Enlightened healthcare reform


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.	ENLIGHTENED HEALTHCARE REFORM --First Steps.
.	by Dr. Gita Elgin
.	blog at HolisticRenewal -- the Elgin Process of Creative Self-Mastery
.	PROBLEMS TO BE ADDRESSED	SOLUTIONS TO PROBLEMS
.	I) Our present healthcare system is based on outmoded & outdated principles:	I) Update our healthcare system?s principles to a more holistic perspective, in line with modern science (Quantum Physics, not Newtonian Physics):
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.	IA) Outmoded Principles based on the wrong vision of what a human being is.	IA) Updated Principles based on the right vision of what a human being is.
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.	A) A human being is not whole, but a multiplicity of parts, often unrelated to each other.The toe is unrelated to the head, and as far as anything not physical, it doesn't exist, "It's all in their head."	A) A human being is a whole, larger than the sum of its parts. He/she is a soul, which has a mind (or "causal body") an emotional being (or "energy body") and a physical body, with highest to the lowest vibrational frequecies, in descending order.
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.	B) Each human being is not unique. When ill, all that matters is to get the right medical or psychological diagnoses.	B) Each human being is unique. Whether healthy, or ill, he manifests his traits in his own way.The holistic diagnosis captures this uniqueness at all levels.The medical and psychological diagnoses are not enough.
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.	C) Each human being is dependent on the health professionals for their health. The knowledge and the power resides with the health professionals.	C) Each human being is responsible for his life and his health.Each one needs empowerment to become experts on themselves, and use the health professionals only as consultants.
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.	D)When ill, human beings should choose the standard treatments of drugs and surgery. Anythig else is secondary.	D) When ill, human beings have choices on how to get well. They can choose natural, non-toxic, non-invasive methods, or the standard methods of drugs and surgery, or whatever combination suits them.
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.	E )When an individual shows symptoms of illness, it is of paramount importance to deal with the symptoms. Causes are secondary.	E) When an individual shows symptoms of illness, it is important not just to deal with the symptoms, but also look at the possible causes--- which may lie in totally unexpected areas--- and find the gestalt.


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.	IB) Outmoded Principles based on the wrong vision of what treatment is.	IB) Updated Principles based on the right vision of what treatment is.
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.	A) Since a human being is a multiplicity of parts, those parts are treated separately by specialists, who often don?t communicate with one another (thus patient becomes a battlefield of competing drugs, with multiple side-effects, and often overlapping each other, and even duplicating each other).	A) Since a human being is a whole, larger than the sum of its parts, each one is treatd as a whole person: someone with a soul, a mind, feelings, and a physical body, living within a specific environment. Doctors treating each patient should communicate ? if not personally, at least electronically ? to make sure they are on the same page. This will prevent many errors, which are very costly.
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.	B) There are specialists for the body, specialists for the mind (who seldom communicate about their common patients), and no specialist for the spirit (except when patient is at death?s door and a spiritual counselor is summoned for the last rites).	B) Regardless of specialty, specialists for the body, the mind, feelings, and the soul need to keep the wholeness of the person in context, and communicate regularly about each patient to provide the best service. Sometimes miracles can happen with the power of prayer, so this aspect should not be left out.
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.	C) In chronic disease ?treatment? equals management, not healing, or cure. Instead of a "healthcare system" it becomes a "disease-management system."	C) Most chronic disease can be prevented, and in many cases healed, with alternative therapies. Western medicine needs to recognize it?s poor track record with chronic disease and not stand in the way of other more effective therapies.
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.	D)There are standard treatments for standard diseases. The patient?s uniqueness is at best irrelevant, and at worst a nuisance.	D) The patient is unique. He needs to be appreciated as such, and the treatment should be tailored to his needs. Rather than being annoyed by this, the Dr. should strive to understand the patient?s uniqueness to better design the treatment. There is no magic bullet ?one size fits all.?
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.	E) Doctor knows best. Patient must follow.	E) Patient is empowered to take responsibility for her health and become the experts on themselves. The Dr. - patient relationship is cooperative, not hierarchical.
