WINNING THE WAR ON HEALTH

WITH SINGLE PAYER UNIVERSAL HEALTH CARE

by Stephen Simac

  Summary: More than two trillion dollars is spent by Americans on health care each year, yet our health is worse than citizens of all other industrialized nations.  Single Payer Medical Care would lower overall costs, yet do little to improve our health.  Universal Health Care that reimburses for Preventive, Complementary and Alternative treatments will significantly reduce costs.  Greatest savings will be in systemic shifts around treating chronic illness and end of life care.  Building coalitions of support for Single Payer Universal Health Care is essential to achieving it. Funding such health care by charging mitigation fees on products and practices that cause illness and injury would create more business support than taxing employment. Toxin and Hazard mitigation fees will reduce our exposure to them. Encouraging  and enabling citizens to lead healthier lives will reduce costs and human misery more than any intervention.

   The Health Care system, as it’s euphemistically called, costs Americans over $2 trillion per year, doubling in the last ten years. That’s not even counting lost economic value from the myriad epidemics we suffer from. Americans aren’t getting great value, since other industrial nations spend less than half as much per capita, while their citizens enjoy better health by every measure. Despite this record, most health care reformers focus on symptom tinkering, instead of  systemic change.

 Single Payer Health Care is promoted by progressives as if government funding of medical costs would solve the health problems plaguing Americans.  It’s hard to fathom this confidence when the Institute of Medicine’s own conservative numbers  blame medical treatment for causing more deaths in the US than anything except heart disease and cancer, over 100,000 iatrogenic deaths per year.  No health improvements could even be shown to result from $700 billion of medical costs, according to the Congressional Budget Office.

  To be sure, significant costs could be saved by reducing the 30% administrative overhead of private insurance to the 3% of Medicare/Medicaid. Electronic billing might shave off a few per cent, but will further erode patient privacy. These savings still won’t make Americans healthier or even contain cost increases to the rate of inflation.

 To be blunt, the abysmal health of our nation is directly attributable to the American Way of Life, (AWOL).  Improving our health will require more than treating the symptoms, but doing so would actually fill the holes we’ve been pouring money into.

   Conventional medicine enjoys a lucrative near monopoly on “health” care without producing acceptable results by any outcome standards.  Most proposed “fixes”  revolve around how to pay doctors and hospitals for treating epidemics of heart disease, cancer, diabetes, obesity, asthma, autoimmune diseases, stress, depression, motor vehicle and gun trauma, accidents, alcoholism, substance abuse, anxiety, chronic pain, neurological malfunctions, viral and bacterial infections along with a  host of other health problems. And then we die, when a natural event is milked for maximum expense.

   Americans’ poor health is not primarily the fault of allopathic medicine, but the system is overwhelmed treating the symptoms of a sick and toxic society. Because of the enormous expense of conventional medical treatment there are politically powerful and vastly wealthy interests opposed to systemic changes that will reduce their profits, regardless of the general welfare.  Medical care employs more than 14 million Americans, four times the automobile industry.  

    An array of hospital, physician and medical profession associations, private insurance companies, pharmaceutical and medical supply corporations, mainstream media and advertising/PR conglomerates, government regulators and legislators, along with academic, scientific, business, and many consumer groups stand in the way of systemic health care reform. Any hope of success for actually improving American’s health will have to weave through their intertwined interests.

 Any “reform” passed by politicians will be shaped by the demands of these “stakeholders” brought in to craft something they can live with, like the 90’s Clinton effort, the ongoing Massachusetts experiment, California Governor Schwarzenegger’s stillborn attempt and likely any proposals by President Obama.

 Dr. Jeanne Lambrew, reportedly one of Obama’s health care advisors, never mentioned single payer in her Oct. 29, 2008 testimony before the House Ways and Means committee.  She referenced “ a wide range of visions and detailed plans …developed to fix the broken health care system.” but claimed “no viable alternative exists” other than employer sponsored health insurance. Apparently she meant within our national boundaries. 

 Since improving Americans’ health has less priority than continued profits, all such plans quickly founder on the runaway costs of medical treatment. In fact, any reform acceptable to those who profit from illness and injury will become too expensive to afford if they also determine treatment options. Medicare and Medicaid for the taxpayers and private insurance for consumers are bleeding government, business and household budgets. The National Association of State Budget Officers (NASBO) projects that state costs for Medicaid  will increase by 4% next year, four times the average state funds growth.

