U.S. Health Crisis! Care In Need Of A Cure

Dear Family and Friends:

Parts of an article by staff writer, Susan Brink, of the L.A. Times are appended below. Even though the L.A. Times show insight into the overall problem, the primary solution discussed herein is not scientifically correct, cost-effective, or a viable solution.

This article was called to my attention by my good friend, John Lewis, of the University of Miami School of Medicine. John is also concerned by some of the implications of the following report.

As you read the article, see if you can determine why I say that the solution suggested here will not work. I will give you my thoughts at the end of the article. U.S. HEALTH CRISIS! CARE IN NEED OF A CURE: A NEW MICHAEL MOORE DOCUMENTARY ON HEALTHCARE, STINGING CRITICISM BY AN NIH OFFICIAL AND A RECENT GLOBAL REPORT POINT OUT THAT THE NATION HAS FALLEN FAR BEHIND OTHERS WHEN IT COMES TO CARING FOR ITS AVERAGE CITIZEN! - By Susan Brink, L.A. Times Staff Writer, Monday, June 18, 2007.

IN the midst of criticism of America's healthcare system over the last decade, Americans held fast to the belief that if you have to be sick,this country is the best place to be. Faced with casual comparisons with Canada or Europe, many were ready with counter arguments: Americans don't have to wait months for bypass surgery, like they do in Canada.

Doctors here aren't constrained by government interference. Unlike in England, American patients receivecostly treatments such as hemodialysis even if they are old and infirm.But now, the knee-jerk attitude that the U.S. is the best place on earth to be sick, fueled by the reputations of great institutions like the Mayo Clinic and by America's leadership in drug and technology development, is beginning to be challenged by rigorous international comparisons.

There is increasing evidence that, despite justified pride in individual institutions and medical
breakthroughs, the world's biggest medical spender isn't buying its citizens the longest, healthiest lives in the world.It's not just moviemakers and comics saying so. The dire message thatthe U.S. healthcare system is, by some measures, an also-ran on theworldwide stage is being delivered by doctors, researchers - even insurance industry giants.

On screen, slamming U.S. medical care is coming of age with Michael Moore's documentary "Sicko." Through the eyes of people who have faced healthcare catastrophes, he tells graphic stories of the problems with America's system. The movie has received Oprah hype, the ear of some in the California state legislature and the support of several national healthcare advocacy groups weeks before its June 29 release.

Considerably more sobering are the warnings from an official at theNational Institutes of Health, who declared in the May 16 issue of the Journal of the American Medical Assn. that the U.S. healthcare system is "a dysfunctional mess." So unusual is it for a government official to speak
out against the U.S. system that Dr. Ezekiel Emanuel, chairman of the department of ethics at the NIH, emphasizes a point made in print during a conversation. "I'm speaking for myself, not for the NIH or the Bush administration,"he says.

As early as 2000, the World Health Organization made the first attempt at ranking all the world's healthcare systems. The U.S. came in 37th out of 190 nations in the provision of healthcare. (France, according to the June 2000 report, was first.) The report was criticized for using inconsistent comparison measures and for failing to note that some countries deny expensive care to very sick patients. Americans could still reasonably cling to their long-held pride.

But in 2006, the Organization for Economic Cooperation and Development,an international organization that aims to lift living standards bypromoting economic development, compared health spending and healthstatistics in its 30 member nations. Its report was more detailed than the WHO rankings, and had more controlled and consistent measures. The data, taken more seriously than the WHO rankings, left Americans with little to brag about.

And Emanuel's recent commentary was published the day after another report released by the Commonwealth Fund, which supports independent research into healthcare issues, found the United States at the bottom among six industrialized nations on measures of safe and coordinated care.

If all of that doesn't seem damning enough, insurance provider United Healthcare Group took out a full-page ad in the Wall Street Journal on March 19 declaring: "The health care system isn't healthy....A system that was designed to make you feel better often just makes things worse." One of the very industry giants that critics point to as a cause of the problem was defensively pointing back.

