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Wellness in the Headlines
(Don's Report to the World)
Obama's Health Reforms: A Proposal To Facilitate One Aspect of Change—Citizen Involvement In Promoting Quality Of Life Advances For All
Introduction—One change at a time, please!
"Every morning when I wake up, I experience an exquisite joy - the joy of being Salvador Dalà - and I ask myself in rapture, 'What wonderful things this Salvador Dalà is going to accomplish today?'
~Salvador Felipe Jacinto DalÃ, 1904 - 1989
The U.S. health (medical) care system is extraordinarily large, costly and complex. To expect President Obama, the Congress and multiple industry sectors (including the doctors, drug makers, hospitals or insurance companies) to support reforms that ameliorate all the big problems is unrealistic. No single plan can or will, in my view, address all or even most of the problems effectively. Each of the disaster areas of our medical system warrants reform legislation targeted to specific dysfunctions. This reality applies with particular force to matters of controlling costs, providing access for all, raising quality of care, supporting groundbreaking research and dramatically reducing waste and inefficiencies. Attempts to shape a single reform package that does all these things are courting failure.
I have a modest proposal for dealing with what should be one of, if not the, paramount goals for reform: creating conditions that encourage healthful lifestyles. The ultimate goal for any system with the word "health" in the name should be encouraging and even rewarding (positive incentives for) citizen efforts to safeguard and advance their own best interests. I leave to others those reforms that might best bring about cost controls, access improvements, quality advances and so on.
My idea, therefore, addresses one issue or challenge—promoting healthy lifestyles via positive mechanisms that can lead to quality of life advances. In particular, my idea for a REAL wellness dimension to system change is designed to promote an increase in the extent to which the American people understand and come to exercise reason, experience exuberance in life, and safeguard and enjoy personal and societal liberties or freedoms.
In a moment, I will sketch the key element in my reform plan for the health care system. The details will follow, in time, maybe after I have been summoned to the White House or testified before Congress about my plan.
For now, I'll just provide enough detail to demonstrate beyond any doubt that my plan is brilliant and should be a priority for reform legislation. But first, to set the mood and establish no doubt in the reader's mind about how important reforms are to the future of America, an overview of the current status quo seems in order. You never know—maybe some people have not been paying attention for the past forty years and do not fully realize how critical things are.
The Current U.S. Medical System—Fragmented, Costly and otherwise a Mess!
Everyone seems to agree that proper reform is key to U.S. economic stability. The "health" care system cost $2.4 trillion in 2007—$7,900 per person. Surely, these figures are much higher two years down this troubled road. Many Americans have no protection or access—that is, they do not have any insurance (46 million estimated) or are underinsured (25 additional million). Employer provided health insurance, cheap when it began during WW II, is being phased out because companies can no longer afford it. This nation spends 52 percent more per person than does Norway, the country with the next costliest system of medical care. In other words, we are spending half again as much as ANY other country. You would think Americans would be Earth models for elevated health status, given this kind of spending. However, you could only think that if you've been living on the moon or other remote location without any newspapers, media or books. Everyone connected with civilization in some form knows better. e're not the healthiest folks—not that medical spending could EVER lead to advanced health status. As all wellness-oriented folks know, health beyond the margins of not being sick is largely a consequence of lifestyle patterns, plus genetics, environment, cultural supports and random chance. Quality medical care is vital for dealing with injuries, illnesses and diseases—but never for enabling people to be fit, sensible, happy, ethical, kind, loving and all the elements that go into advanced well being. As I wrote about 100 years ago (40, actually), "Modern medicine is a wonderful thing but there are two problems - people expect too much of it and too little of themselves." (High Level Wellness: An Alternative To Doctors, Drugs And Disease, Rodale Press, 1976, p.3.)
Besides Norway, other nations with substantial investments in their medical systems are the United Kingdom ($2,760 per person), France ($3,449) and Canada ($3,678). Of course, these figures are not so impressive compared with our spending. (Data source: The Organization for Economic Co-operation and Development.)
OK, our system is expensive, but critics of a government option (favored by the president) argue that U.S. medical care is superior. Maybe, but a lot of data suggest otherwise. We rank 50th in life expectancy, and 43 countries have lower infant mortality rates (including France and Sweden). (Data source: The CIA World Factbook.)
All sectors of the American political arena agree that some reform is necessary. President Obama, Republican and Democratic members of Congress, the American Medical Association and the insurance industry are urging reforms—but they disagree with the Administration and with each other about how to do it. President Obama and most of the Democrats want a government-sponsored option similar to Medicare. They seek to forbid insurers from discriminating against those with pre-existing conditions. Much to my liking, the president's plan, at least at this stage, is likely to contain incentives for wellness and preventive services.
The debate is about how to pay, how much to pay and who should pay the most. Critics of the president's ideas for reform ask, "How does the president plan to pay for this?"
The answer, of course, is he doesn't. That is, President Obama has no intention to pay for it—and besides, he can't afford it (despite his cool job laden with fantastic benefits—like Air Force One). President Obama expects taxpayers to pay for it. Since we can assume he, too, remains a taxpayer, I guess he DOES expect to pay for it, like the rest of us. Obama suggests that part of the money will come from dollars saved by rooting out waste, fraud and abuse in the system, particularly in Medicare and Medicaid. In addition, Obama wants to reduce or eliminate many tax deductions available to high-income Americans. Nearly all the non-rich Americans like that last part.
