Whatcom: Chronic & Acute

“America’s health care system is neither healthy, caring, nor a system” Walter Cronkite said long ago.

Right on Walter!

Obama’s Affordable Care Act (ACA) has benefited 20 million previously uninsured persons, BUT repealing or replacing it will do little or nothing to improve the healthcare of hundreds of millions of Americans already receiving healthcare.

Washington’s notion of reform is a distraction from real reform that’s needed to benefit the entire U.S. population.

I’ll go Cronkite one better and say, “American healthcare is a maze of confusion, disorganization and antiquated information technology. More of the same only for more people is not reform.”

Many federal government programs have been labeled healthcare reform since the Truman administration of 1945. But none have reformed healthcare at the patient/provider level, where it really matters. Some reforms have been bigger and better than others, such as Medicare, but most reforms have been another bandage on a mishmash of healthcare. There was the Clinton Health Security Act, the Health Management Organization (HMO) that would save healthcare in the 1990s, recently there was Obama’s Affordable Care Act (ACA), and now there’s proposed Trumpcare, otherwise known as the American Health Care Act (AHCA). And that Ryan/Trump proposed replacement, with services slashed to appease right wingers, will make things a lot worse.
I’ve seen all of these schemes since 1938 and still haven’t experienced anything resembling the kind of reform I’d like to see that would yield meaningful improvement in diagnosis and treatment for patient and physician.

True healthcare reform would change the existing healthcare system, rather than add more twists and turns to an already impenetrable maze.

Of course its good to have affordable healthcare, but if it only affects about 5 percent of the population how good is it? What’s so good about the ACA or anything by any other name if it is just grafted onto a dysfunctional system in need of real reform?

I saw a politician recently shout into a TV camera that America has the world’s best healthcare system. It was a claim I dismissed, thinking he undoubtedly had no personal experience with it.

Technically the politician was right, but not in a meaningful way. If you picture the American healthcare system as a great pyramid terminating in a lofty apex — i.e., money — yes, the apex is the best healthcare system in the world, but it’s too tiny to accommodate very many patients. It is literally out of reach of ordinary patients who must swarm around the massive base of the pyramid seeking diagnosis and treatment among the more down-to-earth immovable foundation blocks.

On July 13, 2016, PBS’s News-hour blog from Associated Press stated: “Health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman and child. The annual increase of 4.8 percent for 2016 is lower than forecast for the rest of the decade.”

The endless national debate about U.S. healthcare focuses on cost, and no wonder. According to a March 21, 2017, Wall Street Journal posting: “The United States spends more on health care as a percentage of GDP than other developed countries, but Americans are less healthy.”

Trying to fathom such numbers IS truly mind numbing. Reading analyses of such numbers along with the legislative mumbo jumbo of offsets, projections, affordability fluctuations and intertwined speculations, shut down my brain.

And, frankly, I asked myself, Why bother? Why bother when I am convinced that this latest approach to healthcare reform will fail to provide any meaningful improvement in diagnosis and treatment of patients: me, for instance.

I’ve been in the Whatcom county and Washington state healthcare systems full-time since 2009 and am dissatisfied. So dissatisfied, that I published a book in 2012, titled “Waking Up Dying: Caregiving When There Is No Tomorrow,” expecting healthcare providers to read it, recognize everyday-healthcare shortcomings and instigate their own reforms.

When my book was banned and unread by Whatcom and Washington healthcare providers, I was disappointed. I wanted to understand why healthcare was so stagnant, unable or unwilling to re-invent itself to remedy its defects. I talked to practice managers, physicians, nurses, hospital administrators, patients and caregivers. Most agreed change was needed, but each felt it was beyond his or her individual grasp. Each admitted to closing his/her eyes to the issues I raised and decided to do the best they could within the existing system to be of greatest benefit to their patients. That’s an ethical goal, but not a realistic answer.

Though I wrote a whole book full of examples, here’s another.

Healthcare’s prime directive, I’ve discovered is: no diagnosis, no treatment. It sounds simple enough, but in the disorganized and mismanaged healthcare system, diagnosis can seem to take forever. Take my recent situation for example, where I went untreated for 11 months.

In October 2015, I began falling and needed the assistance of a cane or walker. I went through two spine surgeries and various other treatments, but kept falling, until August 2016 when I finally received a leg brace that stopped me from tripping and falling. I was treated in four healthcare systems: Eisenhower Medical Center, Rancho Mirage, Calif.; PeaceHealth and Family Care Network, Bellingham; and U.W. Medical Center, Seattle. Considering the grim hazard that falling is for anyone over 75 years old, why did it take so long to get the brace? Even after a neurologist prescribed a brace, a physical therapist withheld it for eight weeks while teaching me back-strengthening exercises. Desperate, I finally demanded the brace. Thereafter, I dispensed with the walker, got around with only a cane and learned to fall less.

A reformed healthcare system would have quickly put a brace on my right foot to prevent me from falling and then would proceed methodically to diagnose the cause of my “drop-foot” tripping hazard, and then seek to cure me with further treatments including surgery and physical therapy. I’d have had the same care from the same providers but in a practical sequence that focused on real hazards such as falling on my face.

This is the difference between patient-oriented care and process-oriented care, which is the difference between real healthcare reform and everything that has been attempted since 1945.
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Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com

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