A little rantlet
Saturday, February 28th, 2009 11:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
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.
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.
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Date: Sunday, March 1st, 2009 05:48 pm (UTC)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.