Amid stacks of reports, all with wonky measures of access, equity, efficiency and medical outcomes, two statistics stand out. The U.S. spends more on medical care than any other nation, and gets far less for it than many countries. According to the 2006 analysis by the Organization for EconomicCooperation and Development, the U.S. spends an annual $6,102 per
person - more than any other country and more than twice the average of$2,571. Yet Americans have the 22nd highest life expectancy among those nations at 77.2 years compared with the analysis' average of 77.8 years.

People in Japan, the world leader in longevity, live an average of 81.8years. The report also found that the United States had about 2.5 times the average years of potential life lost due to diabetes: 101 years per 1,000 people compared with the average of 39 years per 1,000 people.
Americans had fewer practicing physicians, or 2.4 per 1,000 people, than the average of 3 per 1,000 people. Infant mortality rates have been falling in the U.S., but are still higher, at 6.9 deaths per 1,000 live births, compared with less than 3.5 deaths per 1,000 live births
in Japan, Iceland, Sweden, Norway and Finland.

"If a politician declares that the United States has the best healthcare system in the world today, he or she looks clueless rather than patriotic or authoritative," Emanuel wrote in the recent JAMA commentary.

BEACONS OF EXCELLENCE

The healthcare picture is certainly not all bad. Emanuel knows, for example, that as an NIH employee, he works for the premier medical research institution in the world. Americans' penchant for raising awareness, consciousness and money have helped the country shine in breast cancer treatment, preventive measures like colonoscopies and world-class institutions like the Joslin Diabetes Center.

And America leads the world in the development of new drugs, in part, the pharmaceutical industry says, because there are no constraints here on what the industry can charge for patented medications.

The examples of excellence, of flat-out "best-in-the-world" care, help explain why Andrew Speaker, the Atlanta lawyer who took intercontinental flights knowing he had drug-resistant tuberculosis, risked worldwide shame to get to Denver's National Jewish Medical and Research Center, and why he didn't just stay put in Italy, No. 2 on the WHO's rankings of best health systems.

America's medical system is nothing if not spotty - and care for rare, drug-resistant TB is one of its spots of excellence. "It's true, there are pockets that are great," says Emanuel. Speaker no doubt erred in timing his trip and choosing his mode of transportation, but he may well have
been justified in believing he should get his sick lungs to Colorado.That's because after
tuberculosis began to succumb to the wonders of antibiotics in the 1960s, most sanitariums closed. The Denver center continued to treat tuberculosis, and it was poised with singular expertise as a multi-drug-resistant strain took hold over the last decade. National Jewish became the nation's de facto referral center as well as a worldwide consultant for patients with the disease. Its surgeons, radiologists, clinicians and laboratories became the most experienced and sophisticated in the nation and world in treating the disorder.

There are certainly other pockets of greatness in U.S. healthcare, both within institutions and for specific diseases. Wealthy people come from all over the world to go to the Mayo Clinic, Johns Hopkins Hospital, Massachusetts General Hospital and others.

Breast cancer survival rates are highest in the United States, compared with Britain, Canada, Australia and New Zealand, according to a 2004 study by the Commonwealth Fund. The U.S. holds its own in other cancers as well. And a higher percentage of American patients received some common cancer preventive measures compared with the other five nations in the most recent Commonwealth Fund study. "We're first on Pap tests and mammograms," says Karen Davis, presidentof the fund and lead author of the study.

Slightly fewer Americans than Canadians die after a heart attack, according to a 2004 study in the journal Circulation that reported that five-year mortality rates were 19.6% for American patients compared with 21.4% among Canadians. Although the study didn't explain why,
it was the first to show an American advantage between the two countries.

FAR TOO MANY GAPS

For all the sources of pride, the U.S.' overall healthcare delivery system has enough gaps to make patients feel they can't quite count on getting the best across the board.

For starters, the American system doesn't measure up worldwide in controlling chronic diseases, such as diabetes or hypertension.

Payment systems reward doctors for doing procedures, not for managing those chronic conditions, so a world-class center - like Boston's Joslin Diabetes Center, which is supported by philanthropy – stands in stark contrast to results seen by regular doctors treating the
disease in average patients.

