Health care in crisis: Part II — Searching for solutions

Treatment for existing disease is not as effective or economical as prevention of disease. Lifestyle modifications are less expensive and generally more effective than medication for most diseases, as proven by research.

by Dr. Mark Force — 

This second installment concerning the health care crisis in the United States lists the component problems that create costly and ineffective health care, and then discusses the steps we can take to rehabilitate health care.

Fundamental components of the crisis

Emphasis on treatment rather than prevention — Treatment for existing disease is not as effective or economical as prevention of disease. Lifestyle modifications are less expensive and generally more effective than medication for most diseases, as proven by research.

Emphasis on high-tech diagnostics and therapies — Using new, sophisticated and costly technologies (including biotech) when simpler, established technologies or exams would suffice.

Coverage for lifestyle-caused illnesses — Insurance coverage for these diseases decreases incentive for personal responsibility and increases likelihood that primary care will be underutilized until more intensive and expensive secondary care is necessary.

De-emphasis on public health services — Public health services have not developed public education programs linking lifestyle choices to health status.

De-emphasis on primary care — Poor compensation for general/family practitioners’ office visits has forced short office visits, symptom-focused care, and overutilization of testing and specialist referral.

Symptom-focused health care — Heavy dependence on referral to specialists, especially for chronic and complex illnesses, significantly drives up cost often without improving patient care.

Pharmaceutical company influences — Big Pharma mislead and misinform physicians by manipulating research, journals and books to favorably influence utilization of medications, educational programs and the media. Also, they continue to market newer patent-controlled drugs when generics are less expensive, safer and more effective.

Underutilization of information technologies — Poor communication between doctors working with patients often results in poor integration of findings and reproduction of testing. Physical files are expensive and prone to error.

Insurance management of clinical practice — Management to decrease immediate costs compromises clinical decisions of doctors and commonly results in the need for more complicated and costly secondary care.

Short-term outcome focus and complicated administration — Controlling costs by treating only symptoms leaves a patient’s underlying condition untreated and allowed to progress to a pathological, irreversible and expensive illness. Approximately 31 cents of every health care dollar goes to administration costs.

Malpractice law — Current tort law drives defensive medicine and overutilization of unnecessary testing.

“Heroic” end-of-life care — This utilization of intensive care accounts for approximately one of every four days of ICU use, and care which accounts for 30 to 40 percent of all hospital spending.

Compromised environment and food supply — Environmental pollutants have been extensively linked to disease, diminished lifespan and decreased quality of life. Soil depletion, food refining, food additives, pesticides, genetically modified food, antibiotics and plastics all compromise food quality.

Poverty — Poverty compromises the environment and diet necessary for health. Poverty forces use of hospital emergency rooms as an expensive and ineffective substitute for primary care.

Compromised offspring — Children from polluted and stressed environments with inadequate diet need more secondary care and tend to become adults with higher disease incidence.

Fundamental solutions for the crisis

Institute universal primary health care — Free and accessible primary care decreases the need for expensive secondary care.

Focus health care on health promotion — Health promotion programs decrease need for secondary health care and decrease disabilities associated with aging and lifestyle illness.

Restore primary practice — Greater compensation for primary physicians allows them to spend enough time with patients to do their job. Allopathic, osteopathic, naturopathic and doctors of chiropractic are all trained as primary physicians and can provide primary care.

Use reasonable standards for implementing or limiting care — We need to be more emotionally authentic as a society and honestly recognize people who are in the process of dying. Most cases of fatal illness in the later stages are better managed with hospice or home care.

Restore personal responsibility for health care costs — Make primary care free and accessible. Make secondary health care (surgery and extensive management through medication) for diseases that are proven by research to be caused by lifestyle choices (smoking, obesity, etc.) not free. Individuals who choose habits that lead to disease would have to carry private insurance for these types of illnesses.

Utilize information technology — Computerizing all the paper in health care decreases the direct costs of the paper, its movement between doctors and its storage. Database management of the information increases likelihood of an accurate diagnosis, prevents duplication of testing, and improves coordination of care between physicians working with a given patient.

Institute malpractice reform — There is a culture in our country of settlements that go far beyond compensation to retribution. This culture could be changed to benefit our society, financially and civilly.

Improve our physical and social environments — Improved health of the environment, quality of food supply and support for the impoverished improves the health of our society as a whole. Greater health equates to greater production and quality of life, and less disease and associated health care costs.

Mark Force, D.C., is a chiropractic physician at The Elements of Health in north Scottsdale, Ariz. He practices functional and natural health care and is the author of Choosing Health: Dr. Force’s Functional Selfcare Workbook. 480-563-4256 or theelementsofhealth.com.

Reprinted from AzNetNews, Volume 28, Number 3, Jun/July 2009.