The Health Care Crisis and Pseudo
Solutions
In 2008, Americans spent $2.3
trillion on health care. In
2011, health care accounted for 17.9
% of the nation’s gross domestic product; it is expected to reach 20% by 2021. If this rate of growth continues, the
health care crisis will worsen. On
the other side of this financial dilemma, there lies another challenge. As a result of the high costs of health
care, Americans are not necessarily getting any healthier. The CDC reports that
chronic illnesses ‘account for 70% of all deaths in the U.S.’ Something is terribly wrong with our
health care system.
In
the search of ‘mending’ a broken system, various different ‘solutions’ have
been proposed. We have failed at
adequately addressing the deeper problems within the health care system. Malcolm
Gladwell wrote that we have instead “opted for a makeshift system of
increasing complexity and dysfunction.”
We have focused on altering the system with a wide range of ‘solutions,’
including cutting costs (i.e. technology, end-of-life spending) to changing
insurance coverage to changing the way the pharmaceutical companies address
‘consumers.’ Although these
‘solutions’ may temporarily address some of the financial and coverage issues,
there are still fundamental problems that are not necessarily addressed. Will these ‘solutions’ be useful for
the long-term health of Americans if the deep problems are not addressed? I think not.
Deeper Issues: Our Cultural Values and Fears
Len
Saputo wrote that the U.S. health care crisis emerges from “our dysfunctional
cultural values,” such as “separatism, mechanism, isolationism, and fierce
competition.” Culture modulates the expression of health care, and if the
foundations are weak, it will eventually impact the system negatively. Another expression of culture that
comes up on the topic of health care includes our deep cultural fears of death,
aging, and suffering. The topics of death and aging have
attracted a lot of reflection. Shannon
Brownlee asked, “How can we best care for patients who are in the final
stages of life? How do we stop
thinking that failing to “do everything possible” for elderly, dying loved ones
is tantamount to killing them?” T.
R. Reid brought up a question that relates to our cultural fear of aging
when he wrote, “Should the health system, or the insurance plan, pay for
Viagra? For Botox?”
When our cultural values,
such as competition and greed, are combined with our cultural fears, such as
death, a lot of messiness results.
My past two blog posts (February
1 and February
15) addressed how our cultural fears of death, suffering, and aging diffuse
into the health care system (end-of-life costs and the pharmaceutical
industry). It is very important
for us to recognize that our cultural values and fears—or our cultural
paradigm—impacts
the health care system. The
paradigm not only impacts the way health care functions (or malfunctions), but it
also impacts the way we create ‘solutions.’ Albert
Einstein once stated, “problems cannot be solved by the same level of
thinking that created them.”
The health care
‘solutions’ mentioned earlier in this post are not really helping people or
improving their health significantly.
They serve as ‘quick fix’ solutions that do not really change anything. Within the realm of health care, the
‘solutions’ may be compared to a dog chasing its own tail (at best) or they may
elicit greater harm to others (at worst).
Solutions to our health care crisis that do not address our
dysfunctional cultural values may not be very useful in the long-term. Because of this, it is beneficial to
look into these very things.
Creating Health Care Solutions From the Ground-Up
It
may initially seem that shifting our cultural values may be very difficult to
do. This is true, as our ways of
thinking and being do not dissolve and change over night. However, there are some practical ways
of implementing new cultural values into the existing health care
framework. This would not require
the total annihilation of the system we currently work with. In this way, the solutions are built
from the ground-up (starting with cultural issues), implemented into the
system, and a more solid cultural shift in paradigm can slowly follow. This allows the newer cultural values
to diffuse slowly into our culture and health care system. Once people see that the new values
bring about results that work for America’s health, there will be less fear associated with changing
beliefs and values.
I will discuss
four solutions that can positively impact the U.S. health care system. They can be incorporated separately,
but when they are combined together, the results will be greater.
First, patient-centered care should be the foundation
of health care.
For-profit health care severely silences and abuses the real needs of
the patient. A great starting
place to address patients’ needs is by looking at what we are scared of. Within the realm of health care,
patients experience a wide range of emotions and fears. Dr.
Scott Fishman wrote, “fear, a potent pain magnifier, is the dominant
emotion - fear of pain, fear of death, fear of the unknown.” A patient’s
experience of his or her disease is often accompanied with such fears. Additionally, Fran
Lowry summarized a palliative doctor’s stance when she wrote, “people who
provide health care are so afraid of death themselves that fear compromises
their ability to administer to the needs of terminally ill patients.” These two examples demonstrate how our
cultural fears can literally
get in the way of patients needs.
In the first example, patients’ fears are not being acknowledged by the
health care system. In the second
example, the relationship between the doctors’ fear of death negatively impacts
the patient. When a system is
centered on the patient, it must adapt to, acknowledge, and address the needs
of the patients.
Second,
our health care system
needs to focus more on the lessons
and meanings of illness from each patient’s perspective. The fears of aging and death call up a lot of existential concerns
in patients. Past cultures have
valued the exploration into such deeply personal inquiries. Len
Saputo discussed, “the deeper meaning of illness is usually
unconscious. Accessing these
lessons requires a willingness to be more open and vulnerable if the deeper
message is to be revealed.” He
also explained that many practitioners cannot adequately support the needs of
dying patients because they have not explored their own morality. One solution within this category
includes the implementation of health education within the topic of
illness. Wolfgang
Hoeschele wrote that an aim of education might be supporting others in
facing their own death. This type of education could strongly
benefit sick and well patients alike because it would allow them to explore
what illness and death means to them.
When these concerns are addressed in a supportive patient-centered
environment, many internal shifts can take place. If a patient feels supported, they are more likely to be
open to exploring such topics.
Third,
focusing on relationships is important
for a positive shift in health care. The first relationship to consider is that of the natural
life cycle. Len
Saputo explained that when doctors ‘lose’ patients, it is often seen as
losing a battle against nature. Daniel Callahan
expanded this concept when he asked, “should death be seen as the greatest evil
that medicine should seek to combat, or would a good quality of life within a
finite life span be a better goal?”
Exploring the relationship to the natural life cycle is related to
fostering other relationships. Wolfgang
Hoeschele explained that once we address anxieties concerning the self, we
are better able to ‘clearly perceive the needs of others.’ Addressing our existential
concerns can result in two things, namely, 1) less exploitation of human
beings, and 2) a greater sense of genuine care.
Lastly,
an honest reflection relating to the
topics of illness and death has the potential of changing our health behaviors
and preventative self-care practices.
In his inspiring article for The New Yorker, Atul
Gawande described a doctor that created teams of health professionals,
including doctors, nurses, and health coaches. These teams worked one-on-one with the “worst of the worst”
patients, who were constantly utilizing health care resources and were in very
poor health. The health
turn-arounds of these patients were baffling—self-care practices emerged from
simple one-on-one conversations with individuals who really cared for the patients.