Kidney disease patients on dialysis have a higher risk of death in the United States. By an act of Congress in 1972, all end-stage renal disease is covered by Medicare, even for patients younger than 65. But because of Medicare funding cuts, patients on dialysis receive less time on dialysis than patients in Europe and Japan. That helps explain why Americans on kidney dialysis have a mortality rate of 23% compared with 15% in Europe and 9% in Japan, according to a May 2002 report in JAMA.

Probably the area in which the U.S. uniquely falters by comparison with developed nations is in assuring that anyone who is sick can receive care. The Commonwealth Fund study found that half of Americans didn't fill a prescription or skipped a medical test because of cost, compared with 13% in Britain; and 26% went to an emergency room for a condition that could have been treated by a regular doctor, compared with 6% in Germany."

People with unlimited amounts of money can fly to the Mayo Clinic, or Johns Hopkins or the Mass. General [three top-rated U.S. hospitals]," says Emanuel. "

But for the average person, that's not the case."That's the rub - treating average, chronic diseases in the average masses. Insured or not insured, Americans can't always count on the best, the most appropriate, the most error-free, or the most coordinated care.

Stories of missteps have entered the collective consciousness. A doctor operates on the wrong leg, a nurse hangs the wrong IV medication, clinicians don't wash their hands. Such events fuel the belief that the system is broken.

A June 2006 survey by the Commonwealth Fund found that 75% of 1,000 adults questioned thought the U.S. healthcare system needs fundamental change or complete rebuilding. Respondents were concerned about costs, about getting timely appointments when they needed care and about paperwork complexity. Forty-two percent said they had had duplicate tests ordered, had received care that involved a mistake, believed their doctor recommended unnecessary care, or were frustrated that one of their caregivers failed to provide
needed medical information to other clinicians,

INSURANCE IS THE KEY

There's plenty of blame to go around, some of it landing squarely on the shoulders of people who eat too much and refuse to get off the couch.

But the biggest reason for the failure of the nation to measure up on the world stage can be chalked up to the fact that 46 million people in the U.S. lack insurance, meaning they don't have ready access to a doctor and often get healthcare later in the course of disease. All other industrialized countries cover all their people. "The main thing that stands out is that we're the only country that doesn't have a universal health insurance system," says Davis, author of the foundation's most recent study, which compared the U.S. with Australia, Canada, Germany,
New Zealand and Britain. "

So problems of access, cost, failure to get needed care are easily explained. "That doesn't explain why the American medical system fails to do some fairly simple things right, she says. "Like diabetes and hypertension.

Those aren't as glamorous as things you go to the Mayo Clinic for," Davis says. "But controlling them makes a huge difference in whether someone is going to have a stroke or a heart attack."One reason why those disorders aren't well controlled in American patients, she says, is that insurance payments reward physicians more for procedures such as heart surgery and leg amputations than for preventing those complications.

Another reason for America's poor showing defies explanation. As much as Americans pride themselves on innovation and change, the U.S. healthcare system is notoriously behind the curve in information technology. In the political debate over how to change the system,
there is near universal agreement that American medicine needs to make progress in this area.

Yet it isn't happening. Davis speculates that, in countries with universal healthcare, the government pays for or coordinates computerized systems. "In the U.K., the government just paid for it," she says. "In Denmark, physicians pay for their own software, but the government provides the central record-keeping."

There is no such central medical record-keeping in the U.S., and most individual practices still have floor-to-ceiling shelves full of folders with hand-written records. "Only 18% of American physicians said they sent computerized medicalreminders to patients," Davis says. That compares with 93% of physicians in New Zealand and 83% in the United Kingdom. In Britain, 88% of physicians can click a mouse and print out a list of all medications an individual patient takes. In the United States, only 37% of doctors can perform that technological feat.

That means fewer American patients get nudged to come in for a blood pressure check, and fewer physicians get a computer-generated safety check on potentially toxic drug interactions.

