Saturday, October 3, 2009

Where There Is No Doctor (Because You Can't Afford One)

Much of this blog has focused on the ongoing economic collapse in the United States, and the warped economic arrangements that prevent ordinary people of small means from becoming resilient in the face of that collapse. American health care is just one aspect of these warped arrangements. Because health care in America is provided by a private “industry” that demands ever-increasing profits, the cost of American health care has become an ever-more-weighty and insupportable elephant on the backs of ordinary people.

Of course, this has led to the widespread suffering of ordinary people, and has generated much attention from politicians who have promised to “reform” the system. Genuine health care reform would consist of transforming American health care from a growth industry to the providing of an essential service, in all likelihood administered by the Government because of the proven untrustworthiness and selfishness of the private sector. Unfortunately, our leaders in government seem utterly unable to come to this conclusion. The best they can do is talk about providing universal health insurance (which is not the same as universal health care) to all American citizens. Their so-called “public option” would consist of a Government-run insurance program that would compete against private health insurance providers. This last week, the Finance Committee of the United States Senate voted twice to reject this “public option.” As things now stand, therefore, we ordinary people are about to be left once again at the mercy of the health care industry and its adjuncts, the pharmaceutical industry and the insurance “industry.”

But there is another option available. It is a “public” option, though it does not depend on the Government for its implementation. Who is responsible for implementing it? You are, dear reader. Today, let's talk again about citizens building a safety net of alternative systems for themselves. I must warn you that the steps of building a citizen-created health care safety net will be somewhat challenging. Some study and hard work will be required. But I have no doubt that many people will be sufficiently motivated for the task, once they find themselves thrown out of work by the present economic contraction. When their unemployment checks total less than $1300 a month and they are faced with COBRA payments of almost $1100 a month, that will be a real kick in the pants! (Source: COBRA Premiums for Family Health Coverage Consume 84 Percent of Unemployment Benefits)

By the way, health insurance payments have risen over 131 percent from 1999 to the present. COBRA payments in some states now exceed the size of mortgage payments on small to mid-sized houses. (Sources: Health Inflation Slows as Economy Tumbles, KFF Reports, and Insurance Premiums Still Rising Faster Than Inflation and Wages.) Thus, one other aim of my “public option” is that it would kill off the private health insurance “industry” in the U.S. if it were widely adopted. And that “industry” is ripe for the killing, if you ask me. (There is yet a third aim: to shut up all the "tea party" idiots now yelling about illegitimate birth certificates and "socialism!!!")

One caveat: I am not a doctor, but an engineer by training. I can't take someone's blood pressure or interpret what I would see if I stuck a tongue depressor into someone's mouth and told them to say “Ahh.” But I'd like to believe that I'm a somewhat competent systems thinker, and it seems to me that the health care problem is a systems problem with a systems solution. My proposed citizen-generated health care alternative therefore addresses three specific system concerns: preventive health care, infectious disease control and injury treatment.

Why these three concerns? What about degenerative diseases such as hypertension, Type 2 diabetes, osteoporosis, and so forth? I believe that a proper emphasis on preventive health care education and preventive health habits would greatly reduce the incidence of many degenerative diseases in the American population. If people took proper care of themselves and lived in unpolluted environments, the only threats to their health that they'd have to worry about would most likely be the threat of infectious illness and the threat of injury.

Preventive Health Care

Preventive health care consists of many elements that are already familiar to most of us, such as the development of healthy habits like eating right and exercise. If you see your body as a machine, it should be obvious that a properly maintained machine is less likely to break down in the first place. We need to learn to maintain ourselves.

