I can’t take a budget that eliminates marketing, outreach and in-person assistors seriously.
— Teresa Mosqueda, member of the Washington State Health Benefit Exchange board.
You can’t afford to get sick, and you can’t depend on the present health care system to keep you well. It’s up to you to protect and maintain your body’s innate capacity for health and healing by making the right choices in how you live.
— Dr. Andrew Weil, an American physician, author, spokesperson, and sort of guru for holistic health and integrative medicine.
Docs and Nurses Everywhere You Look
I grew up around doctors and nurses, and while my surgeon uncle and nurse aunt had come from humble beginnings in Minnesota and Iowa, their practice in New Jersey and Dr. John’s work at Columbia Medical Center and the Mayo Clinic allowed them to live comfortable and rich lives. A urologist son (my cousin) and doctor of psychology eating disorder expert daughter (my cousin) later, and to this day, these smart Princeton, Duke, UCLA, Vanderbilt graduates still have some major blind spots in their thinking even with successful practices.
They do not understand the benefits of alternative medicine, veganism/vegetarianism and what the poor in America really face when it comes to lack of health care and the stress caused by poverty, toxic neighborhoods and back-breaking/sleep-depriving/poor-nutrition inducing work. I thought I would go into medicine while a diving bum in college, but the scuba diving bug and journalism obsession overtook me.
The irony is I am working now, in my day job, as a case manager for a non-profit in Portland which serves thousands of people experiencing homelessness, chemical and alcohol addictions, approved early release from prison, and military veterans falling through safety nets. Who would have thought getting that new smile changes everything; i.e., pulling teeth and obtaining dentures as one step toward confidence and self-image many who are in our housing find through subsidized mental-spiritual-physical health support in our clinics and programs.
Entire sets of teeth pulled at age 50 and in some cases late 30s. Almost to a tee, my clients experienced extreme poverty as children and teens with parents who most times were using chemicals and booze and de facto abusing their offspring. Lack of any preventative care and the school of hard knocks have worn down many of my clients – some in their early forties experiencing medical issues 70- and 80-year-olds face.
Bad diets on top of the addictions and the constant fight or flight cortisol streams rushing through their systems while braving the mean streets have hobbled many of the people I serve. My job is to help them get stable, stay clean and sober, and look to an employment path.
A sound body probably makes for a sound mind, but unfortunately we are a country with more than 50 million people living in poverty – close to abject poverty – and another hundred million working jobs without benefits or measures to protect workers who are sick, injured or fatigued from being sacked – let’s call us the working-almost-poor.
Spokane County’s poverty rates are some of the highest in the state, as we all have read throughout the past two decades, and children receiving federally subsidized lunches and breakfasts is higher in our K12 schools than elsewhere in the Bill Gates-Jeff Bezos-Paul Allen State.
Food, Where You Go, How You Do It – Preventive Care for Life
Many of the conversations I have after job developing and up-skilling my homeless-recovery clients connect to their early-onset bad diets and even worse physical inactivity regimens. Sometimes I bring up to them one aficionado-journalist working on food and diet, Michael Pollan. He’s a Pied Piper of major reform for this country’s farm and food policies.
“The food system and the diet it’s created have caused incalculable damage to the health of our people and our land, water and air,” Pollan writes. “If a foreign power were to do such harm, we’d regard it as a threat to national security, if not an act of war, and the government would formulate a comprehensive plan and marshal resources to combat it.”
There are hundreds of thousands of Americans dying yearly from preventable causes – tied to chronic diseases resulting from the American Diet. This next generation of children will not live as long as their parents, and Type 2 diabetes – once very rare – will afflict a third of kids before they turn 18. (It cost Americans in 2012 $240 billion to treat diabetes, about 23 percent of the national deficit).
Again, asking, “how is the state of Washington’s and the Inland Empire’s health?” becomes a very complicated question, embedded in the so-called “health” of the health care system and then the “health” of the average resident of the state and our neck of the woods. Ironically, when I first moved to Spokane in 2001, I discovered here in River City that fast-food chains use select markets around the country – Lilac-loving Spokane being one – to roll out new products in their fat-salt-sugar line up of food to get a thumbs up or down for eventual national new product promotions.
Old timers I met at community meetings 15 years ago talked of Spokane once being a real gardener’s paradise – as in food growing. Now, it’s hard to see real effort around the region put into veggie and fruit growing.
The past-time is drive-through eating, all-you-can eat spreads, sort of a Pig Out in the Park (a once-a-year food festival in downtown Spokane, not unlike that of Taste of Tacoma or any hundreds around the country where food and lots of it is the centerpiece of the respective cities’ big annual event) year round. Again, Pollan: “There’s a lot of money to be made selling fast food and then treating the disease fast food causes. One of the leading products of the American food industry have become patients for the American health care industry.”
