The first step toward a solution is to know what the problem is.
Healthcare in this country has been the subject of widespread and highly politicized debate in recent years. Most of us agree that there’s something wrong, but we tend to disagree on what, exactly, that might be. It’s little wonder that the solutions that we try are subject to controversy — and that controversy includes widespread civil disobedience, of a type and breadth not seen since the civil rights era of the 1960s and 70s.
The trouble is, we don’t know what precisely is wrong. We haven’t diagnosed it. So… let’s.
Here’s some of the symptoms:
- Millions of people have health problems and don’t know it.
- Millions of people can’t afford treatment, even if they know there’s a problem.
- Insurance costs more than health care would, and millions of people can’t afford either one.
- Millions of minor health problems become major ones because people don’t get simple preventative treatment.
We’ve got an impressive health care system, designed to make insurance available to everyone, and a substantial percentage of the country is unhappy about it. Frankly, I’m not worried about their happiness so much; I’m worried about their health.
“But why is my health any of your business?” some ask — and not unreasonably. Privacy is an important right to Americans, and what’s more private than your health? People might answer that it’s a burden on the economy, or that there’s a chance of unpaid bills that the system will have to absorb in the case of deadbeat (or even dead) patients, but is that any concern of ours? Not really, not on a personal level.
What is our concern, however, is that the above problems aren’t rare at all. They’re extremely common, and that makes it a societal issue. We have access to the most advanced medical technology in all of human history, we live in one of the richest of all of the industrialized nations, and still, we have deaths every year due to things like tuberculosis, pneumonia, the plague, and measles.
“The United States experienced a record number of measles cases during 2014, with 668 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.” That’s from the CDC’s website. Why is this? In many cases, it’s because people choose not to get medical attention.
So why don’t people go to the doctor?
Well, there’s the inconvenience; I mean, who has the spare time to go check out a problem that might be minor, or something that can’t be fixed? We have too little spare time in our lives in the first place. And we’re expected to go to a clinic, fill out paperwork, sit in a waiting room with a bunch of sick people, hang out for fifteen minutes with a nurse who pokes and prods us and asks us lots of questions that have nothing to do with why we came, then wait half an hour for a doctor to swing by — a doctor who’s got no idea why you’re here in the first place, so why did we fill out those forms anyway?
We get ten minutes of the doctor’s attention, a nod and a word or two, and then we get bundled out the door holding a prescription that may or may not have anything to do with why we’re there (“Take these for a week and then come back if it doesn’t solve the problem.”) And then we go wait at the drugstore for another hour — again with lots of sick people — and finally, when we do get home, the initial health problem isn’t anywhere near as pressing as all the missed deadlines at work, your mother-in-law’s upcoming visit and the attendant house cleaning, or your sudden need for a nap after all that running around.
Second, there’s the expense. You go to the doctor, you pay the doctor. You go to the drugstore, you pay for the pills. Someone tells you to take up jogging for your heart, so you buy the sweats and the sneakers and the custom headband. And when do you do all this? When you’re supposed to be at work, trying to make enough money to pay the mortgage.
Third, there’s the fear of finding out what’s wrong, or even worse, not finding out. Let’s say it’s cancer. Do you really want to know, or would you rather live out your last few months in blessed ignorance? Even worse, let’s say your doctor misdiagnoses you with cancer so he can run a scam on Medicare and give you unnecessary chemotherapy. (It’s not common, but it happens.)
And that’s if you GET a diagnosis. It’s much more common to go, get prescribed a pill for something you don’t have, and end up having to go to appointment after appointment until either (1) you die or (2) you get better on your own.
Fourth, we’ve got a large number of children in this country who don’t get immunizations. There’s highly effective vaccines available for measles, mumps, rubella, diptheria, tetanus, whooping cough, polio — each one a childhood killer, each one long since defeated, and each one currently in outbreaks in this country because people choose to not let their children get vaccinated. Some don’t think the vaccines are safe, some have religious problems with them, and some… well, some parents can’t be bothered.
To be frank, some vaccines haven’t been safe. Storage methods have been changed to reduce or eliminate mercury levels, and there were some quality control and preparation problems that were uncovered not too long ago. Mostly, though, the main safety problem is caused by protective parents who, largely through ignorance and often thanks to deliberate fraud and disinformation, endanger their own children and those of others by failing to vaccinate. The fears of some may be justified, but from a societal standpoint, the number of deaths from even a single outbreak is far greater than the number of fatalities caused by vaccinations. Still, it must be acknowledged that there have been some adverse reactions, including fatal or developmental ones due to high fever or an allergic attack. Some of the fears – not most, but some – are legitimate.
All of this, in point of fact, is the cynical “What might go wrong?” stuff, the more unpleasant scenarios. But it’s us worrying about that sort of thing that drives our behavior, more often than not, so we really need to take it into consideration. Just because our fears may be uninformed or irrational doesn’t make them go away.
So here’s the questions that I see that must be addressed:
- Why is medical care so inconvenient? What can be done to help that?
- Why is it so expensive to go to a doctor?
- How can we protect ourselves from nondiagnosis, or even worse, misdiagnosis? How can we best address our own fears of the unknown?
- How can we fix the immunization problems? (I include addressing legitimate objections here.)
During this series of articles, I intend to explore each of these questions, and a few others, in some detail. Since we’ve got to start somewhere, I’m going to go straight to the wallet.
With specific regard to the expense, there’s a question that often gets asked: Why don’t we just nationalize all healthcare, and make it free to everyone? Personally, I don’t think that’s quite the right solution, so I’ll pose a different question:
Why is essential health care a for-profit industry in the first place?
Think about that for a while. I’ll be back with another article on the subject in the near future, and you can always argue with me in the comments section in the mean while.