Healthcare Reform

Healthcare reform is perceived here in August 2009 as a problem needing to be fixed. The trouble is that when a problem is solved it creates another problem. Hence, we can see the trouble President Obama is having in Congress establishing this program.

For a successful healthcare plan to work it needs to incorporate education and energy renewal, the three prongs of President Obama’s plan to renew America. These three prongs of this plan represent an integrated unit. The centerpiece of this program centers on the mutual participation of the healthcare provider and the healthcare recipient. This is a special kind of partnership where the focus is on the recipient receiving an education about his condition that allows him ⁄ her to be actively engaged in making informed choices and decisions about healthcare. In such a dyad, the healthcare practitioner becomes a catalyst to aid the process. This means that he ⁄ she does not take an authoritarian stance to exert power as control. Rather, one creates a space that honors the legitimacy and authenticity of the other’s decision.

This education involves a truly integrative approach, the term "integrative" here meaning viewing the individual as a unitary human being who operates along the axis of physical, emotional, mental, social and moral functions taken together to form his⁄her unitary beingness. Currently, the term "integrative" has come to mean nothing more than combining naturalistic (e.g., herbs) with conventional invasive methods.

The above leads me to define healthcare and compare it to medicine. Medicine refers to that narrow band of interventions based on a cause–effect model, viewing the patient as a passive participant in the process and surrendering power to the authority and supposed expertise of the physician. This is a power as control game posing very few options for the patient usually provided in an atmosphere of fear. On the other hand, healthcare, while recognizing and acknowledging the medical model’s usefulness in the acute clinical situations, presents a broadband of methods and techniques, that, in contrast to the conventional medical model, are usually – if not invariably – non–invasive and of low risk to the patient’s well–being. Most of these methods and techniques derive from ancient sources, both Western and Eastern, going back literally thousands of years. These ancient systems, which involve active patient participation, particularly in the Western forms, are called "traditional." The modern Western medical system dates back to approximately 400–450 years ago and can be called "alternative" ⁄ conventional.

Within the framework of these ancient systems is embedded a spiritual understanding and application as the source from which the therapeutic process stems. By "spiritual" I mean the presence of an intangible force, or energy, or consciousness providing sustenance and nourishment for healing purposes. (The Eastern notion of chi energy, upon which Chinese acupuncture is based, is an example.) The accompanying quote by Dr. Jeffrey S. Levin, an epidemiologist at the University of Kansas Medical School, gives weight to this discussion:

"Since the nineteenth century, over 250 published empirical studies have appeared in the epidemiologic and medical literature in which one or more indicators of spirituality or religiousness, variously defined, have been statistically associated in some way with particular health outcomes. Across this literature, studies have appeared which suggest that religion is salutary for cardiovascular disease, hypertension, stroke, nearly every cancer site, colitis and enteritis, numerous health status indicators, and in terms of both morbidity and mortality. Further, this finding seems to hold regardless of how spirituality is defined and measured (beliefs, behaviors, attitudes, experiences, etc.). An especially large subliterature of over two dozen studies demonstrates the health–promotive effects of simply attending church or synagogue on a regular basis. Finally, while no one study has conclusively proven that a spiritual perspective or involvement in religion is a universal preventive or curative factor, significant positive health effects of spirituality have appeared in studies of whites, blacks, and Hispanics; in studies of older adults and adolescents; in studies of U.S., European, African, and Asian subjects; in prospective, retrospective, cohort, and case–control studies; in studies of Protestants, Catholics, Jews, Parsis, Buddhists, and Zulus; in studies published in the 1930s and in the 1980s; in studies measuring spirituality as belief in God, religious attendance, Bible reading, frequency of prayer, father’s years of Yeshiva, numinous feelings, and history of bewitchment, among many other constructs; and in studies of self–limiting acute conditions, of fatal chronic diseases, and of illnesses with lengthy, brief, or absent latency periods between exposure and diagnosis and mortality. In short, something worthy of serious investigation seems to be consistently manifesting in these studies, and understanding the "what," "how," and "why" of this apparent spiritual factor in health – may be critical for reducing suffering and curing the sick."

(This quote comes from my book Healing Into Immortality [Bantam Books, 1994; ACMI Press, 1997].)

