Homeopathy's place in health care reform

Watching our legislators wrangle over the different plans being considered, I sometimes wonder whether any of them has a truly profound understanding of the systemic problems that have led to this reform initiative. It is clear that all involved understand that change is necessary: that there is a need to cover the uninsured and under-insured; that there is a need to assure that people have real insurance, not nominal insurance, and to hold down the ever-expanding growth of health care, which now consumes somewhere around 16% of our gross domestic product (GDP). Everyone seems to have a different idea of how to do it, yet to me none of them seem to relate their solutions to causes of the problems. As a homeopath, this band-aid approach seems to be in lock-step with conventional medicine, which aims for a solution without truly understanding the causes of the disease.



The causes of our health care mess are certainly manifold, but probably include the familiar suspects, such as over-bureaucratization of the system (so called "overhead" costs), the high cost of pharmaceuticals and medical devices, and insurance companies' providing too expensive or inadequate coverage. They probably also include excessive doctors fees, over-medicalization and over-treatment, overuse of diagnostic technologies, a lack of incentive for using less expensive treatments over more expensive treatments, fear of lawsuits and excessive medical malpractice fees, lack of patient incentives to follow-through with their treatments, both preventive and therapeutic, and excessive medical school debts, which force doctors to require higher incomes than they would otherwise need. As a homeopath it is hard to omit that there is an emphasis on suppression of disease, which leads to vast co-morbidities from iatrogenic illnesses. According to the American Institute of Medicine report in 1999, 10's of thousands of people die yearly from preventable medication effects. This does not include the non-lethal illnesses that result from iatrogenesis. Moreover, suppression of disease leads to the outcropping of even more disease, which leads to the need for more and more medical care.

A health care reform bill that makes any sense needs to address these multiple etiologies for the illness that afflicts our health care system. The goal of universal coverage makes sense, but so do things like balancing the budget and peace, yet there always seem to be good reasons not to do these things, because we realize that simple sounding problems do not necessarily lend themselves to simple solutions. Here is my bare-minimum list for what good health care reform should include:

1. Reform of medical education costs. This means reducing physican post medical school debt. It would eliminate the need for doctors to charge excessive fees so they can pay off the gargantuan debts they have accumulated over four years, which of course, are only added to any college debts they have not yet paid off. As I have alluded to in early blogs, physicans could trade in free years of medical school education for an equal number of years of community service, either in underserved areas or at medical clinics for the indigent, where fees typically are very low. Salaries would be lower, but the needs of the indigent would be taken care of and physicians would not feel the need to charge high rates or go into expensive specialties so they can pay off their debts. They would be more comfortable going into lower paying primary care specialties.

2. Pay for such primary care specialties must be increased along with other incentives or mandates for medical students entering primary care. Medical school may need to be legally mandated to graduate a certain percentage of students into primary care residencies, or lose funding or accreditation. Increasing the number of primary care physicians would tend to balance out our over-specialized high-cost system.

3. Legislation must help to hold down the costs of malpractice insurance and the fears of lawsuits that tend to cause over-testing and over-treating. Physician errors must increasingly be dealt with intramurally, with tighter professional self-regulation and non-monetary forms of compensations or penalties in cases of malpractice.

4. Government must regulate the insurance industry more to prevent "cherry-picking," denials of coverage for various pre-existing conditions and other hidden clauses that keep insurance companies from having to pick up the tab for their subscribers illnesses and threaten all Americans with medical bankruptcy. Insurance industries may need to have a mandate to be non-profit, to prevent the whims of the marketplace from corrupting the real purpose of insurance, which is to prevent financial disaster for all citizens as a result of health problems.

5. Physicians need to have an incentive to reduce the health care expenditures of their patients without compromising their health. This would tend to promote doctors' interest in doing a better job and securing compliance from their patients. It would also be a shot in the arm for homeopathy, which has been shown to be one of the most cost-effective means of treating a wide variety of health problems. Although some would object that this will lead doctors choosing healthier patients, doctors would be rewarded not for the total expenditures, but for the amount they were able to reduce total health care expenditures for their patients or at least to hold down the growth of expenditures as compared to their colleagues with comparable patients. One can argue about the feasibility of such an idea, but if doctors are accountable for their results, they will be more likely to work hard to improve their results than when they get paid regardless of thier patients' outcomes. Government can get involved by rewarding those physicians who can demonstrate cost-savings compared to their colleagues with cash rewards. A system similar to this already exists in the United Kingdom.

6. Patients must also have incentives for improving their own health, as measured by health care utilization. It is well known that at least 40% of health care problems are linked to self-induced illnesses, such as obesity, diabetes and hypertension, with their sequelae due to lack of exercise, poor eating habits, smoking, drug abuse, gambling, or other self-destructive behaviors. If patients actually could have their health care premiums reduced by reducing their consumption of health care resources, such financial incentives would likely motivate them to take steps to improve their health. Using health modalities such as homeopathy, they would be able to reduce their dependence on pharmaceuticals and reduce their need for medical treatment in general. Some might argue that people would tend to avoid treatment that was truly necessary, only to pay for it later with higher costs, but this tends to assume a ridiculous level of short-sightedness. Sure, it may occur occasionally, but people will learn quickly enough and adjust their behaviors. In addition, no one is penalized for getting treatment. One is simply rewarded for reducing consumption of health care resources.

7. Doctors, technicians, hospitals, insurance companies, pharmaceutical companies, and the entire health care industry will need to accept a down-sizing. We are already staggering under the weight of a morbid obesity in financial terms, and much as noone wants to have lower salaries or fewer jobs, there's no way to reduce obesity than to lose weight. Many will be looking at unemployment, some will be looking at lower income. This is what has happened in other countries already that have universal coverage. It must be imposed from the government, and it will not happen unless government over-rides the lobbying from the special interests that insist that their slice of fat should not be trimmed.

8. Coverage will need to be made universal by extending government insurance to all those who can not presently afford it or by mandating that everyone get health insurance and that insurance companies offer a broad pallete of policies along with government subsidies, so that all will be able to afford to choose a private plan (or be faced with fines). The latter is the Massachusetts model, and it is causing significant cost overruns for that state. So it may not be the best solution, or will need to be paired with other legislation that will tend to hold down costs from the many new members of the insurance pool.

There you have it. A sensible, if impossible reform plan, grounded in the causes, not in idealogy or partisanship. Now if only I could get anyone to take a look at this...