What Sort of Health Coverage?

Ingrid Naiman

In the scope of medical history, the concept of universal health coverage is new. It is basically a late 20th century notion that began in countries with socialized medicine. There are many idealistic as well as purely ideological reasons for coverage of everyone. From a humanitarian perspective, health care for everyone is obviously something to celebrate; however, as soon as there are bones, there is a tendency for barking and growling over bones:

Once people get used to a situation, they tend not to question the situation, but let me rock the boat a bit by proposing that the silliest system ever is one in which the employer is responsible for providing healh coverage. Employers are responsible for on the job safety, and many are remiss in this. Consciousness of hazardous work began a long time ago when cancer of the scrotum among chimney sweeps was identified as a work-related condition. It was unique in that boys used to remove their clothes while scurrying up and down chimneys to clean them. Miners also had unique health issues related to their employment in places that often posed mechanical as well as more subtle risks to their survival. Recently, Bill Moyers exposed grievous conditions in the petrochemical industry. Any sensible person can agree that employers must do everything possible to minimize the risks to their employees. It might also be agreed that they are under obligation to notify employees of risk and to provide health care for any problems that arise as a result of their employment. If this rule were broadly applied and damages were sought for complications that arose as a result of work-related hazards, there would probably be some bankrupt companies.

This said, I have sympathy for companies that try to perform their work honestly, and I do not see why a corporation should have to provide special care for pregnancies or even lung cancer among smokers or heart problems among those on wretched diets. If a corporation offered health coverage as an employment incentive, maternity leave and day care as an inducement to accept a job offer, this is another matter, but linking health insurance to employment is ridiculous, like someone wasn't thinking straight when these precedents were set.

The more health care is placed on the shoulders of someone else, the less responsible people tend to be about their health. The monkey is on the backs of doctors and scientists to cure them of conditions caused by folly or the capricious winds of fate. The other problem is that many people would tend to stay in jobs they hate because of fear of losing benefits so the "mercy" of coverage has a sharp edge, one that is depressing to the spirit and hence also to the immune system.

So, I feel that while health care for everyone is an ideal to be sought, this obligation is not a corporate one. It is a responsibility of government, either state or federal government, or individuals themselves. In many parts of the country, the picture is so confused that the coverage as well as oversight is overlapping. In most developed countries, there is universal health coverage. It varies from country to country. In some places, everything right down to bandaids is covered. In others, people, even unemployed persons, are required to have insurance coverage, but they can be insured by any recognized insurer. In some countries, the government provides all the health care, and in some countries, the situation has become so inadequate that many people are buying private insurance on top of what is provided by the government. In the United States, we are in the shameful situation of ignoring the plight of roughly a third or more of the population.

In the states in which there is coverage, there may be lists of conditions and a budget. One year, there are enough funds to cover the top 300 conditions on the list, another to cover the top 500 conditions, but this means that the conditions on the lower end of the list, often half or more of the list, are not covered because the funds do not stretch that far. This means that insured or not, treatment for the condition will not be covered unless it can be rediagnosed as something else, certainly grounds for medical chaos if not also fraud.

Then, there is the big pile of bones. Everyone wants a piece of the pie and therefore engages in ceaseless lobbying to have his pill, device, protocol, procedure, or patent, or condition recognized. Patients organize into awareness groups that quickly become political action associations with memberships, fund raising, and varying degrees of influence; and all these groups are courted by the purveyors of goods and services that would or could become more profitable if used for a condition about to get more funding.

Illness has become a political football, a toy that ambitious and often greedy individuals and corporations use to make money. The potentially great humanitarian issues are used as rallying calls but the limited resources are poured into the campaigns of persons running for office—where wining and dining becomes a more effective tool for influence than outcome studies of the efficacy of modalities used to reduce suffering of those who are ill.

Worse yet, the energies that should be sanely distributed between disease prevention and relief of illness become more bones over which to bark and beg. As many doctor gurus are today saying, the miracle of the 20th century was neither antibiotics nor immunization, it was sanitation. There is no evidence at all to support the idea that increased longevity is due to "medicine."