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.	F) Treatments promoted are drugs and surgery, and little else.	F) All effective treatments should be promoted, giving preference to those that are natural, non-toxic, non-invasive and using drugs or surgery as a last resort.
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.	G) The causes of the presenting problem are often ignored if they fall outside the specialty, or if they cannot seem to be deciphered they are often given a fancy name --?idiopathic?-- which doesn?t mean we or the patient are idiots, just that we don?t know.	G) It is important to not just treat the symptom, but strive to find the cause, which may be outside one?s specialty. For example: Multiple Sclerosis (MS) linked to a trauma 20 years before, or Irritable Bowel Disease (IBD) linked to a grief experience.
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.	H)Natural, non-toxic, non-invasive methods are suspect, regardless of their healing effects.	H) Natural, non-toxic, non-invasive methods are explored and researched, given the enormous acceptance they have in the public, and the empirical effectiveness demonstrated.
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.	J) Preventive medicine is not profitable, so it is not practiced because the results are long-term (and insurances are not interested in this, because by then patients may have another insurance).	J) Preventive medicine is essential for a healthy population and it should start at pre-school, with school breakfasts and lunches. (The obesity epidemic needs to be stemmed before it becomes diabetes and cardiovascular disease. The same goes for smoking, drinking and drugs).
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.	IC) Outmoded Principles based on the wrong vision of what a healthcare system is.	IC) Updated Principles based on the right vision of what a healthcare system is.
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.	A) Our Healthcare system is an industry, a business, whose product is treatment, not health.	A) Our Healthcare System is not ? or should not be ? an industry. It is not a business. It should not sell anything. It is a service, focused on healing.
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.	B) The Healthcare system is "profit-on-disease-centered."	B) The Healthcare system is patient-centered. (After all the patient is the consumer, the one we are serving.)
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.	C) No one is entitled to healthcare unless they can buy it.	C) Universal Healthcare is a right to which everyone is entitled to. No one should have to"buy health insurance to be treated." (Like firemen and policemen:they don't "sell you protection,"they just do it, and they don't try to check your insurance before protecting you, or dousing the fire burning your house.)
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.	D) Often, even if you have health insurance, you do not know exactly what you are buying and what the cost will be (especially in Emergency).	D)Just like when you go into s store and know exactly what you are buying and for how much, you know , or should know, exactly what treatments you are buying and for how much.No after-the-fact-surprises.
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.	E) Since insurance will not pay for prevention -- because it is not interested in the long-term results-- this is one of the best reasons to focus on short -term results, that will increase the profits of insurance.	E) Since insurance will not pay for prevention -- because it is not interested in the long-term results-- this is one of the best reasons to have a single-payer , who will benefit from long-term results.
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.	F) Different health insurances compete with one another for patients. Each has a large bureaucracy to manage the interface between patients and doctors. They maximize profits by providing less treatment, at higher cost to the patients, and less payments to doctors.	F) The fat bureaucracy of health-insurance is eliminated in favor of a universal, single payer. It provides the best treatment for patients, at a cost, and competitive rates to doctors.
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.	II) No one is satisfied with the present healthcare system? except the corporations that are profiting from it -- for the following reasons:	II) Everyone is happier with a better healthcare system (provided healthcare insurance is eliminated in favor of a single payer, who provides universal coverage):
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.	From the Dr.?s perspective:	From the Dr.?s perspective:


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.	A) The Dr.-patient relationship is ? if not altogether gone? highly dysfunctional.	A) The Dr.-patient relationship is restored.
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.	1) The insurance is in control. Doctors must ?process patients,? like and assembly-line procedure, or they risk poor marks by the insurance company who they contracted to provide services under, risking losing their jobs.	1)The insurance is out of the picture. Drs. are no longer controlled by insurance and they have time to communicate with their patients and establish a healing relationship.
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.	2) Doctors are required to refer as little as possible to specialists, to save money for the insurance. This causes a conflict of interest between serving the patient and serving the insurance company.	2) Drs. refer to specialists whenever it is in the best interest of the patient. There is no conflict of interest between the patient & the insurance.