As can be gathered from Dr. Levin’s findings, something unavailable in the current medical model and not part of a prescriptive education recommended to patients through that model is but one example of a broader education to be extended to patients as part of their healthcare needs.

It was interesting to note that in the recent testimony given by so–called alternative physicians (please note many broadband healthcare interventions are delivered by non–MD’s) none of them really defined mind in their mindbody model, focusing heavily and really singly on the body or physical processes. Additionally, there was neither real discussion nor definition of Spirit and its role in health, or of actually religious factors as Dr. Levin outlined in the accompanying quote.

I might mention insurance issues here as well when considering healthcare reform. Many healthcare interventions are relatively inexpensive, way less than almost all medical interventions. One reason is that the medical model cannot handle chronic illness, which is multi–factorial and not subject to one–cause to one–effect as in the medical model. Hence, in the mad scramble to deal with ailments not subject to medical cure, there is a persistence of using more and more tests (many painful and invasive) to understand the illness and the use of more and more medications in combination producing many "side" effects, necessitating more medication use to cure those effects. The net outcome of all that erroneous expenditure of energy – a macro input for a micro output – is to drive up insurance costs even more. The net of that are the prohibitive costs of health insurance passed on to consumers.

Spiritually speaking we don’t look at problems as such. Alternately we apply two other considerations:

As I’ve mentioned in a recent Dr. Jerry’s Corner, I have suggested 1) changing the word "problem" to "question." Questions call forth answers, an easier proposition to deal with rather than trying to find a solution to a problem. As I indicated previously, imagine placing a drop of ink into a glass of water. The drop will quickly disperse into the water and will be in solution. Then, try to regain the drop of ink. It will be impossible and that will be a new problem. On the other hand, ask a question and an answer may readily come forth. This could happen (as it often does) spontaneously. Sometimes a question can be contemplated or meditated upon before an answer appears. Or, we can do an imagery exercise to find an answer as I commonly do with my students. Simply put, follow the advice of the gospel statement: "Ask and you will be answered." (Matthew & Luke)

2) Rather than solve a problem, look for the source of the difficulty. Finding the source gives us a clue to making the repair or correction. In this case, the source is inherent in the word "healthcare." This term refers to a broad band of health interventions ranging from acupuncture to herbs, to hands on healing, to imagery, to nutritional therapy, to homeopathy, and a whole host of naturalistic, non–invasive methods and techniques that go back thousands of years and operate by means of traditional models of healing pre–dating the current modern medical model. The latter represents a narrow band of intervention with few options and is not suitable for dealing with chronic illness. It is a model based on a problem – solution (fix it) dynamic focusing on a particular part needing to be fixed. In contrast, the traditional model is based on a wholistic model which takes into account the picture of human beings in their totality – physical, emotional, mental, social and moral – appreciating their interrelationships, seeking to address this wholism and making the sufferer an active participant in the healing process, which the medical model does not.

Healthcare reform also has to focus on the term "reform." This term means to form again, a reformulation. Such reformulation has to include all healthcare practitioners working in cooperation acknowledging the authenticity of all age–old proven methods as equally possible healthcare modalities; not a system placed squarely in the hands of MD’s who seek to protect their financial interests, often while denigrating and disparaging other methods as "non–scientific" or "not proved scientifically." This is a clear ruse intended to dissuade the public from utilizing these beneficial practices in favor of interventions that are actually "not proven scientifically" (as will be taken up in another installment).

What is then set up in the current system is a hierarchy where the operators of the game are given high priority rather than looking at the game itself. The game is one of substituting an acute care model for one that cares for the chronic disorders. That said, reform requires that the healthcare system not be put squarely in the hands of MD’s and insurance carriers who won’t pay for other treatment methods. Yes, these other healthcare options are treatments as effective as medical ones and maybe even more so. Obversely, all healthcare practitioners have to be regarded collegially, comrades–in–arms, rather than threats to one’s position or treatment competence.

Reform then means not only that everyone have the privilege of receiving healthcare benefits (it is not a right, but a privilege = something that can be given to or taken from you by someone or something else) as is the aim of Obama’s "surge," but also that this care be provided by a wide variety of practitioners as the case may warrant, not jut MD’s.