GROWING AWARENESS

It will take more than a round of outrage over a heavily promoted documentary to make change happen. But "Sicko's" emotional slap in the face might be a conversation starter, similar to Jonathan Cohn's recent book, "Sick." Subtitled "The Untold Story of America's Health Care Crisis - and the People Who Pay the Price," the book has been hailed as an eye-opening
look at the failures of the nation's system.

Like a heavy drinker standing up at an AA meeting and declaring, " ... and I'm an alcoholic," the system's road to recovery begins with recognizing a problem. Davis is encouraged that America seems to be taking that first step. "Politicians don't go around saying we have the best healthcare system in the world any more," she says. "We're getting out of denial and
delusion.

"Many of the major presidential candidates have proposals for improving America's healthcare system - widely divergent in depth, scope and payment schemes, but reflecting the understanding that the problems can't be ignored. Audiences will no doubt get riled up when they see, in "Sicko," an unemployed carpenter deciding between having his severed ring finger reattached for $12,000 or his severed middle finger, for $60,000.

They may look enviously at the systems Moore shows in Canada, France - even Cuba - where everyone is assured healthcare.

Hundreds of members of the California Nurses Assn. showed up last Tuesday, chanting "Sicko, Sicko, Sicko," on the Capitol lawn in Sacramento as Moore spoke to legislators about universal coverage.

Oprah, who called the movie the one film her audience must see this year, has a "Sicko" message board.

Unfortunately, unlike emotional documentaries and comedic punch lines, political solutions to America's healthcare problems are complicated, controversial and deadly dull. "A movie like 'Sicko' [is an] important way of communicating that the system is not working, and that it takes a human toll," says Emanuel.

The documentary is packed with dramatic human stories of how the healthcare system has failed, and harmed, people. Such stories trigger outrage - but don't point to solutions."

The public has to be willing to engage in more than stories," says Emanuel. "Solution language is more dry. It's abstract policy talk." For anything to change, he suggests, Americans have to stay awake and pay attention to what the policy wonks are saying.

WE'RE HURTING

Overall rankings on safe and coordinated healthcare as calculated by
the Commonwealth Fund:

1 ... Britain
2 ... Germany
3.5 ... Australia
3.5 ... New Zealand
5 ... Canada
6 ... United States

(snip)

The remainder of the article goes on to describe the health care stance of various politicians. Needless to say, there are no alkalarians among the candidates. None appear to understand the folly of the present approach to health care in our nation.

More insurance for more people may be a good idea, but it is a LONG WAY from the solution to the problem of declining health care in America.

The only real cure for any problem, medical or not, is prevention. Prevention can not and will not happen in the United States until the WEGOS (Western God of Science) begins to explore the reasons that some patients leave their doctors, leave the care they are receiving, and leave the WEGOS system of care while declining toxic medications, poisonous radiation, and
debilitating surgery. And yet, many come back 6 or 12 months later in complete remission or well on their way to recovery from a serious health challenge.

When you take a close look of many of these heart-warming stories, you will see many factors that seem to account for the positive change in patients’ medical status. These factors include: a radical change of diet, a rework of personal and/or family lifestyle, broad research into other medical methods, alternative and complementary programs, spiritual and religious experiences,
meditation, detoxification, stress management, psychotherapy, group support, and so on.

The prevention of all disease and most dis-ease will be found in the form of proper diet.

America needs a new look on its family dinner table. The American dinner table must look almost exactly opposite of the grocery store shelves. Grocery stores offer you 90% acidic food and about 10% alkaline food. Your body requires—actually demands—almost the exact
opposite—90% alkaline food and 10% acid.

For the time being, more insurance in America also means more financial support for failed medical theories and practices. Today we have more medicine and less health with the current medical model!

The primary solution to good health comes from more than 2000 years ago when Hippocrates said, “Let you food be your medicine and your medicine be your food.”

In Love and Healing Light,

Robert O. Young, Ph.D., D.Sc.

(part of the article was taken from the Los Angeles Times Printer Friendly Version )

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