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.	3) Doctors must comply with the multifarious insurance companies? specific policies ? some of them verging on the ridiculous ? if they expect payment for their services.	3) Drs. no longer have to comply with different insurance policies, contracts, different schedule of fees and co-payments, OTRs, etc., etc. Only one, standardized, digitized process is necessary.
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.	a) This often means that the doctor & patient no longer control their interactions, but a third-party clerk can tell a Dr. how many times he can see a patient, for how long, and what treatments are acceptable.	a) The kind and length of treatment is once again in the patient?s and Dr.?s hands, and there is no clerk ? without any medical training ? determining what they need to do, so her salary will be paid.
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.	b) Sometimes these guidelines are so ridiculous that ? instead of changing them? the clerk will tell the Dr. how to cheat to get around them.	b) In a rational system there is no need to cheat to make it rational.
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.	4) The amount of paperwork generated by this system is often overwhelming to the Dr., to the point where he spends more time doing bureaucratic work than seeing patients. Many quit altogether, or switch careers.	4) Paperwork is minimized. Digitization of the records, claims, OTRs, and any other information will practically eliminate the paperwork, which will allow Drs. to serve their patients better. Storage of this information encrypted on the net will allow tele-medicine and tele-psychology to operate more flexibly in serving the patients (besides saving on gas & transportation costs for both patients & Drs.).
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.	5) Because Dr. & patient seldom can afford the time to really connect, malpractice lawsuits are much more common, to the point that Drs. must practice ?defensive medicine,? and order tests sometimes to protect themselves rather than benefit the patient. This, of course increases the cost all around & defeats the purpose of the ?assembly-line? approach.	5) Malpractice lawsuits are uncommon (sorry, ?ambulance chasers?).
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.	6) All this increases malpractice insurance, the cost of which eventually is passed onto the consumer.	6) Malpractice insurance costs go down, which will make healthcare less expensive.
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.	7) Drs. are seldom paid their fees. The insurance company determines what their fees are going to be, when under contract. Many intermediaries are getting their checks on the Dr.s? and patients? backs.	7) When seeing patients outside the single-payer system, Drs. determine their fees & decide when & to whom they need to make adjustments when needed. Within the single payer system they get paid directly and uniformly for their work.


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.	8) If a Dr. learns some ?non-standard,? but very effective treatment modalities, he risks losing his license if he uses them. (Some have even been put in jail for healing patients from cancer by using macrobiotics, regardless of the fact that the patients recovered).	8) The single-payer, or government, adjudicates funds to do researchon alternative, effective treatments, thus validating what 50% of the population are already doing.
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.	B) Hospital privileges put another layer of complexity in Drs.? sphere. They may not be able to follow their patient in the hospital, and their treatment may be derailed.	B) Because of prevention and better healthcare, there is less need for hospitalization. Drs. will be able to follow their patients in the hospital, either personally or with video-conferencing, and with the digitization of records, it is less likely that the patient?s treatment will be derailed.
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.	From the patient?s perspective:	From the patient?s perspective:
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.	A) Healthcare is too expensive.	A) Healthcare is affordable.
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.	1) Many cannot afford it altogether and go without.	1) Universal coverage allows everyone to be covered.
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.	a) The result is that in case they need help, they enter the system through the Emergency Room ? the most expensive, wasteful, and less user-friendly entrance into the system. Expensive because their fees are exorbitant; wasteful because a multiplicity of tests are routinely performed, many of which are for self-protection, and not sequenced depending on results; less-user-friendly, because often there is a long wait ? regardless of the severity of the condition, to the point where some patients have been known to die waiting; when admitted, the patient is not consulted and engaged in the process, but rather dictated what to do. That may lead to hospital stays that can be unnecessarily prolonged, thus increasing the cost. Also Drs. in different shifts often don?t communicate and the wrong diets are prescribed.	a) Unless in dire emergencies, patients dol not enter the healthcare system through ER. But if they do, Drs. in ER need to be trained in the new model, so the waste, expense, lack of understanding and empowering of the patients will be a thing of the past. Again, communication among Drs. & between Drs. & patients will be emphasized
.	b) This leaves the patient with 4 alternatives:	b) Patient is covered for all his treatment.
