Tuesday, July 28, 2009

WHAT is health care? And who gets to define it?

The US Senate Finance Committee is meeting behind closed doors to hash out a plan to reform health care. The current debate between Congressional Democrats and Republicans is a debate centered on partisan lines and defined by the demands of those with the greatest access -- not you or me, not the thousands of Americans drowning in medical bills, but by corporate LOBBYISTS.

I love our President. I still think he is the best thing that's happened to this country in a long time. He is just one man - and no, he is not capable of transforming a toxic political system, a broken health care system or a wobbling economy overnight - so be patient folks. Nevertheless, he is largely on the wrong track with health care reform.

So, how do we slow down a juggernaut that is blinded by the primacy of allopathic medicine and over-fueled by politics and special interests -- an underinformed, ill-advised race to piecemeal, corporate-defined care?

Make no mistake - this is not a transformation of our system. It is a desperate, if valiantly motivated lunge to try to increase access to the most expensive and often least efficacious paradigm of care. And, since medicine is the most expensive option, all these desperate attempts to figure out how to reduce costs become a bandaid on a gaping wound.

It is not only our health care system that needs healing. It is congress too, and our entire political process. Politics is inevitably toxic when self-interested parties continually have the greatest access to forming the policies that affect the entire country.

Nothing will change overnight. But we need our Senators, Congressmen and women, our President and those he has tasked to understand health care's problems to rise above the toxicity that politics has become. To take a stand and say no to corporate special interests. We also need our congressmen and women to stop being mired in a political game of constant power plays -- overly worried about raising money, re-election, and their own constituents -- at the expense of the future of the country at large. The American public is tired of partisanship, ideology and ill-begotten, pork-ridden, poorly designed policy. Between partisanship and lobbyists, our policies are falling far short of what they need to be. Who will be brave enough to change the way things are done? We all deserve better - even those on the hill who are mired in "just the way things are". It is up to each of you - to each of us - to change the world in which we live, and we can't change it if we can't change how decisions are made in our political system. This fact is evidenced in your actions around health care reform.

So first, successful health care reform requires overcoming the fallacy of believing that health is medicine. It requires that the American public, Congress and the Obama administration fully understand that by design, medicine is a system that intervenes after we are already sick. It is a system that primarily manages symptoms of underlying illness.

Health care reform requires that we decide as a society whether we want health care that includes medicine as part of the pie or as the whole pie. It then means that we decide whether health care is a right or a luxury, and if it IS a right, then to WHAT do we have a right? This means deciding what and how we ration - and what each of us is responsible for on our own.

Health care reform means that we, as a country, understand that every sector, every stakeholder has played a role in making our system sick, and that every one of us is accountable for creating a functioning and affordable system. This means overcoming the huge lack of integrity on the part of drug companies and the FDA. It means putting the American Medical Association in its place and it means that conventional physicians must accept the fact that they no longer control "what" care is or "who" is allowed to provide it - so if they aren't willing to open their minds about what health entails and requires then they better get used to a shrinking customer base.

Health care reform also means that the American public must be honest with itself that our predominant culture, habits and food production are not conducive to health. There is much to change on this front. Suffice it to say - we have too long been disconnected to the truth of WHAT health is, what it requires, and what it asks of each of us. We want a panacea in a pill and we are making ourselves and our planet sick because of it! Drugs are not health, and it is not up to the doctor to make us well. We are full participants in wellness and illness - whether by any action on our part or not - and learning to accept this fact and navigate it is a liberating and empowering process. The more we learn about ourselves and the interconnectedness of our spirits, hearts and bodies, the more power we have to define ourselves and decide how to be in the world, whether we are well or ill.

Health is integrity, honesty, heart, spirit, passion, love, and treating ourselves and each other well. Health is a socially just society in which we make sure we provide ample opportunity to all to live decent and meaningful lives. Health is getting over being so consumptive, and it is learning how to preserve and live with this planet, rather than destroy it. Until we do these things, we will continue to impinge upon our ability to FEEL healthy, because whether we are conscious of it or not, we are all a part of a larger, collective psyche, and what we do here MATTERS, both physically and energetically.

But bringing this back to health care reform, we must ask ourselves this simple question:

WHAT is health care?

At its foundation, it is the system we create to provide CARE for one another, to restore our ability to be well, to feel good, and to contribute to our society. While this definition is ubiquitous when it comes to actually conceiving a new system, it is a much-needed reminder of why we co-created health care in the first place. We want and need to be well, and we can't always do that on our own! So, we need to know -- what is our purpose? What can we agree upon? What are the best tools we have at our disposal now, and how do we take those and recreate a system that is genuinely about health? Because medicine is useful, but it is unaffordable at the same time that it is not enough.

We need to simultaneously dream bigger (and understand there is a world outside of the drugs and surgery paradigm) while better understanding the nature - and real failures -- of the current system. And then we need to build a bridge between the parts of our system that work now and a vision of a brighter, less costly, more efficacious system that just makes sense - because it is ABOUT your health.

Challenge #1: Distinguishing medical care from health care, getting through to Congress, and reigning in the lobbyists.


