and decisions made by health insurance companies have great an affect on many results achieved by physicians and hospitals. Though malpractice insurance rates have been partly responsible for raising health care costs, many medical decisions are now being driven by the decisions of insurance companies themselves. Insurance personnel making medical decisions are not medically trained, yet they drive many of the medical determinations in medical care.

Medical insurance policies are written in such a flexible (for the company) and confusing manner that they fail to cover much of what should be covered at face value. Medical insurance does not reward frugality or good health. Medical insurance rarely pays the providers what they need to thrive, and to maintain enthusiasm for their good work. This is one factor which prevents medical insurance from being portable, from one location, presumably dense with their own subscribers, to another location, less subscriber-dense. Having medical insurance neither guarantees that you will get medical care, nor that you will be able to afford it if you do get care.

No part of the health care industry rewards good health. Good health would seem to be the perfect goal from birth to death. Our culture is more likely to prolong death and an unhealthy life, than it is to support good health.

Our government constantly reduces its recommendations for what it takes to be healthy. On the other hand, the fitness industry demonstrates good health with images of vanity and sexuality, both limited in their usefulness, while ignoring aging and well-used bodies and joints. The advertising industry is guilty of both of these biases as well. Sex sells, but why is it such a strong selling factor after prime mating age? Why do we let it be so? Why do we buy into it?
The more accessible media has become, it seems the more we give away our own personal expertise – what used to be called “common sense.” We have had financial crises when many put their common sense aside to be lured into deals they never dreamed they could afford. People are taken in by scams that their common sense says are too good to be true. Parents give in to public opinion about the needs of their children, over what their gut feelings combined with their common sense tells them. People eat more poorly and move less, because “diet” experts and advertising “experts” tell them, against their common sense, they can have it all – gluttony, sloth and good health.

Patients go in for surgical procedures, with no other lifestyle changes, and expect those surgeries to be successful, because they have given their expertise away, long ago, about how their bodies work. If we ever hope to have a working health-care system we must first take responsibility for our own health expertise or negligence; for our own intellectual and educational expertise or negligence; for our own political expertise or negligence; for our own social and family expertise or negligence; for our own spiritual expertise or negligence; and for our own communication expertise or negligence.

Remember this: An expert is anyone with an opinion, who goes out and gets information to back up that opinion. If we are to have successful lives, we must make our own decisions about what that means, and we must become the experts on ourselves and our own needs.

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