Of course, part of that maintenance has to do with how we eat, and how much we eat. But another part of that maintenance consists of proper exercise. By this I don't mean the sort of “exercise” that's often sold at chain-store health clubs. I mean real, functional physical conditioning that enables people to do strenuous things without hurting themselves. My personal leanings are toward the Crossfit program ( and its teachers, although I don't agree with everything they say, and their classes are too expensive for me. (Also, I'm not quite as hardcore as they are.) But I like the fact that they encourage people to work hard, to develop functional capabilities that actually have some use, and that they are willing to train anyone for strength, from children to the elderly. By starting people off young and training them in a wide variety of fitness strategies, they help people build a solid foundation for maintained physical capability in later life, without worries about things like osteoporosis, injuries and other fractures, circulatory diseases, and diabetes.

Exercise should be a family affair. If you want strong, capable kids, you've got to work yourself to be strong and capable. I remember when I used to live in Southern California, that there was a horse/nature trail near my apartment. The trail head was right behind a County courthouse, and wound around past a medical office complex before ending again at a small man-made “lake” (a pond, really). Sometimes when I walked that trail, I would encounter a large family jogging past me. Usually their group consisted of several of the kids, the oldest of whom was in high school. But one time I think I saw the entire family – Dad, Mom and all the kids (they had many) running along in shorts and jogging shoes, with the youngest (who seemed to be around nine or ten years old) pounding along at the rear. That family was an inspiration and an example to me. May they be so to you also. So get off the couch, put out the cigarette, put down the sour-cream-and-chives potato chips, turn off the TV and start modeling some good behavior.

Dealing With Illness and Injuries

Last week's post, Communities of Healing Hands - The Hesperian Example, described the work of the Hesperian Foundation in developing simple, practical printed literature to teach untrained health care workers how to help sick and injured people. The writers of this literature strove to provide health care workers with tools that are uncomplicated, widely available, inexpensive, and easy to implement.

Ordinary Americans who want to free themselves from worry over possible medical emergencies should master this literature. As many people a hundred years ago knew how to treat a fracture, how to clear a boil, and how to deliver a baby, I think it's going to be necessary for many of us to re-learn skills like these if we don't want to be bankrupted by the medical “industry.” We are also going to have to learn to make our own medicines, and how to deal with infectious diseases. And we are going to have to learn to identify environmental factors that make people sick, and learn what to do about these.

As the Introduction to Where There Is No Doctor says, “...even where there are doctors, people can and should take the lead in their own health care...Health care is not only everyone's right, but everyone's responsibility...Informed self-care should be the main goal of any health program or activity...”

Educate, Practice and Agitate

It's time to educate ourselves, and to practice the techniques we learn through this education. Our goal should be to create community-based health care systems that work so well that we no longer need health “insurance” or special access to the overpriced products of the present health care “industry.”

If this goal appeals to you, then consider buying the Hesperian literature (or downloading it for free from their website). Start a reading/discussion circle to study this literature with friends, neighbors or co-workers. (At my job, we're going to kick off a study group for Where There Is No Doctor. Our first meeting is a week and a half from now.)

If you want an opportunity to practice what you learn, consider volunteering to provide basic health care services for the homeless, or at a local rescue mission. Document your efforts, along with any lessons learned, in a form such as a blog that allows a large audience to learn from what your doing. Try to analyze and measure the effectiveness of your efforts, and compare them to the results that would be provided by the standard American health care system.

As I have said, the Hesperian literature is written at a very basic level. But for those who want a more advanced theoretical background knowledge of health care, the Massachusetts Institute of Technology has provided online study materials for its Health Sciences and Technology curriculum under its Creative Commons-licensed OpenCourseWare. There are also many other sources of open-source or Creative Commons-licensed health care and health education information on the Web.

Lastly, we need to agitate. Where there are institutional, legal or political barriers to community-created health care, these must be publicized and those who create these barriers must be shamed. This is especially true where available cheap generic drugs are blocked from the market by powerful pharmaceutical interests and their political hired guns. I think of the way in which cheap Canadian generic drugs have been blocked from being imported to the U.S. by means of Congressional legislation. This legislation was especially ridiculous in 2006, when Republican congressmen argued that by banning the entry of cheap Canadian generics they were helping to protect the U.S. from terrorists! I wonder what drugs those Republicans had been taking...

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