Given this proposal for reform what is at its heart is the need to transform healthcare delivery; not only for who delivers it, but also to dedicate research to those other modalities to be done outside the setting of medical institutions. There is already much research being done along these lines. To be considered here also is that a good deal of this research involves a different theoretical base that is not derived from the "scientific method," the latter only capable of dealing with quantitative phenomena. The other, called the "phenomenological method," deals with the qualitative, personal, subjective experience often disparagingly called "anecdotal" by the modern scientific schools in an effort to deride their significance and importance.

More to Consider

There are additional factors to contemplate about healthcare reform ⁄ trans–formation. There is the spiritual element, which is the defining point of attaining to health. There is a spiritual crisis running through American life, symptoms of which can be noted in the extraordinary levels of alcohol, drug, and sex addictions and their concomitant devastating ill effects on overall health and healthcare costs. Add to that the huge amount of chronic illness and spiraling costs of pharmaceutical drugs used to stem that tide without noticeable effects on disease rates. A macro input for a micro result. The mindbody model of health was jettisoned over four centuries ago and simply buried the roles of moral and social factors in the genesis of illness, eventually replaced by the germ theory of illness causation which netted next to nothing in getting beyond treating acute illnesses successfully. It is now time to reintroduce the ancient model to effect a more complete system abutting the acute, technological advances placing the latter in its proper perspective as part of the whole, not the whole in and of itself. Until that day comes when MD’s can disassociate themselves from the taint of business models that have tarnished healthcare beyond repair it doesn’t matter what the Obama legislation brings to bear on healthcare "reform" that is simply another economic system to replace the current one where, admirably, all people will be covered. That is a big plus and humane. However, the system is not humane by not attending to all the needs of an understanding of human suffering, which in the end, by including all possibilities of treatment interventions, will be the most cost–effective way to provide immediate help, not to mention providing avenues to health maintenance and prevention of illness. To those ends I propose requiring a revamping of healthcare education and devising new curricula, and perhaps new healthcare educational and training schools to incorporate the knowledge, wisdom, intelligence and skills these healthcare providers possess. Here, we must also include making sure insurance carriers cover these practitioners.

Two Healthcare Stories To Round Things Out

Story 1: Over 30 years ago I saw a woman who came seeking help for an ovarian cyst. She was told there was no intervention for the condition other than surgery. The latter was not necessary at the time, she was told. Rather, the surgeon recommended he would watch the cyst, monitoring it. If it grew significantly he would operate before it could rupture. She came to me to do mental imagery to see if she could heal it. We worked on an imagery program for her to use. She worked with me for three weeks and described her response to this self-healing mental work. From her responses I asked her to get another radiographic exam to see what effect, if any, had taken place. She did so and called me to tell me the cyst was gone. Needless to say, the surgeon was quite surprised but accepted the findings. I rendered her a bill for $750 – $250 per meeting – which she submitted to her insurance company. They responded by stating they would not pay her for this HEALTHCARE TREATMENT. I wrote to the company telling them that our work together save them $20,000, the cost at that time for an operation to the afflicted area. Seven hundred fifty dollars of cost for $20,000 savings, I said, is a very good deal from their end. They paid her the insurance claim.

Story 2: Today I received a follow–up call from a student who called me a week ago suffering from a leg infection not responding to antibiotic treatment. I have her an imagery exercise to heal the infection. I asked her to dose this exercise to herself three times a day. She called to tell me the infection healed up. She stopped the antibiotic at the time she started imagery work and saw the results of her own efforts. A most cost effective intervention (and not uncommon in my and my students’ practices).

Finally

I guess we have to be reminded of the most repeated phrase in the Bible – 50 times – to help the widows and orphans in their trials and tribulations. This phrase is at the heart of the Judaic and Christian worldviews. The 46–50 million disenfranchised from healthcare insurance "widows and orphans" have to be helped. That’s the first order of business to be settled. There is really nothing to discuss further about that matter. It’s not a matter of "socialized medicine" or governmental intrusion into our individualistic lives. The meta issue is to help the widows and orphans. The economics of that initiative can then be constructed to accommodate that thrust. To do so might require some sacrifices on the parts of insurance companies, doctors, the rich and others who can contribute to this effort. The ancient sages who understood the issue of care and love for each other were fully aware of the need to serve all who are disadvantaged. This is the meta issue arising above the reluctance to deflect this basic point into political and individual me first selfishness.