Part One: Health Care forum report for Obama-Biden Transition Team

Community Health Care Discussion, Miami Florida
December 15, 2008

[Most of the dozen participants were members of the North Beach for Progress group, which came together during the Obama presidential campaign. The group is continuing on an ad hoc basis. Its first major action was to call a forum on health care and report its conclusions to the Obama-Biden Transition Team. In three parts, this is the complete report.]

By Dava Michelson

Our meeting represented a diverse group of providers and consumers of health care; the professions represented were Medical Doctor, Ophthalmology, Acupuncture, Medical Qigong & Chinese Medicine, Homeopathy, Massage Therapy & Chiropractic. Among us were a retired journalist, computer specialist, lawyer, student, independent medical and health care practitioners and owner of complementary and integrative multi specialty clinic. Comments here represent everyone’s ideas, but not necessarily consensus; they also include those from people who were unable to attend the meeting but wrote in their ideas.

In discussing the problems with our current system and the changes we would like to see, certain themes emerged. We found ourselves coming back again and again to the question of: What is health care? What is the difference between promoting medicine as opposed to promoting health? What are our choices, and what are our responsibilities in regard to developing and maintaining our own health? How can the priorities of providing the service of caring for and responding to the needs of another human being be reconciled with the bottom line of the finance departments and stock holders? What is preventive medicine and the importance of expanding choice.

In outline form below is a synopsis of our concerns, observations, experiences and suggestions, followed by some of our personal stories.

COSTS
• Huge administrative costs and legal issues siphon off funds from health care
• As we tax cigarettes, tax certain foods that are now known to present health risks and use those revenues for health care
• Do not allow patents to be issued on naturally occurring substances, or products in common use for years, such as ayuvedic herbs.
• Apply UCR: usual, customary & reasonable pricing standard
• Insurance companies have created a system, not based on UCR, that forces practitioners to inflate charges… in one example, doctors having to charge $900 to get paid $72
• Control pharmaceutical advertisements and charges.
• Disallow price fixing by the drug & insurance companies. Disparity of pharmaceutical costs in the US vs. other countries. One participant paid $50 in Israel for a prescription that cost $300 here in Florida. Many people trying to go to other countries for their meds.
• Exaggerated costs of dental care need to be brought under control.
• One participant paid $12,000 in Colombia for medical procedures that would have cost $1,500,000 in the U.S. IF someone would agree to do it, but couldn’t get the surgery approved. She would have died if she had been limited to care in the U.S. (see Linda’s story below)
• Drs. and providers put in a position by insurance reimbursement policies to work to build up their billings rather than making decisions solely on what is best or necessary for the patient.
• Concerns with insurance greed in lobbying: good for insurance companies for medical costs to be high: more money, more lobbying power.
• A hugely excessive amount of time is required for providers to fight with insurance companies for payment. Even on pre-approved cases, it can take over a year to get paid, or be denied. One participant in private practice spent 3 days of her week working on insurance billing until having to hire someone to do this. Obviously her costs now must cover this extra time and salary.

CHOICE & EQUAL ACCESS
• We need Health Care Freedom of Choice, and for it to include alternative and complementary providers and modalities and other natural remedies.
• Independent research is necessary, rather than by pharmaceutical companies who have motive to skew research results and minimize or deny side effects.
• We are stating strong opposition to the Department of Health and Human Services' (HHS) Provider Conscience Regulation, which allows providers to deny health services without disclosure based on personal moral beliefs. It simply must be repealed.
• People’s health care choices are severely limited by the lobbying of the AMA and pharmaceutical companies, which have prevented the availability and education of many forms of care.
• Make pharmaceutical televisions ads illegal (companies spend $10,000 per year per doctor, use of sorority girls to sell pharmaceuticals: put money towards doctor education

EVIDENCE BASED MEDICINE & INTEGRATIVE CARE
• The emerging information technologies provide much promise and benefit, yet great care must be taken to make sure that we not become limited to information and research that makes it through only a certain filter of review. An outrageous example of this is my daughter’s pediatrician who was chastised and warned by those in charge of her group practice for prescribing alternative unproven medicine. Chamomile tea for mild stomach upset apparently is dangerous until it goes through scientific double blind studies, so the drugs that have a list of side effect disclosures are what must be prescribed. We MUST remain open minded knowing that tomorrow’s wisdom will prove things we are as of yet unaware. (See My mother’s 15 years of pain story below) Some wisdom has yet to pass scientific scrutiny; years of experience should not be reduced to “heresy”. There must be respect for empirical evidence.
• Many forms of complementary medicine, such as Homeopathy, Acupuncture and Chiropractic, are constitutional based medicines, treating issues in the context of the whole person; body mind & spirit. As such, treatments are individual; what works for one person’s headache will not be the right approach as for another. The efficacy of these protocols cannot therefore be evaluated through the current statistical model which requires the same treatment be repeatable.
• The training programs for MDs to be certified as acupuncturists are between 100 and 300 hours. While they may do some good with their training, it should not be considered equal or comparable to professionals who study 4 years in the current entry level Masters degree programs in Acupuncture and Oriental Medicine. One cannot understand or master an entire medical system in such a short time, the best they can do is use some of the tools of Oriental medicine in a western allopathic way.
• As such, it is imperative that as acupuncture and Oriental medicine is embraced and included in integrative practices, it’s design and regulation must not come from MDs, but from people FULLY trained in the field.

PROMOTING HEALTH
• While Western Medicine can be brilliant at fighting disease, promoting health requires a perspective shift from a disease model to health model.
• What helps people to want to be healthy? What can government do to create incentives for the public to be healthier?
• Start in the schools. As recycling was popularized by kids bringing the ideas and passion for it home from their learning and involvement at school.
• Promote physical fitness with mandatory PE classes in school.
• Expand our understanding and practice of PE (physical education) to include yoga, marshal arts, meditation, and self care)
• Create infrastructure that supports physical health such as: bicycle & walking paths. As we have a public library system, create public exercise facilities, and promote public transportation
• Promote healthy food choices and availability: teach kids better habits in school through nutrition classes, providing healthier food in cafeterias and removing junk food from vending machines. Investigate corporate influence in American Dietetics Association.
• Get McDonalds out of the hospital lobbies. Provide healthy food choices.
• Vegetable gardens in public schools and provide, promote victory gardens in cites and suburbs, plant fruit trees on public lands
• Promote air, water & food quality
• Create incentives at work for healthy life style choices: smoking cessation is an easy one to agree on, but things like food choices and exercise are so individual, trying to come up with a standard to reward people for is difficult but should be explored.
• Expand & support Second Harvest, and other food recovery programs. A blemished tomato, a broken chicken leg render these items unable to be sold and are routinely thrown away along with tons of perfectly good products whose expiration dates really do not render the products inedible at the stroke of midnight. This waste is unconscionable considering how many people are hungry and undernourished in this country.
• Funding of community health clinics that offer holistic and preventive as well as allopathic choices of care. These clinics should be as easily accessible as Starbucks!

[MORE: continued in following post.]