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.	(1) Patient cannot pay at all and the bill is written off as a loss by the hospital, which increases the cost-sharing for those who can pay.	(1) Hospitals & Drs. don?t have to write off expenses, that we tax-payers will eventually have to pay anyway.
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.	(2) Patient might qualify for Medi-Cal, if he is so lucky as to be guided by a social-worker ? who may, or may not happen to be there at the time ? and then eventually get it. Which means, we tax-payers foot the bill.	(2) Medi-Cal is no longer necessary. This eliminates a great source of fraud, thus lowering the healthcare costs.
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.	(3) Patient may try to pay some and negotiate with the hospital a bill of several pages that reads like Chinese to him and there is no help deciphering it. He will also get a multitude of bills from each Dr. that just sopped by to see him shortly and say hello (this can cost $250.00), plus each procedure, plus each medication, plus the ER bill for the hours spent in it, even if all he was doing was waiting for a hospital bed. All of this means he might be paying for many years and he may end up working just to pay the medical bills.	(3)Patient is not be saddled with outrageous bills for the rest of his life.
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.	(4) Patient may be forced into bankruptcy to avoid the avalanche threatening to submerge him and his family.	(4) Patient does not need to go into bankruptcy.
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.	2) If a patient can afford healthcare insurance there are many things to consider: being able to see the practitioners that they like, which means they have to afford a PPO, with the co-pays and deductibles. If not, they are stuck with the HMOs, where they cannot choose who they see and it?s the luck of the draw. Then there are all those services not covered, like optometry, dental (dentists are allowed to charge whatever they want, so choosing in this area is very important), chiropractic, acupuncture, alternative therapies. Plus, there is the supplemental insurance to cover what the main one doesn?t, including excessive fees by the Drs. (Does it ever end?)	2) If a patient can afford to see practitioners who practice outside the universal-single-payer system, he can do so. If not, he is covered by all the practitioners involved in the system. These are the only 2 choices he will have to make (no more HMOs, PPOs, supplementals, etc.) And they are not mutually exclusive. For instance, he may have his regular Dr. in the universal-single-payer system, but may want to consult sometimes with holistic, or alternative practitioners, outside the system.
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.	B) The scope of the "health-care system"is too limited.	B) The healthcare system is comprehensive, inclusive, holistic, and integrative.
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.	1) If patient wants to see a holistic doctor, he will not be covered by the system.	1) If a patient wants to see a holistic doctor, he will be covered by the system.
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.	2) If a patient wants alternative therapies, which have worked for him before, he has to pay for them himself.	2) If patient wants alternative therapies, they are covered in the system.
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.	3) Doctors have no clue about holistic health.	3) Doctors are trained in holistic health.
.	a) Often patients don?t feel seen or heard.	a) Patients feel seen & heard because practitioners will be re-trained in holistic ?bedside manners,? as opposed to ?assembly-line processing.? Also, they will be required to have follow through on their patients.
.	b) Often patients do not know how to empower themselves to communicate with the Dr. Therefore, they often leave feeling powerless to bring up things they deemed essential, and the prescription they carry is not filled, or if filled not taken, or taken sporadically because there is no follow through.	b) Patients undergo training on how to take responsibility for their own health and become aware of their body, feelings, sensations, thoughts, beliefs, and environment, and become experts on themselves from the inside out. They will also be encouraged to search the net about their condition and to communicate all this with their Dr. If they are still not satisfied, universal-single-party-payer system will have provisions for second opinions.
.	c) Patients who can afford it look elsewhere, where they can be seen by healers who can really understand them and help them get over their problems more naturally and prevent future ones from recurring. This?parallel healthcare system? is sought out by about 50% of the population. It is one not controlled by health insurance, therefore the Dr.- Patient relationship is more normal, without intermediaries.	c) The universal-single-party-payer-system includes holistic practitioners within the system, given certain conditions, where alternative, or holistic therapies are known to be effective. It sponsors many experimental programs to validate their effectiveness.
