A little rantlet

[serai]

...or maybe just a meandering. Watching Gavin Newsom on Real Time, I started thinking about this subject.



When listing the things that health care ought to be, he mentioned preventive, and I got this vision of the problem and what seems to me the best way to take it on. It'll probably be a while before we hit on it as a solution, because it's not just a Band-aid, but a real transformation, and those are never the first things people try.

I believe that, in order for health care to be universal, portable, and all the rest of it, our system of medicine is going to have to shift its focus from being curative to being preventive. That is, that the main thrust of doctors' training will become know how to keep people healthy, rather than how to cure disorders and disease.

In Chinese medicine, an ancient system, doctors would be paid only so long as the patient was healthy; when he fell sick, the doctor had to cure him for free, because he had failed in his job. This seems to me to be an eminently sensible system, since it would encourage doctors to become as knowledgeable as possible on the positive aspects of human health, and in supporting healthy patients, would contribute to the reduction of disease. Curing negative conditions could eventually become a specialty, rather than the main thing doctors expect to be doing all day long.

Can you remember the last time you went to the doctor with no actual complaint, simply because it was time to go? I think the last time I did that, I was around 19. We actually had a family doctor, a GP whom we saw once or twice a year. An avuncular, pipe-smoking fellow, he was our gateway into the medical world, and the majority of our inroads were gently stopped in his office, where he poked and prodded, listened to our hearts and our concerns, prescribed minor medicines, and generally kept us tuned up. I can't imagine trying to raise a family without someone like that at the other end of my phone line, frankly.

This was a good system, and I find it strange that it has fallen by the wayside in favor of rampant specialization, if only because it seems to me to be much less expensive. If ill health were not allowed to gain control, then a hell of a lot of money could be saved, and much ill health can be prevented if it's dealt with in a timely, efficient manner. That's what I hate the most about our system, I think - it's just so fucking sloppy.

It was the worst kind of wrong turn to allow the insurance industry to gain any foothold in health care, and the demise of general practice is just stupid, greedy and wrong. There are very few medical students going for a GP license anymore, and so I believe that's where we're going to have to start. One of the most important things the Obama administration could do to address the health care crisis, besides working on the industry infrastructure, is to find a way to make GP work attractive to prospective doctors again. To make that what most people mean when they say "doctor" again.

We've got to set that system of gateways back up, and make hospitals and acute care a rare occurrence, rather than the catch-alls they're becoming. I hope there's provision for examining the role of preventive, regular care in the new health care map, because in order to make health care really universal, the expensive acute stuff is going to have to become a much smaller percentage of the game, and we can only do that by making healthy people.



Anyway, that is all I have to say.

Comments

[fantasy-fan.livejournal.com]

I think you are right, but I also think that the drive to become healthy has to be a partnership between the patient and the doctor. A doctor can't keep a person healthy who refuses to do anything for himself. One example: there has been a meteoric rise in esophageal cancer in the last ten years. Why? It is because of the epidemic of obesity, which leads to greatly increased numbers of people with reflux disease. Attributable to obesity, no other cause required. Over time, all that acid splashing where it's not designed to go leads to changes in the cells at the bottom of the esophagus (Barrett's esophagus) which becomes adenocarcinoma in a great number of people, given time. We've now reached the time when the years of damage are paying off as cancer in many many people.

A doctor can tell people to lose weight. She can tell them it will lead to diabetes, high blood pressure, kidney disease, vascular problems, back problems, strokes, and even this type of cancer. But unless the person is actually willing to make a lifestyle change, and eat less and move more, what good does a doctor telling you that ever do? We are a lazy and entitiled populous, and that is a larger problem that impacts so many areas of our culture, including healthcare.

[rabidsamfan.livejournal.com]

70 percent of the weight you are is attributable to genetics. Seventy percent. And any acid reflux I have (yes, I'm fat) is probably rooted in the occasional bouts of reflux I had when I was still a skinny kid or the asthma inhaler (and yes, the asthma started before I gained weight too) I use, which weakens the esophogeal flap.

The trouble with "preventative" medicine is that so much of it focuses on things which we cannot change without side effects and, sorry to be the one to tell you, weight is one of those things. With diet I might lose, and be able to keep off, about five to ten pounds. More than that and it will be back within five years. And it's been demonstrated, repeatedly, that yoyo weight loss is worse for you than fat.

