[The Law of Karma. A brief interlude.]
My main concern: People falling through the cracks. And how to address that under a Public Health umbrella.
We need not only universal health care - and in my view - a single payer system, but we need ways to track who needs what. We need better Public Health. In my view a Public Health System should literally do a census of the country. I know that sounds impossible. But I'm envisioning making use of the already existing ground-network the Obama campaign used to such efficiency. If the neighborhood networks (in battleground states) were replicated all over the country, and volunteers (I'm sure Obama could raise an army of them with one appeal to the nation) fanned out across the land, armed with a public health questionnaire, to locate the elderly, the disabled, the frail, people with chronic illnesses or newly diagnosed, etc - as well as people facing unemployment and losing their homes and other financial difficulties - ok, I know this sounds pie in the sky - but we need an accurate accounting of where we are as a nation in terms of our health and the people affected by current social upheavals (which affect their health!). Only then, once we're got a data base of who needs what, could Public Health decide how to allocate both professional resources (whether for prevention or ongoing assistance) and the implementation of a volunteer cadre to assist the elderly, the disabled, etc.
I'm a psychologist. A therapist. And I'm also in the middle of the muddle that is our health "system" but which too often is not "care." I'm in a position to see how so many things interact and can affect one's health and one's mental health. I know that simply a bunch of changes in one year, whether positive or negative, can lead to physical or mental difficulties. I know that too many people fall through the cracks, due to ignorance or pride, or a feeling that no one cares or no one is there to listen or assist. We've had this national fantasy that everyone is self-sufficient. People feel guilty in this country for simply being in need. We guard and protect people's self-sufficiency, but we don't have a social mechanism to protect them when they're really in need and don't know where or who to turn to.
Insurance is out to make a profit. We know this. Managed care is driving providers nuts - on purpose. We know this. Treatment decisions are too often taken out of the hands of professionals and given to people who make a profit from denying care or from putting obstacles into the way of receiving care. People who are ill, particularly people who are mentally ill or cognitively unable to process all the information or access the sources of help (even if they existed!) shouldn't be saddled with trying to decide which insurance plan or drug plan (Medicare Part D is perfect example of this nonsense!) to use and whether to change it every year. And they can't be saddled with having to navigate insurances and everything else all by themselves. It's really a totally unfair system, right now. Rigged against providers, against patients, against a system of care which could so easily be set up in a non-profit way. Why do we need so much duplication of possible agencies, insurances, paper-pushers and overseers, etc - when all of that only makes it harder for those who are most in need of the services - by facing them with too many choices and hurdles?
Those who've controlled the fragmented pieces of this health care dysfunction (we call a "system") have made the case that "choice" is what every American wants. As if my husband, newly diagnosed with cancer, is going to do a survey of all possible providers to see and find out their backgrounds and their preferred methods and so on. Nope! Maybe if you're Senator Kennedy, you have people to do that for you. But most of us don't. (We access the already existing little part of the system we're plugged into - that is nearby - and take it all on faith!)
Choice should involve primarily picking a primary care physician, who is hooked up with a medical center you trust. That physician should be surrounded by nurse practitioners and physician's assistants (and ideally psychologists, like me, to do a consultation if the medical person thinks it's advisable to have someone talk to them at greater length - or even on a regular basis). Doctors should be paid for their time, not the service they provide. And medical education should be financially assisted by the government, so that no one has to go into a high-paid specialty to pay off loans. (which has led to too many specialists - in cities - and too few generalists anywhere) We need more primary care people. We need them to spend time with the patient. We need them to be able to follow that patient over years, not changing doctors and patients all the time, due to insurance changes... which seem deliberately engineered to interrupt care and thus make greater profits for their share-holders.
So I picture a primary care setting where patients really can truly find a heath care hub. Where doctors are not spending time arguing with insurances or trying to find out which medication might be on that insurance companies "list" of meds they actually pay for. And so forth. Where the doctor's office (or hospital) does not require personnel to list more and more procedures and so on... so as to find ways, from their end, to game a system rigged against them. (We have armies of insurance people reading charts to try and deny care along with armies of people assisting the medical system reading the same charts to find every jot and tittle to claim for payment!) Yes, I picture a system where, instead of assuming self-sufficiency on the part of every patient, we make sure that care for the frail, the elderly, the new mother, the handicapped, the chronically ill is followed up by Public Health workers (or volunteers), making sure no one drops the ball and no one falls through the cracks. Continuity. Treating each one with dignity.