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.	4) Pre-existing conditions are usually not covered. When you need it most, you are abandoned, because you are not profitable to the "industry."	4) Pre-existing conditions are covered.When you need it most, you are not alone. You re not a damaged piece of equipment in an "industry." You are a human being.
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.	C) Healthcare is linked to a job, therefore that is a major consideration when deciding where to work. Some people may disregard their skills because they cannot get a job that has benefits by using those skills.	C) Healthcare is not linked to a job, therefore people are free to choose the work that best suits their interests and skills, without endangering their health.
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.	From the employers? perspective:	From the employer?s perspective:


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.	A) Healthcare is too expensive to provide for the employees.	A) Employers are not required to provide healthcare benefits for their employees.
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.	1) Healthcare is a drag on the economy. Often healthcare costs determine the difference between companies being in the red or in the black, so companies keep cutting their benefits.	1) Healthcare is a benefit to the economy, as an efficient system that promotes healthy employees. This may be the tipping point that can make companies competitive in the market nationally and globally and may ?unfreeze? the economy.
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.	2) The system is too wasteful and has plenty fraud associated with it, that ends up being paid for by the companies & tax-payers.	2) A system of accountability and constant improvement is established within the new system, such that a massive, detached, bureaucracy cannot survive within it.
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.	3) The choices provided to the employers are often dire: minimizing the use of healthcare at the cost of patiet's health, to make a profit for the insurance company.	3) The choices provided to the employers are all the same and inclusive. No special contracts are needed.,
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.	B) Unlike Europe and Canada, in the US health insurance will not pay for preventive programs and wellness programs, which could reduce the cost dramatically. So it is up to each company to fund this, which means two parallel systems: the one that manages illness, and the one that prevents it.	B) The new system emphasizes preventive and wellness programs, that reduces the cost of healthcare in the long run. Sometimes a stay in a spa can be more beneficial than one in a hospital.
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.	From the country's perspective:	From the country's perspective:
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.	A) We pay too much for healthcare.It is a drag on the economy.The healthcare system eats up 17% of our gross national product (GDP), that is $2.4 trillion in 2008, 4.3 times the national defense spending, and it rises at twice the rate of inflation.	A) We pay uninflated healthcare costs.It helps the economy because absenteeism and poor health are reduced.Since healthcare is not an industry, but a service -- like police, firefighting, forest rangers -- we pay in line with other services.
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.	B) We don't get what we pay for.Outrageous costs do not deliver quality healthcare, just profits for the industry.	B) We get more than what we pay for through our taxes. Since the fat is taken out of the system and practitioners, patients, and administrators are trained, we get quality healthcare at reasonable cost.
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.	C) Waste and fraud permeate the system. We pay for services never performed, or for services not needed, but performed anyway.	C) The system is well regulated, such that waste and fraud have no place in it. Patients only get the services they need and those are the only services paid for.
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.		PROBLEMS WITH THE SOLUTIONS TO PROBLEMS
.		I) Marketing.
.		A) In order for this model to take root we need to market it to the grassroots.
.		B) The grassroots needs to demand it from the politicians.
.		C) There has to be a systematic campaign against lobbyists opposing the system: insurance companies, big corporations who have made a bundle in the failed system will want to keep the status quo, or just modify it at the fringes, to pretend they are doing something.
.		D) It may be necessary to do like Gore did with global warming and sell it around the globe, so it finally comes home.
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.		II) Implementing it.
.		A) Accountability and transparency need to be part of the system. One of the dangers of universal-single-party-payer is that you can re-create an already dysfunctional Medicare system and expand it to cover everyone. You don't want a "fat government bureaucracy" sitting on top of you. Competition among different entities for the privilege of providing this coverage sequentially, may be a way to overcome this. Patient and doctor feedback loops, with veto power over an entity, may keep the system functional.
.		B) ?Where there is a will, there is a way.? Let us have the national will to wake up from the ?Bush/Chaney - induced trance? and take our life in our hands where we want to take it.