Should I exercise more? Sure. Strength, flexibility, stamina -- all of those are "use it or lose it" propositions. But becoming essentially anorexic, or deliberately mutilating my body so that I deal with malnutrition all the rest of my life aren't things I ever intend to do. Quality of life counts too. I don't want to waste all my time and energy thinking about food.

High blood pressure, diabetes, kidney disease, vascular problems, strokes... they all happen to skinny folks too. But the diet industry can't make any money off of them. (And gosh, we can't make fun of people for their ethnicity or race any more, we've got to stress them out because of SOMEthing they got from their parents.)

[fantasy-fan.livejournal.com]

First of all, a disclaimer. I am 190 pounds, 50 years old, and had fat parents. I am not skinny and will never be so. The last think I want to sound like is one of those annoying 20-year old size zero twits who say things like, "Just lose the weight" when they've never had to and have no idea what it's like to try. If it came off that way, I apologize.

And I'm not advocating anything radical. My brother, who weighed 450 pounds, had gastric bypass surgery, and I see the radical lifesytle change that he had to make afterwards. That's drastic stuff, and not for most people. I do think that he's lengthened his lifespan by doing it, however. 90% of his medical problems have disappeared over the last three years, along with 250 pounds.

The anorexic as an ideal is annoying to me as well. But what I was advocating in my response, however poorly chosen my example, was participating in your own medical care. I could have picked on smoking, or refusing to take prescribed medications, or existing only on fast food, or failing to research and ask questions of a doctor. It is not healthy to do any of those things, and it is statistically not healthy to be completely sedentary and eat poorly. No matter what the scale says, almost everyone would be well served by increasing activity levels, however they can.

Another disclaimer - I used to walk for exercise, but I had to stop because of foot problems. I never lost more than 20 pounds, but I had more endurance and felt better that I did before or I do now. It was also good for my blood pressure. One of the biggest benefits, though, was that I was doing something for myself instead of just waiting for the diabetes to kick in and kill me, like happened to my dad. That's mostly what I'm talking about.

[serai1.livejournal.com]

One of the things about this country's health care that I find irritating is the vast focus on weight control, as if it were the only thing that can be changed, and as if a person's health were predicated solely on that. It's a very convenient way of putting most, if not all, of the blame on the patient, which is of course very good for the insurance-based system. If the cultural view is that fat is the patient's fault, and we manage to connect pretty much all bad health with weight, then presto! The insurance companies can deny all kinds of things because they're caused by the patient's negligence, and not by anything THEY say they're responsible for. Nope, it's too easy.

Weight is PART of people's health, and I'm sorry, I don't believe it's a major part. Stress is far more important. Lack of sleep is WAY more important, but we've been successfully brainwashed by American culture to believe it doesn't really count as a factor, when it may be the BIGGEST factor affecting our health. (You can thank Eternal Asshole Henry Ford for that cute little development, him and his "I sleep four hours a night why don't YOU" lying horseshit.) Quality of food is far more important - when the quality is better, people tend to eat less whether they hanker for it or not. The human body can deal with quite a lot, but it has to have the right conditions to do so, and we do not live in the right conditions at ALL.

We've been bamboozled into believing that the system we have is the only possible one, that if WE would just buck up and do what we have to, it would all work just fine. It's just bootstrap bullshit that's gotten us into the mess we're in with health care, and it's never made any sense to me. Weight has become the Winged Victory Of Samothrace in the health-care industry, the thing that the pickpockets point to, to get us to "look over there!" while they rifle our wallets. It's about time we stopped obsessing on this one aspect of health and start paying attention to the whole enchilada.

[belleferret.livejournal.com]

I watched Michael Moore's "Sicko" the other day. One of the segments was on a British GP, who contrary to popular belief, was well-paid, had a lovely home and drove an expensive car. They are paid more if their patients stop smoking and control their weight, blood pressure, etc.

I am interested in your statistic that 70% of a person's weight is genetically based. There has been a well-documented rise in obesity in this county over the last few decades, and alarmingly so in children too. I don't think we can attribute that to genetics.

Certainly genetics plays a strong role in propensity for obesity, and for many, getting the weight off long term is very difficult. But I've known people who have yo-yo-ed for years or even decades, and then finally found their key to keeping weight off. It can be different for everyone.

