2 words to banish from healthcare

Say you’re a betting person. If someone gave you great odds to get rid of the words “recission,” and “pre-existing condition,” in the healthcare debate, would you take it?

If you would, you’d be skunked by the obvious.

It seems like a given that any healthcare reform legislation will make insurance companies invoking pre-existing conditions and cancelling their contractual obligations with policyholders through recission illegal. But let's agree to remember egregious examples of these practices as evidence of past barbarism.

So, what’s the first word we must absolutely ban? Consumer.

After all, we don’t really consume health care the same as we “consume” Skittles or nacho corn chips. Only people in the thrall of a sugar imbalance or addicted to the fifth taste, umami—a meaty or savory taste produced by several amino acids and nucleotides—consume Skittles, nacho chips, and other snack foods. Ordinary people may occasionally eat Skittles and nachos. They may also eat high-fat charbroiled burgers and French fries created by food flavorists for various fast food brands. Some people may also eat lots of antioxidant-loaded fruits and vegetables created by nature, although sadly, they’re probably in the minority.

And most prudent people seek professional care from doctors when they get sick; unfortunately, we’re a hearty species and can punish our bodies, minds, and spirits for years before we suffer a crisis that threatens us with death and debility. It’s usually at this point that even the poor seek medical assistance to return to a state of health, and hence, the term, healthcare.

To use the word “consumer” in the context of healthcare is to flatten the value of regaining health to the accountant’s ledger or the businessman’s abstraction. And yes, I realize this is not a new insight—yet it remains significant—especially if we consider Professor George Lakoff’s message to progressives to frame debates to reflect their values—or lose the argument.
(See: http://www.truthout.org/082009B [1] )

To say you “consume” healthcare is to tacitly agree that it’s okay to regulate its consumption—and to profit from its consumption—much in the same way as you might profit from the utilization of widgets or any unit of production. The word “consume” is bloodless, which is extremely convenient since people denied access to treatment can end up very bloody indeed, and even dead.

Besides, do insurance companies produce healthcare? No, they’re middlemen who determine access to various systems of acute care and create quotas for levels of consumption based on business alliances and so-called cost-cutting measures. If you seem to have disease x, you can get tests a and b, but only from a preferred provider. But forget about getting procedure c anywhere, it’s experimental. Or if a healthcare professional (HCP) doesn’t know which disease you have based on your symptoms—your insurance company will allow you to “consume” tests d and e. But if that doesn’t nail it, tough noogies, you’re over your widget quota anyway, and don’t switch jobs or it’ll become a pre-existing condition. That’s if you haven’t already been kicked off your plan for having zits as kid that you didn’t fess up to during enrollment, i.e., you’re a victim of recission.

Okay, so do physicians produce healthcare? Of course not! Nobody produces healthcare. Caring for people who are ill is, at best, a service. Caring for the ill professionally—i.e., minding people who’ve manifested a disease through evidence-based medicine requires close attention to their lifestyles, knowing the latest research, being a good diagnostician, and having an intangible factor that comes from interacting with people. None of which is ever really possible when healthcare is a commodity, because the doctor isn’t there for the patient, he or she gets 5 minutes tops to prescribe meds and order tests to be consumed.

Does anyone remember that when the now much-maligned health maintenance organizations came into being in the 70s, it was with the supposed raison d'être that prevention of illness or maintenance of health is ultimately cheaper than expensive acute care for disease? Of course, that was before we’d heard the Nixon-Ehrlichman conversation on Michael Moore’s SICKO and were let into the insurance scam of denying care and still making money! (See: http://www.alternet.org/movies/55049/sicko_is_michael_moore's_best_and_most_powerful_documentary/ [2] )

But let’s take a deeper look. Say you manage to get access to affordable healthcare in a humane medical system and the doctor cures your illness, does that mean you’re well? Probably not. So there are 2 choices you can make. Sometimes when you’ve been cured, the disease will scare you into changing behaviors that may have, might have, even remotely could have contributed to getting sick, and soon enough, you’re feeling good because you’re living cleanly. And that’s what’s called “wellness.” Of course, there’s another choice, and that’s doing nothing, or ignoring all the behaviors or lifestyle choices that contributed to your illness in the first place—and that means you’ll stay chronically ill—with continual drugs to suppress symptoms and tests to “detect” the next acute breakdown. And nobody can call that “wellness.” No one should call it health, either, although it’s the best we can hope to get under a reformed system that doesn’t address prevention. Nope, without dealing with the cause of illness, this state is more of hellish Limbo where you wait for the inevitable shoe to drop.

Any healthcare system that really stands a chance of limiting costs and increasing wellness must address all of the slings and arrows of our outrageous environment—from factory farming that dumps pesticides into depleted soil and sells infected meat, to giant corporate food businesses that inject preservatives and chemical flavors into high-fat, high-sodium, high sugar and low fiber food products that starve our bodies of nutrition and force them to adapt through inevitable chronic illnesses such as obesity, heart disease, stroke, diabetes and various autoimmune diseases, to name just a few. It’s a life of self-created pestilence to increase the profits of shareholders. Save money. Live better? We should all look more closely at the high cost of low prices.

Maybe the biggest environmental outrage is perpetuating the flatland of values that enshrines laissez-faire, the-market-always-knows-best, blind capitalist’s valuing profit above all else. What such a flatland ultimately does is create a mega-frame impervious against all arguments for human decency, the public welfare, and just plain, old good common sense.

So here’s the other word we need to ban from the healthcare debate: profit.