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What Happened?

What Happened?

In many of my blogs, I mention my belief that the practice of medicine in America is much behind the times. I also suggest there are other countries that can and do deliver a much better healthcare to their citizens on the whole. It will not take anyone much time to realize that the World Health Organization has ranked the US system out of the top twenty in the world for health. I believe we are somewhere near thirty-five.

Regardless of your political persuasion, one cannot deny that our citizens spend more of their own money than any other country in the world on healthcare and our return on our investment is disturbingly poor at best.

It is not so much that I am down on the practice of medicine in general, I am down on the idea that American healthcare institutions in general are more interested in the profits associated with the practice of medicine than actually helping people to get well. The same holds true for hospitals, physicians, physician extenders, pharmacies, pharmaceutical companies, device manufacturers, durable goods manufacturers, ambulance companies and the greatest offenders: healthcare insurance companies who deny paying for care on a daily basis.

What is the core issue? Profit making. Our country is the only country in the world that relies on private dollars to provide healthcare to its population, with the exception of the government sponsored social programs (Medicare® and Medicaid®) for those over the age of sixty-five years old or the severely impoverished. There is no quarrel over the fact that medical insurance companies have found that medical insurance is very profitable, especially if the premiums paid into insurance are far less than those paid out for care. However, hospitals, drug companies, pharmacies, and medical equipment companies are right behind the medical insurance industries. Healthcare reform has only hurt the ability of physicians and nurses to make more money. The rise in profit generation does not bleed into to physicians and nurses pockets as a whole.

The majority of medical schools were at one time funded by teaching and research grants paid by the US government. Now a giant share of their operating dollars are generated by patient care. That translates to Deans of Medical Schools focusing on the business aspects of medicine instead of the education of physicians. Furthermore, faculty of medical schools are often physicians who do not want to see patients for a living, so they teach. Many have never cared for patients independent of a medical school setting and have no understanding of the desire of patients to be cared for in a holistic way.

There are no allopathic medical schools that inspire or promote holistic approaches to healthcare. There are medical schools that have established alternative medicine departments, but these are departments that chase research dollars from the US government. Their faculty have very specific research agendas such as prayer in medicine. Prayer is important for healing, but prayer cannot, by itself, be the only modality that heals disease. I see hundreds of people on a yearly basis, who pray to heal. Prayer provides comfort, but it rarely provides miraculous healing.

Our medical schools have to change. Their admissions processes are absolutely antiquated and unnecessary. College students are the majority of their applicants, although there are still some programs that allow high-school students to apply. One does not need a diploma from college or high school to be accepted into medical school. Currently, students take the MCAT test to evaluate their academic readiness for medical school. Some students take the examinations several times to increase their scores. Students apply to multiple schools in hopes to pass screening for an interview. If they get an interview, they have a decent chance of being accepted. Many people believe that the interview is to determine the applicant's social skills and communication abilities. I believe the interview assures that those students who are creative, intelligent and desire to change medicine will not be accepted into medical school. Those students would ultimately create havoc for the administrations. If you do not possess the capitalist ideology of the old guard in medicine, you will not be allowed to participate in the current medical system.

Most of the old guard has seldom practiced in the real world and they do not care about the real world problems associated with providing care to the infirm. Professors in medical schools write the standard practice guidelines for insurance companies and hide in the bowels of the ivory tower after those guidelines have been disseminated as medical gospel. These same professors teach their brand of medicine to the students, further closing minds to alternate treatment strategies that are potentially more effective. It is all connected to keep the system stagnant and predictable. Other countries do not share in our system's vision about maintaining the status quo. They are much more progressive and much less vertical. Foreign systems do not depend on drug companies and hospital revenues to fund medical schools, so they are much more likely to find the best way to treat a disease verses the most costly or profitable one.

I believe anyone who wishes to go to medical school should be allowed to go. Standard testing after each academic year should be administered and those who pass the testing, move on to the next year of training. The weeding out process occurs on an academic basis, not a quota system for race, gender, sexual persuasion, religious convictions, creed or color. We need the best and the brightest in medicine, no exceptions. This change would reduce the costs of student education and everyone would get a chance to compete for a spot at graduation. I digress.

So where is the best medicine practiced?  It is not a simple answer. I would suggest that those who have a disease which is unrelenting, episodic and progressive look to models of healing that incorporates all of the dimensions of health, not just drugs. I try to send breast cancer victims to the Paracelsus Klinic in Switzerland to receive treatment from Thomas Rau, MD. He does a great job of utilizing allopathic therapies with anthroposophical treatments. His success rate is much better than the US, but not everyone is a candidate due to the cost of treatment. Insurance companies will not reimburse for Dr. Rau's care even though the care is out-of-network. If someone has a severe back problem, there is a German neurosurgeon in Baden-Baden, Germany that has excellent success using techniques he pioneered. American surgeons do not embrace his techniques and consequently have less positive outcomes with their procedures for multi-level fusions. However, cost is again an issue. There are physicians in India that I have referred to as well for metastatic colon cancer.

America does not have a lock on innovative, expert care. Since all other developed countries have tax based healthcare, the innovations that serve the public the best are encouraged because costs are reduced and the burden on tax payers is less. It costs much less to care for people in a tax based system who are fit and healthy despite having illness than those who are ill and unfit in a private pay system. The incentive in the private pay system is to generate as much cost as possible to feed the economically driven industrial healthcare machine, even if the costs are not helping the patients to be better off.

Many chronic illnesses are a mystery to providers in any healthcare system. It is very difficult to tease out the confounding variables in chronically ill people and correct each one independent of the other. It can be done, but it takes time and commitment. It is also the case that most who regain health tend to find ways to sabotage themselves because the lifestyle changes are much too difficult to maintain in our rapid fire world.

Who has the best medical care in the world? Depends on your world. Our world needs change. Are our societal capitalistic beliefs a part of the solution or the problem? Our society can choose a more socialistic approach to healthcare would be socialists, we do it in Social Security, the Veterans Administration and other government operated programs. I think we can do it together.

Then you will not have to go to Switzerland for care. Just down the street. 


Posted by Amanda Sanders at 12:25 PM
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