That's where things are today. These are the problems that most concern U.S. policy makers face when studying or advancing health or medical system reform ideas.
So, you might be ready to ask, "What exactly is my plan for creating conditions that encourage healthful lifestyles?"
My Plan: Metropolitan Quality of Life Councils (MQLCs)
No matter what reforms are passed to deal with the big medical issues, public acceptance of the reforms established will be highly desired. Support for the changes will be critical to their eventual effectiveness. However, something special is needed to carry out that part of reforms designed to promote healthy lifestyles. For that purpose, I think the nation needs a return to citizen councils, spread across the nation, established to offer advice and guidance for healthy lifestyles that advance quality of life. I suggest they be called Metropolitan Quality Of Life Councils, henceforth MQLCs.
There is a solid precedent for this idea. In 1966, Congress enacted a comprehensive nationwide health-planning program. Public Law 89-749 was entitled the "Partnership For Health Act." It provided for state and regional health planning councils with consumer majorities, a rather remarkable innovation at the time. Fifty statewide councils and over two hundred area-wide agencies were funded. These organizations carried on, with varying effectiveness, for about half a decade until superseded by new legislation in 1974. A few years later, most went out of business.
The area-wide or regional councils had little or no actual power, and their record of effectiveness is mixed. Whatever the verdict, some features of the 1966 legislation held a lot of promise. These councils, if nothing else, provide a forum for tens of thousands of citizens to participate (if not direct or manage) in health system issues, particularly those concerning construction and expansion of medical care facilities.
Since my plan for promoting REAL wellness with new area-wide agencies (i.e., MQLCs) is somewhat inspired by this experience, I should note my role in the early health planning movement. During the era spanning the mid-sixties to the end of the 70's, I worked on area-wide council-related matters in four roles:
- Evaluated and proposed structural forms for the councils as a researcher for Dr. Paul Ellwood's "Interstudy" think-tank, funded by NIH for about one year.
- Served as executive director of two of the largest public and non-profit area-wide agencies—one in the Minneapolis/St. Paul Area; the other in the San Francisco Bay Area—for six years.
- Consultant/adviser to planning organizations providing technical assistance as well as organizing and conducting workshops and seminars (as a member of the Arthur Young and Company team funded by NIH for this purpose)— for three years.
- Editor of the American Journal of Health Planning—for two years. In the last three roles, I campaigned for wellness as a priority health planning function. In the near future, two essays that I wrote and published in 1976 and 1978 will be made available online here at SeekWellness.com. These ancient articles might give anyone interested in the MQLC idea a sense of what consumer-led activists can promote in seeking ways to make reason, exuberance and liberty contemporary values as part of health system reform.
The two articles are:
* "From Omnibus Tinkering To High Level Wellness: The Movement Toward Holistic Health Planning," American Journal of Health Planning, October, 1976. Volume 1, Number 2, pp. 15-34.
* "High Level Wellness And The Health Systems Agencies: A Health Planning Success Story," Volume 3, Number 3, July 1978, pp. 1-18.
A Few Suggestions on the Funding, Structure and Role of MQLCs
I suggest that the health system reform bill contain modest funding for a dozen or fewer demonstration or model MQLCs—and invite states to compete for funds to establish these and other consumer led councils (if the MQLC experiment proves successful). Instead of assigning the task of setting out criteria for proposal assessment and program administration to a medical agency—most likely the Department of Health and Human Services, the Congress should ensure that the legislation as written assigns this role to a Consumer Financial Protection Agency, such as one along the lines that President Obama is seeking. He wants to offer greater consumer protections and more transparent rules and regulations. This placement would help avoid pressures and biases that could allow health industry forces to dominate and medicalize the REAL wellness agenda that MQLCs should be designed to promote.
The role of MQLCs would be to promote advances in health status. Citizen education and support for local groups to conduct genuine wellness education (including for schools and companies) would be a priority for the councils. The focus would always be on the promotion of wellness lifestyles that advance quality of life. Topics to address and promote would include exercise and fitness, good nutrition and the REAL (reason, exuberance and liberty) topics linked to quality of life, such as happiness, ethics, meaning and purpose, environmental responsibility (global awareness) and critical thinking.
Among other tasks, the pilot MQLCs would prepare, with public input, Quality of Life Plans for the area served. They would maintain websites and feed the media with newsworthy information and insights about practical benefits of REAL wellness ideas. They would be charged with stimulating citizens and public officials alike to recognize differences between good medical care—a system responsibility, and quality of life—a mission largely in the hands of each person.
The medical system problems, as noted at the beginning, are large, costly and complex. The details for shaping councils such as I propose, based roughly on the old health planning consumer-led agencies, will require considerable study and ingenuity. I do not suggest that anything about this idea is simple or easy. But, providing citizens with a meaningful opportunity to translate and implement details of health reform, oriented exclusively to health status advances rather than only medical reforms, could and I believe would make a substantial and positive difference—for the better.
It's an idea for your consideration.
All the best, be well and look on the bright side as reforms come your way in the days ahead.
Domain: purposeSubdomain: applied wellness
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