Our culture of fast and convenient foods loaded with sugar and fat makes it very difficult for even those not prone to weight gain to eat healthily. Foods that are labelled low fat can be loaded with sugar, and sugar-free foods may have tons of fat.

[serai1.livejournal.com]

What is 70% genetics is a person's potential weight gain. In other words, my genetic pattern determines that I can get up to, say, 250 pounds, while someone else's won't let her get up to more than 170. Whether we do or not is based on a large array of factors, only one of which is the patient's attitude towards weight. Stress, lack of sleep, boredom, anxiety, happiness (or lack of it), income - all these contribute, some of them more than a person' attitude. I think you can tell I consider the weight thing as we see it in America as a boondoggle, a way for unscrupulous people to make a killing on the insecurities of a populace that is kept uneducated and in the dark about the health care system.

The entire thing requires an overhaul. Along with shifting to preventive care, there will have to be a change in many other things - the food industry, the way we work, sleep, socialize. All of it. My opinion is that we have to start with the GP's because people really need someone in their lives who knows not only about the human body, but specifically their human bodies, and can guide them in how to keep theirs running well.

[serai1.livejournal.com]

Also, yes about the GP doing well. The 80's were a huge blow to the idea that one can live a nice, reasonable lifestyle; in that decade, life suddenly became about being RICH, as opposed to being comfortable, and that's what drove so many students away from GP practice. Our family doctor had a very nice house in Santa Monica, one of the best areas in L.A., and lived a comfortable life, and he was only a GP. But all that became not enough somehow, and going into general medicine to make a nice, secure living became passe.

But if the universal system we're all hoping for is based on a solid foundation of GP practitioners, whose training would be far more broadly based in all the different aspects that make basic health, then that kind of medicine would become attractive again. Also, after a few years of economic difficulties, a nice, comfortable, reasonable living might well gain popularity again. You never know.

[mews1945.livejournal.com]

Until we Americans change our diet completely to eliminate all junk foods, and start walking instead of driving everywhere we go, nobody is going to be healthy.

Until we voluntarily curb the number of children we bring into the world to the number we can bring up properly, and control our population growth, only the wealthy will get the health care they need, and have the resources to maintain their health. People eat what they can afford and what they can afford doesn't contribute to a healthy body.

The health care system is a huge business that depends on sick people to continue in its course, and the insurance companies and the drug companies and the businessmen who run hospitals as for-profit institutions are not going to accept change that interferes with their profits.

[serai1.livejournal.com]

And this is a reason not to try? Nothing changes without a beginning to change, and this is a big one, in my opinion. The force of a good doctor's word, a doctor who knows you and not just your chart, can be a major impetus to taking care of oneself. By reviving the GP profession, we create a whole population of doctors with GP concerns, concerns that have to do with the regular health of the populace. Not with things like catastrophic disease and acute conditions, which have plenty of advocates already, but with things like basic nutrition, job conditions that impact health, etc.

The health care industry will not change, no - by itself. That's why the government must step in, and why we must have universal health care. Like I said, it was stupid to allow insurance to get involved in the first place; money never cares about anything but money. The point is to slowly shift health care away from being an industry and make it back into into something that's about helping, rather than getting rich. And we won't get there by letting things slide. We have to start somewhere. This is where I think we should start.

[mews1945.livejournal.com]

I agree. I just don't think it can happen in our liftime. Everything is so interconnected in this country that making changes will affect every part of our lives, and change is going to come very slowly. I don't think there's anyone who wouldn't like to see the changes you're talking about.

[claudia603.livejournal.com]

I'm afraid that insurance companies are still too powerful and they've had WAY too much say over the health system for far too long. AND it's not just that. There are too many people in the US who have some gut response to the idea of government having any kind of interference in the health system. They scream, "OMG I WON'T GET TO CHOOSE MY DOCTOR111!" But the fact of the matter is, our system does NOT work except for the very wealthy. Even people with great health insurance have problems with the system. I don't have health insurance (except for my overseas insurance that MIGHT cover catastrophic issues), so I don't go to the doctor. I won't go to the doctor unless I'm dying. It's a totally inefficient system and one that absolutely needs to be overhauled.