   Successful reform, instead of merely shelling out for the spiraling medical costs of a morbid population, will need to build coalitions of supporters while exploiting divisions among the opposition’s ranks to undermine their influence and sap entrenched positions. Ultimately more users and providers must demand and work to help Americans become healthier. Winning over disaffected members from the opposition is essential to success. This will require creative tactics and a long term strategy to win the war on our health.

REAL UNIVERSAL HEALTH CARE

   Physician associations are not as monolithic as they were. Conventional medicine has been frayed around the edges by doctors’ dissatisfaction with patient loads and their chronic illnesses, HMO oversight, reduced payments  and increased overhead. The growing enthusiasm for holistic medicine by many M.D.s is fracturing treatment consensus.
 Nevertheless, most physicians will fiercely resist reimbursement for alternative treatment options. “The reality is none of these things work. They’re placebos.”, Dr. Wallace Sampson, former professor of medicine at Stanford University and founding editor of Scientific Review of Alternative Medicine was quoted in a Dec. 11, 2008 AP article about the growing popularity of alternative medicine. The old guard will die off,  however the new guard will likely fight a delaying action.  Richard Nahin of the National Center for Complementary and Alternative Medicine “cited the lack of rigorous scientific testing  in declining to call such use harmful or beneficial.” in the same article. This is the agency that has received billions for over a decade to provide such testing.

    Volumes of scientific evidence is available to any researcher willing to do a literature search to prove that many lifestyle and environmental illnesses can be treated at least as effectively, at far less cost than “scientific medicine”. with various forms of Complementary and Alternative Medicine (CAM).  This knowledge base exists in a parallel universe of awareness but growing numbers of Americans have tapped into that awareness. The Center for Disease Control and Prevention’s  2007 survey found 38% of Americans used alternatives to conventional medical treatment,.  Almost half of this was herbal remedies, mainly Echinacea for colds. If using vitamins, minerals, folk remedies or praying were included in the CDC’s definition of alternative medicine, nearly every American did more than take two aspirins and call the doctor in the morning. 

  The majority of physicians are  aware that prevention through minor lifestyle changes is far more economical than treatment.  Most went into medicine because they wanted to improve people’s health but now are stuck, due to their extensive training and income requirements, doling out symptomatic crisis relief in the current system.

 There’s an enormous need for this kind of care due to AWOL, but conventional medical care makes highly educated and well paid professionals perform heroic rescues and scribble scrips below the masses doing a  high wire act with no nets. Doctors call up Be Careful, Put out that Cigarette, You're Too Heavy, Let’s Beef Up the Wire!  Meanwhile a legion of carnie barkers are enticing Americans to climb up where the action is.  

  M.D.’s are splitting over how to pay for their treatment.  Tens of thousands of doctors nationwide have signed on to The Physicians for a National Health Program proposal. Their plan calls for federally funded medical insurance for all Americans.   In 2003, they estimated their proposal would cost about $1.8 trillion a year, roughly three times the federal military budget then.  They want it to be paid for with a payroll tax of 7% for employers, 2% for employees and a repeal of Bush's tax cuts to cover all "medically necessary services" such as doctor's visits, hospital costs, substance abuse treatments, pharmaceutical prescriptions and medical supplies.

   Even these M.Dissenters still limit reimbursement within their exclusive domain.  Reimbursement for other licensed practitioners of health care is not in the plan, although this would reduce patient loads for overwhelmed M.D.s. and lower overall costs. There is a severe shortage of primary care physicians on the horizon, but losing potential clients generates more opposition than enthusiasm from them. 

 Patients who choose most CAM treatments or preventive practices pay out of their own pocket, since medical insurance rarely reimburses for such treatments, then usually only for chiropractic and acupuncture. Any type of treatment is more effective for patients who believe in it’s efficacy, but the placebo effect isn’t powerful enough to account for 80% of patients rating their CAM treatment as helpful. 

  Single Payer Universal Health Care (SPUHC) would cover or subsidize (with affordable co-pays based on income) treatment by licensed or certified practitioners of Acupuncture, Addiction Recovery, Chiropractic, Dentistry, Exercise, Health Education, Homeopathy, Massage Therapy, Naturopathy, Nutrition, Physical Therapy, Psychology and other treatment and prevention modalities.  Regulatory oversight by their licensing associations and an independent investigative agency of the  single payer would control fraud and misuse.

  This expansion of treatment reimbursement would build broad coalitions of support for single payer health care.  Currently excluded practitioners could promote Free Care Days  for  the 50 million Americans without medical insurance. This would gain publicity,  attract millions to alternative care and  build practices, while adding to the ranks of systemic health care reform supporters. 