"One by one and all together"

Thursday, July 23, 2009

Respectfully, "Medicine is not "Health", Mr. President

Dear President Obama,

I heartily applaud your efforts on health care reform, and in particular the change you are bringing to government simply in the quality and integrity of your person. We are so fortunate to have you in this office, and I pray that this country has the collective intelligence to understand the depth of complexity and difficulty in the challenges you face. I am writing because I am certain that I can provide valuable assistance to you in your health care reform strategy, despite the fact that it is well underway. There is a way to simultaneously and sustainably decrease costs and transform our system. The problem is, although you are surrounded by some of the best experts in the country, nearly everyone is failing to diagnose the true problem! And until we do, all efforts at truly changing our toxic system will fail. So, I’ll keep this brief and hope that it reaches your hands:

Proper Diagnosis of the Problem
Medicine is NOT health. The American public has failed to distinguish between health and medicine. We call it “health care”, but in the US, we have MEDICAL care. Medicine is by far the most expensive, and often the most invasive treatment modality. Medicine is a paradigm that works backwards from disease to health, intervening most often when people are already very sick. The medical model is critical for acute care and emergencies (and we should have access to this as a right), and useful for diagnostics, technology, and some chronic diseases, yet profoundly limited when it comes to understanding what is causing so much illness and disease, or what “health” means in a society and entails in a human being. The medical system is not about health, Mr. President; it has largely evolved into a system of expensively managing illness. Our system’s history is one of the rise of a vast industry – and the assumption of primacy and efficacy – of medicine. This primacy has combined with a host of factors to blind us to the dangers of assuming that allopathy should continue to be the first and primary method of intervention (despite clear evidence of its limitations and poor outcomes), when other methods of intervention could be used to decrease costs while vastly improving health outcomes. Your plan is working to increase access to a broken, unaffordable, and misdirected system.

Costs of a Medical Monopoly
The AMA has a statutory monopoly on physician billing codes. This is likely the largest monopoly in the history of US health care, yet it is so institutionally and systematically entrenched that few people know that it exists, much less understand the full depth of its consequences. It has been calculated to cost the federal government upwards of $50 billion dollars per year. Suffice it to say: the AMA has undue control of the definition, costs and delivery of health care in the US. It is a private trade organization with the power to continue to define WHAT health care is, by refusing to write codes for several million licensed, qualified health practitioners. The “agreement” used to procure the use of CPT codes, (which has subsequently and indirectly been legislated) forces the US health care system to rely primarily on physicians for the 80% of non-acute care needs in the US. This forces insurance companies to rely first and foremost on the most expensive practitioners and methods of treatment, which drives up premiums, and forces many employers who cannot afford it to drop health insurance as a benefit. It prevents US firms from competing overseas, and forces the US public to pay out of pocket for thousands of treatment modalities that have provided minor to major relief to millions of people at a fraction of the cost of medical care. Most importantly, there are more than 3 million licensed practitioners offering qualified care in the US who lack codes to adequately describe the care they provide. These include nurses, chiropractors, acupuncturists, mental and behavioral health therapists, nutritionists, midwives, and natural health MDs, DOs, naturopaths, and others. There are only 567,000 MDs in the US, and fewer than 250,000 of those belong to the AMA. Yet, while there are more than 8,800 codes to describe the services of conventional physicians, there are approximately 100 codes for everyone else. The “code monopoly” stands at the center of US health care and is a primary obstacle to both decreasing costs and transforming our system.

Strategy/Policy Issues
Transforming our system means first understanding the difference between health and medicine, then understanding the tremendous costs involved in relying primarily on allopathy, and finally investigating our options for supporting the health of the American public from a proactive rather than reactive stance. Comprehensive strategy must be developed from this basis. But first, we need to shift the national discourse on health care reform! We need to break this “wheel in the mud” cycle of arguing over costs and access and talk about access to WHAT, and how to change that “what” to better reflect health needs and treatment options based in the 21st century. In fact, shifting the discourse at this time may be the best strategy you have to combat the real challenges of cost, to reframe the debate and to provide viable, nonpartisan solutions and overcome the all-too partisan politics of your detractors.

My Credentials (briefly)
I have worked as a consultant in the field of integrative medicine, spoken in front of the Clinton Commission on Complimentary and Alternative Medicine (now NCCAM), in front of the California State Medical Board, and in front of former Oregon state senators Ben Westlund and Vicki Walker. I have assisted in strategy for individual practitioners and integrative medicine societies. I have presented at multiple conferences, worked as a patient advocate, overcome my own severe health challenges with the help of both conventional and natural medicine; met with Congressmen John Conyers, and currently have a paper circulating at several federal agencies, including the Department of Justice, regarding the AMA code monopoly. I am pursuing a PhD in Public Administration and Policy and a Masters in Public Health. I have devoted my life to system change, and I am passionate, articulate, and dedicated to intelligent diagnosis of systemic issues, as well as to the concept that transformation of systems requires a hard look at the truth of how stakeholder entrenchment can blind intelligent diagnosis and solutions. I have devoted many years to understanding how history, psychology, politics, profit and industry have collided to create a deeply toxic health care system, and have arduously sought practical, implementable solutions.

I would be happy to chat with someone in your administration and supply more information, research or references if requested. Meanwhile, I wish you well and support the efficacy of your valiant efforts at a difficult time. Aside from the practical value of your actions as President, personally, I believe your approach to governance to be a balm on the collective psyche of a nation that has too long been off track. May our efforts, consciousness and levels of integrity strive to meet yours.

Thank you…

Jennifer “Tangerine” Bolen
(Tangerine is my long-term nickname, due to my red hair, and the name I go by. I’ve been on Oprah, and Ms. Winfrey, Congressman Conyers and others all know me by this name).