Again, if the ideal is freedom from suffering and the agonizing effects of disease, the first place to spend money is on prevention. This work isn't glamorous. There are few fabulous grants and even fewer lobbying for this because prevention isn't as profitable as treatment. Prevention would entail even more efforts to keep our hospitals clean because infections contracted in hospitals are a major cause of death. The methods that would assure this are ignored, demeaned, and even prevented from being used. For example, the entire blood supply could be rendered safe by spending half a cent, okay maybe one cent, per pint on vigorous oxygenation or ozonation of the blood, but few people with the means to make a difference are demanding that our blood supply is safe. We would rather spend money on advertising the shortage than correcting the problems related to contamination. I feel passionately about this because one of my favorite students died from a blood transfusion that was HIV contaminated. The last years of her life were miserable.

Serious air filtration equipment, medical ozone in operating rooms between procedures, better methods of hazardous waste disposal, etc., etc. are all important but much neglected aspects of better professional health care. Every doctor and dentist and health care provider should be more aware of hygiene. I often say we are living in a post-Semmelweiss society in which there is once again massive denials of the risks. Sure, we now get doctors to scrub, but more life-threatening infections are contracted in hospitals than on subways.

The next point about which I am passionate is experiments with viruses. Some viruses are so tiny that they can go right through a five-foot thick porcelain wall (I read that somewhere) so why do we think we can contain them in glass boxes? Why are we fooling around with mutations of viruses? Why are we using viruses to create new foods and other genetically modified products? Why can't we be wholesome and clean?

In the current scenario, unscrupulous persons are in a position to cause a disease and then sell the ostensible solution for the problem, all of which have been conjured up in the imagination of scientists who are goaded by corporate officials to deliver on the investment. Vaccines are approved for marketing that have never been tested. They are approved on the basis that they were developed using similar methods as existing vaccines. In short, a rubber stamp authorizes their use, this when absolutely no outcome studies have been done.

It is the same with even more controversial treatments, such as chemotherapy. Here is a brief synopsis of the manner in which drugs are developed. An hypothesis is written in such a way as to limit all observations and data to a single variable. It is not scientific to look at the whole picture. Let's say the hypothesis is that a particular substance will be used and the members of the study group will be tested later, say 90 days later, to see if their tumors have shrunk. All results are attributed to the substance, not to diet, not to immunity, not to handling by researchers. There is only one variable. The critters used in these inhumane studies are little innocents who did not develop tumors naturally; they had them transplanted into them. In other words, unlike people and pets who develop cancer, laboratory creatures are "given cancer," in a procedure that should have every animal rights activist complaining. If the poor creature dies before the test period is over, he isn't counted because the only figure that matters is the percent of reduction at the end of a stipulated time period. On this basis, a drug is approved after $125 million of paperwork has been completed, and it has still never been tested on a person. Worse, if it fails to work for people, it will not lose its approval because the approval process is governed by procedures that have nothing whatsoever to do with the real world. I actually learned this in graduate school where, in order, to be fashionable, one began by assuming away reality. Since I could never do this, I decided to get out in the real world where presumably people were more logical and grounded.

As a consequence of a system that is so flawed, people are not getting meaningful health care, even if they are insured. The inhumanity of the coverage is that only methodologies that are approved are covered though a few enlightened companies are offering really unique insurance coverage. One company that approached me offered a policy that paid $50,000 the moment a person was diagnosed with cancer. The patient was free to use this money however he or she chose. The patient could go on a spending spree and throw parties or choose surgery or whatever alternative the patient preferred. The insurance was created to offer relief in a time of crisis, but there were absolutely no strings attached to the use of the money.

Another insurance company asked me to "create" a wellness clinic that would be more cost effective. Cancer was, according to that executive, expensive. A typical policy was capped at $2 million, but the average cost of treatment for each cancer case was half a million; and in contrast to the figures used by fund raising companies, the actuarial department maintained that there was a zero percent cure rate for cancer. Translated, this means that payments stop when the lid is nailed on the coffin because no one diagnosed with cancer is ever pronounced as sufficiently cured to stop making claims against the insurer.

If less expensive and more effective means for treatment existed, the company wanted to explore the possibilities. What happened instead is so diabolical that I dare not print it. Suffice it to say that the quest for more cost effective options was terminated from above.

What I want to say is that if we are serious about health care, we have to look at the various modalities of care that are offered, most of them by licensed practitioners. If we recognize the systems of medicine practiced by medical doctors, chiropractors, acupuncturists, and naturopaths, then we also have to accept the methods of healing and approaches to disease used by these professionals. If we accept the validity of their work, then we have to cover their cures and treatments to the same degree that conventional medical protocols are covered. If such work is covered, then why not give the patient the freedom to choose what he or she wants? This would be the crown of an enlightened health care system: universal coverage and choice of modalities by the patient!

 

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