IMPROVING HEALTH SAVES BILLIONS

  Paying for more types of treatment will reduce the expense of treating many maladies, because most alternative options cost less than conventional care. Patient choice and education will determine numbers of clients for practitioners.  Real Change would focus on improving Americans health through systemic social programs and shifting treatment options away from unneeded care. SPUHC could then be funded for less than the billionaire bailout package recently rushed through congress.

 Larry Summers, a member of President Obama’s fiscal team wrote that health care “is now the principal fiscal issue facing the federal government.” Since 49% of  foreclosures were caused by medical problems last year according to a 2008 study by the Kaiser Family Foundation, then the economic meltdown wasn’t caused just by subprime mortgages. Health care costs Americans more than housing or food and is a bigger expense for businesses than materials. 

  Eighty per cent of medical costs are spent on 20% of the population, mostly those with chronic illness or near death. Changing how we treat these patients could realize huge savings for any health care plan. Death with Dignity options would reduce costs dramatically for end of life care.  Managing patients with chronic illness with a team of therapists can cost less than crisis response, but is still expensive. The health care model will soon dissolve under financial and geriatric pressure unless systemic social reform changes our way of life.

  Transforming social and environmental conditions to actively prevent many illnesses and injuries will save far more money and reduce overall misery. Awareness is growing among networks of millions of groups and individuals working for change in these areas that they are also health care reformers.  Hooking up with networking tools like wiserearth.org is critical for reformers to realize we are not alone and join forces.

   Most information about health care treatment flows from a mainstream media as enthralled by modern medicine as they are heavily subsidized by pharmaceutical and medical treatment advertising. Less than 4% of news content last year was on health or health care issues according to another 2008 Kaiser Family Foundation study. Most coverage of health issues was about specific diseases, mainly cancer. Health care reform received only 1% of their  attention, even though it consistently rated as the public’s number one concern during the campaign season the media relentlessly covered during the same period.  Lack of relevance is one cause of their demise.

  Health care reformers are natural allies with political lobbyists for legislation to restrict ownership of public airwaves to media only companies, expand public service access to those airwaves, remodel the FDA and corporate/academic medical research, corporate charter reform and restricting advertisement of prescribed medicines to prescribers. These and other federal actions will reduce corporate media bias, but going around their Maginot Line of propaganda to reach consumers and doctors with viral marketing memes about real health care will gain more rapid results.

 Americans want to Feel Better, Lose Weight (usually), Save Money (definitely), Reduce Greenhouse Gases (as long as it doesn’t cost too much).  Promising these results from health care systemic change is no exaggeration, and sounds sexier than Single Payer Now.

   The pharmaceutical industry is on the ropes now with scandal after public health catastrophe dogging them, but their enormous wealth and PR machines will crush any pre-emptive strike against them. Retaining exclusive prescriptive powers for current prescribers of restricted pharmaceuticals might blunt opposition to expanding reimbursement for CAM treatment. Or not.

TOXINS AND HAZARDS PAY THEIR WAY

  Business groups are mainly opposed to single payer insurance because proposals for funding invariably start by taxing employment. Massachusetts and San Francisco mandate businesses to provide medical insurance for employees or make payments to a government fund.  Since the price of insurance rises faster than inflation, more businesses will choose to pay a fee, which won’t cover government subsidies for lower income consumers to purchase inflated insurance. Mandating that everyone buy a flawed and expensive product that they may not need to spread the risk for insurance companies is hardly reform, even if that industry now supports mandatory coverage for all Americans.

 Having a job improves health, so taxing employment will have unintended consequences. The current economic catastrophe will soon reveal why our employment based coverage is an anomaly in the industrialized world. Medicaid expansion to the jobless is predicted to rise by a million clients per 1% increase in unemployment, and both those costs will rapidly break most state budgets.

   There are other funding options than taxing employment. Funding SPUHC by charging mitigation fees on substances or practices known to cause  illness and injury to pay for their health care costs would split business opposition. The rapidly growing Green Business sector will become  competitive with Polluting, Health Hazardous Industries that have profited from externalizing their harm.  These fees will add allies to the coalition while dividing business interests.

  It’s usually futile to try to ban  toxic substances and practices. Consider Tobacco, Diesel Exhaust, Radiation or Aspartame.  It took a decade to ban DDT after Rachel Carson wrote her bestseller Silent Spring in 1962, then manufacturers just shipped it off to the third world.  It’s still in American mothers’ milk.  There’s 100,000 synthetic chemicals already in play, and 2,000 new ones added each year, with only a few dozen banned while only a tiny percent are even regulated.

