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Military Industrial Complex = Peace
The above statement is ludicrous. The fact that we have come close to destroying our planet via nuclear war is amazing but underscores the above. In 2001 the United States will spend $180 billion dollars on arms acquisitions and another $120 billion dollars on its' domestic "war" machine. President Bush is working on a "strategic defence plan" which has the potential to de-stabilise the world and bring us closer to the brink of nuclear war (Armageddon). The imagined foes are North Korea (whose citizens are starving to death), China (whose economy is just beginning to modernize) and rogue states like Iran and Iraq, none who really pose a threat at all.
" Our Health System is not a Health System"
Our "health" system is not a health system. Our health system is a disease (physical ailment) dis-ease (those who are worried they have disease but are usually worried about dying, suffering from mental illness, stresses of daily living, unemployment, poverty and lack of all the other determinant of health - these people are the "worried well").
Our health system remains very much a medical model. Society has put modern medicine and science on a pedestal. Much of our doctor's status is conferred by society. In the former USSR doctors were paid amounts similar to those of factory workers. In Italy there are unemployed doctors who drive taxis. This status is re-enforced by daily reports of the "miracles" of modern medicine most of which never come to fruition. Physicians like the Emperor have convinced society that it is modern medicine that has made them healthy, where in fact it is the determinants of health that contributes 85-90% of the health the public in Western societies enjoy that is enjoyed today.
I am not writing this paper to destroy modern medicine but to make the public aware of medicine's actual contribution to their health. I am here to make modern medicine better, to make it evidence based, efficient and at a cost we can afford. I am grateful to our current medical system. I would not be standing here but for a simple antibiotic called Cloxacillin which killed the bacteria when I had "Flesh eating disease" - Strep pyogens during my visit to northern Quebec in 1988. I am grateful that my mother was given thrombolytics when she had her second MI - I would been happier if her family doctor got her to stop smoking. Our medical system can do good but unfortunately it can also do harm. The system needs to be integrated and made efficient. The players need to be coordinated in a stream-lined manner, the right provider needs to see the right patient. I believe the Crisis in Health Care can be solved : Information technology and Primary Care Reform are the corner stones of this reform.
Human Nature
The reality is that we have things we like to do in life and those things we don't like to do. We also have different ways we can change behaviour : one can be punished (physically, sexually or emotionally) these people often end up with low self esteem are major consumers of health care; unfortunately most are not recognized by their PCP who are poorly trained to identify them and hence are churned between various specialists (who consume masses of resources) only to be told that they are fine. The other way to change behaviour is through incentives - praise, rewards etc. Napoleon was a master of using rewards - his soldiers, generals etc were given elaborative medals, varying uniforms etc.
Government uses incentives (carrots) and disincentives (stick) in much the same way a parent tries to change a child's behaviour. I always think of a donkey with the stick behind and the carrot in front. Unfortunately doctors are not children, they are extremely intelligent and with each new (disincentive) roadblock they find more innovative ways to circumvent the obstacle.
This has had a disasterous result on our system often driving utilization, in an attempt to "keep up with the Joneses"
The Nature of Disease
The nature of disease has changed substantially over the last century. Infectious disease has been conquered in the developed world but remains an issue in the developing world. Sewage, clean water and immunizations have had the greatest impact on the Western world's health.
Today medicine is challenged by those who have chronic illness (CHF, COPD, DM, hypertension), those who worry they have illness but don't (irritable bowel syndrome, fibro myalgia), those who have mental illness (anxiety, depression etc) who present with physical complaints and by common minor complaints that are self limited (colds, heartburn)
The fact that nearly every aspect of the human condition has been medicalized is worrisome. Our health system is the entry point for all of societies ills. The fact that it is "free" has not helped. Our money would be better spent raising income, achieving full employment, providing adequate housing (ie achieving the determinant of health) than to pour money in the suck hole of modern medicine. More worrisome is the fact that all those who enter our medical system are treated a physical problems, often ignoring the real cause of ill health -dis/ease. The result is vast amounts of money spent with no change in outcome; furthermore the client comes back with more of the same. The frustrated primary care provider (PCP) orders more and refers more in an attempt to solve a problem they can't solve because by its nature it is out of their scope of practise. (Ie they can't give the person employment, eliminate poverty, achieve social justice) The cycle continues.
The Causes of this Mess
Paradoxically we live in a era we as an species we live longer than any of our forefathers (79 for men and 81 for women in Canada) yet we are a death denying society. Death has been sanitized. Whereas most dying people 100 years ago would have died at home and had a "wake", a celebration of life, today most people die in hospital; where death is treated as a disease and the final event as defeat (with tubes sticking out of every orifice!!) The funeral is a sombre event, almost to be avoided. We are a death denying society. Members of such a society perceive that their headache is caused by a brain tumour (Very rare) or meningitis (very rare); that there sore throat is caused by the strain of bacteria that killed Jim Henson (of Muppets fame - extremely rare), that there heartburn (from overeating, drinking too much beer etc) is the big one - an MI. This drives unnecessary demand on the system.(I shall talk about this later under utilization)
Whereas in the past we had little but were happy with what we had today materialism and greed predominate. The shopping mall is our modern day temple, consumerism reins. This is having disasterous effects on our environment - we have consumed more in the last 50 years than was consumed in the 50 million years before us. The modern day garage sale is where we get rid of all the things we over bought or no longer need. Physicians like the rest of society is driven by the need to achieve and accumulate wealth and things. As the drivers of the vehicle known as "our health system" their actions drive demand for their own services.(I shall talk about this later under utilization)
In the past members of communities helped each other, today individualism reins. Members of our society have rights but no obligations or responsibilities. We have the right to medicare but not the obligations or responsibilities to use the system wisely. (I talk about this under accountability) Individuals, physicians, the government and the private sector "abuse" the system.
The breakdown of the family unit has also contributed to our woes. Today 47% of marriages in Canada will end in divorce, a symptom of a society in chaos. The ramifications on our health care system is staggering. In the extended family the grandparent was a valued member often giving advice to the new parent, providing ongoing support and a source of wisdom (some cultures this is still true) Unfortunately in our Western society the elderly are discarded, warehoused, abused and neglected!! A great resource is ignored
In general the elderly are well, live at home. As a group they consume a disproportionate amount of "health" resources especially as they near the end of their lives (the end of a natural process). As far as the medical profession goes they are over medicated and neglected. (See cherry picking) New family medicine graduates have little interest in caring for the elderly, partially because they lack training in this area and secondly because they are often complex and tax the mind, the result is that they are sent to multiple specialists who end up ordering and treating often with little co-ordination. Outpatient geriatrics needs to become a major part of family medicine and nurse practitioner training.
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