I'm sorry. Health care should be like the public school system. A right for each person. A duty exercised by society. Ok, if people prefer a "private" alternative, that's their choice. But it should not be the norm. We don't seek choice for our electricity. It's there all the time. Whether we need it right now or not. Just plug things in when they're needed.
We know from research that many stressors, family conflict, workplace disruptions, financial hardships etc, contribute to mental health problems and physical health problems. We know that not having paid vacations and paid sick days are a recipe for getting physical and mental problems. So much of this is all interconnected! Helping people handle stress or change (through access to mental health) prevents overuse of medical care. (Contrarily, a plethora of choices and insurance hurdles adds to stress of any illnes and thus to the potential for further setbacks in the healing process.)
So I'd like to see Public Health as a kind of overarching umbrella, making sure people don't fall through the cracks. Making sure that as seamless as possible a health care system is put in place. Making sure that Public Health nurses, for example, visit the frail and elderly on a regular basis or call them in for evals - just to check on them. Making sure that young mothers receive extra assistance or information or whatever, so they can adequately handle new responsibilities. Call it pie in the sky - but it can be done - and far easier than raising an army!
Right now there are so many ways that our current system leaves people floundering. Confused. Disregarded. Overburdened.
This can't go on. I myself have nearly stopped practicing psychotherapy due to utter frustration with the way insurances have made it difficult to treat and bill and so on. There's no safety net any longer for therapists. It's as if we're left to try and deal with suicidal people on our own. Denied enough visits. Denied payment. Denied hospitalization as a way to protect people in a crisis - except for a day or two - if we're lucky. It's insane! I would gladly sign on - for free - to assist in setting up or monitoring a system that prevented people from falling through the cracks. I'd gladly work - for free - to monitor ethics and so on. I'm very concerned about our nation. I'm concerned about those among us who are the "least" and the most "vulnerable" and unable to fend well for themselves. This is breaking my heart here. I'm seeing it with my elderly parents - still at home - wanting their independence - but no longer able to really notice and think through what they might need - and honestly, at a certain point in life, the elderly are often best served by dedicated strangers than by family members (where there's no baggage on both sides that gets in the way).
So I come back to Public Health. Everything should come under that, I think. Enfold the NIH. Enfold the Military health care system. Enfold the VA. Enfold Medicare. Enfold Medicaid. Enfold private hospitals. Ok, enfold me too! Enfold it all under Public Health. I suspect that by integrating already existing parallel systems into one whole integrated system, we'd be better off.
Consider this. If a person goes crazy, why should we worry if it's a Vet with PTSD, to send them to a VA (hours away?) Or if the person is homeless or has insurance or not. Or if they're "free" to just be homeless and crazy (because you're giving them a choice!). No, if someone needs care, whether it's due to a broken leg or mental illness, that care should simply be provided. At a place nearby. No soldier should have to prove their difficulties are due to war - in order to get care or benefits they need. And neither should anyone else. If they've been a victim of incest in childhood, that should be as important to our society as if they've gone to war and been driven nuts that way!
Too many people are falling through the cracks. Now is the time to get this right. Can't we do that? Can't we access the professional skills and experience of people like me in setting this up? I am sure I am not the only person willing to volunteer time and energy to make sure we do better as a society. I've been blogging like crazy during the election. Now I'm blogging here this morning. Yes, Karma sent me: I'll admit that with a husband facing cancer treatment - who's 69 - and my elderly parents, clinging to their independence but really needing way more social assistance - at 86 and 91, I'd be thrilled if the public health census person showed up at my door and asked me if there was any way I or a family member might have medical problems and the consequences of aging or ill health. I too need help - right now! Yes, I'll cope. I'm well at the moment. But suppose I get sick too. Then what? Nobody but me to fight the system with my catastrophic coverage only!
Public Health: The right to live with dignity.