  The California EPA is implementing a Green Chemistry Initiative, to guide manufacturing processes and design away from using toxic chemicals and reducing hazardous waste. Even though the CAL/EPA has followed the polluter pays principle by increasing waste discharge fees to permit and monitor toxic discharges onto land or water, they aren’t proposing to charge mitigation fees to pay for human health costs. This would accelerate green chemistry practice more than a voluntary initiative.

  A tiny minority of victims of some toxins and hazards have been compensated through the court system.  More benefits have flowed to their lawyers and legal firms representing the polluters. Improvement to community health is rarely the result of legal action.

  There’s little economic incentive for government to ban health hazards, but charging mitigation fees to pay for their medical costs has plenty. Cigarette taxes have been raised with impunity by most states, but most of these monies go into general funds. They’re not linked to the medical costs of tobacco, otherwise they’d be much higher. Alcohol taxes pay for only a fraction of their social and medical costs, but not directly. Even with the dire straits of state budgets, there’s no groundswell to raise alcohol, tobacco or gas taxes.

  There have been some recent state efforts to tax sugar filled soft drinks to combat obesity.  New York Governor David Patterson is proposing an 18% “obesity tax” on sugared soft drinks,  to raise money for new health programs but not to pay for the medical costs of almost a third of their citizens being clinically obese now.    Voters repealed a similar tax in Maine in November, after their state government passed it in the spring of ‘08, so sin taxes are a hard sell.

  Mitigation fees that raise money to pay for the actual costs of unhealthy products and practices, might make more voters see their value, especially if they were offered SPUHC as a prize. Increased expenses for toxins and hazards will reduce their use and public exposure.   Government needs to find new ways to raise money and there’s no shortage of hazards, especially if fees are based on the Precautionary Principle, when enough evidence indicates a likelihood of harm, rather than  absolute proof  that products or practices are killing or harming people.  Like a civil court judgement instead of a criminal one.

    Determining and collecting mitigation fees will provide stable employment for and political support from allied armies of epidemiologists, statisticians, accountants, lawyers, biologists, chemists and engineers. Mitigation fees could keep Medicare/Medicaid solvent even through the silver tsunami predicted to swamp them as baby boomers age.

 California could charge mitigation fees for substances already listed under Prop. 65 shown to cause cancer or birth defects, instead of merely requiring a label. Fees could be based on the LD50 (Half their lethal dose) rating of substances. Taxing injury, disease and mortality inducing products and practices such as heavy metals, radioactive particles, transfats, refined grains, sweeteners, salt, charbroiled, dry roasted, inflammatory and oxidating agents,  decibels, persistent chemicals, hormonal mimics, high speed vehicles, wheeled toys, etc… would help pay for health care for all Americans.

  Our exposure to these products and practices would be reduced by pricing, further lowering costs. Charging fees based on resulting health care costs would add pressure from industries paying the fees to include compensation for lower cost alternative treatments.

  Prevention costs less than a dime for every dollar spent on treatment, so funding to promote the general welfare to enable people to walk regularly, eat more organic or locally grown vegetables and fruits,  strengthen social ties and reduce financial stressors along with other health enhancers  will significantly reduce costs.

  This will take a New American Revolution.  One that will help Americans Lose Weight and Save Money, just the ticket to sell it to the people who must demand and enact it to win the war on our health.

 I have a masters degree in integral health studies and counseling psychology from CIIS, and have worked for years in those fields,  I love sharing knowledge about growing and harvesting plants, orchard maintenance and improving soil . I'm also working towards a permaculture certification.

  I have a small nursery in west Marin where I specialize in growing aromatic/therapeutic plants, mainly pelargoniums, (fragrant leaved geraniums) salvias, tagetes and mints, along with some natives and succulents.  After over a year of bureacratic wrangling the county approved  my proposal to construct a 200 square foot agricultural accessory building (the first  permit  for west Marin under the greener International Regulations replacing the Uniform Building Code) for  a hydrosol (floral waters) distilling operation. They also approved (after balking) rainwater catchment storage from the roof. I intend to build with  sustainable materials and methods and could use help from anyone interested in participating in this learning process.

 I'm a journalist  who has been writing and publishing on environmental, health, politics and other issues for decades, usually based on perspectives beyond the pale of mainstream media.  My latest series of articles was on How to Really Reduce Greenhouse Gases, Lose Weight and Save Money.  Some of my articles  are at coastalpost.com, a monthly out of Bolinas, Ca that has printed my articles since 1990 and online since 1996.