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.
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.
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).