Factoids that cause ventricular fibrillation:
- unnecessary medical care in the USA is around 30 percent of total doled out
- US health care costs account for 17.5 of total GDP
- 10,000 people in the Baby Boomer category turn 65 a day
those Baby Boomers’ need/desire for health will add to the already $2.5 trillion spent a year on health care- a report by the Association of American Medical Colleges projects by 2025 a 150,000 primary care doctor shortage
After decades looking at the health of wild communities (terrestrial and marine), at biodiversity, sustainability, environmental justice, urban planning as well as shepherding the intellectual well being of students, I can see the connection between obscene profits in a Western health care system that is about disease management rather than preventative and cradle to grave mental and physical well being. It’s driven by unfounded research and development of drugs, high tech treatments and therapies that have taken us so far away from the real fabric of raising healthy communities.
The Doctors and Nurses Have It – Mad As Hell for Single Payer System
When I had a radio show in Spokane, Dr. Jeremy Graham of Spokane was a guest twice, part of a group of physicians and nurses in the state and around the country pushing for a single payer health care system. Physicians for National Health Care Program is still around, advocating for the complete transformation of Affordable Care Act (Obamacare) into a single payer system. The movement then was dubbed the Mad As Hell Doctors and Nurses for National Health Care Reform.
They filled the mock courtroom at Gonzaga. That was 10 years ago. However, there are proponents of fixing a broken or very broken system. One active member of PNHP Northwest is Dr. David Mclanahan, Surgeon Emeritus, Pacific Medical Centers, and Professor Emeritus, University of Washington School of Medicine. David is the co-founder and coordinator of the Washington Chapter of PNHP.
He’s clear about the failings of the political system around our nation’s health care system and how Obamacare has only gone so far:
One improvement is getting more people covered, doing away with pre-existing conditions. However, ‘under-insurance’ is now the norm and it hasn’t been able to control costs, or bankruptcies. It’s still based on an inefficient for-profit private insurance system, now even more subsidized by tax payers.
Like so many medical practitioners I have met over the years, Mclanahan sees his role advocating for a single payer system against the tidal wave of this privatized system as a case of social justice: “I am seeing increasingly decreased quality of patients’ lives, satisfaction, and patient care vs. fear of change by a privileged class.”
Like so many others in the health care movement – to cover everyone, to bring down costs and to reduce unnecessary prescriptions, visits and treatments, they battle the very concept of for-profit: Health of a country is anathema to “providers who see health care as a commodity.”
Patchwork versus a Quilt of Many Colors
For those advocating for more coverage, better coverage and taking the fear out of being labeled as “undocumented,” this is a fight that has many fronts. For Teresa Mosqueda, she’s looking at the minutia of the Open Exchange in the state where before Obamacare, 1 million went uninsured in the Evergreen State. Now that’s down to about 550,000.
“I have a huge concern for those people who can’t afford to use their health care coverage and those who have no coverage at all,” she said. She’s working to get more than 200,000 Washingtonians to realize they ARE eligible for health coverage, and another 100,000 who are Medicaid eligible.
More money needs to be invested into Apple Health, Teresa said, and if it has to be through data collecting, outreach and reports where that change will occur, then she’s all for that. Right now, however, the larger battle looming is the state’s tax loopholes, where “we are giving billions of dollars to large corporations . . . there has to be a call to have revenue reform, and an end to this regressive tax system.”
There are several hats folks like Mosqueda wear, as she is a proponent of full coverage, as well as system change, which her position as Political and Strategic Campaign Director for the WA State Labor Council, AFL-CIO, focuses on.
She cites the Affordable Care Act Waiver 1332 proviso that allows states to propose and implement different things with their health care system, including a bundled insurance approach, as long as the same number of people are covered with the same or more coverage.
“Our state is doing a great job of covering undocumented kiddos up to age nineteen,” Teresa stressed, as Apple Health’s CHIP (Washington’s Children’s Health Insurance Program) has increased enrollment.
The language under the umbrella of Apple Health for Kids Program is pretty watertight, something other states should have endorsed and passed into law:
In Washington State, there are both state and federally funded medical programs for children. The state asks for immigration documents to try to determine whether your child could be on the federal program. The federal program covers children who are U.S. citizens or lawful permanent residents, and most children who have applied for or been granted some form of legal immigration status. The state program covers children who do not have an immigration status that makes them eligible for federal medical coverage. This includes children who are undocumented.
Reports from outfits like Georgetown University Health Policy Institute’s Center for Children and Families as well as dozens of other policy research groups articulate what is intuitive to many of us – providing health insurance to kids is a long term investment better than anything a hedge fund impresario might promise: research shows that children with access to Medicaid have fewer emergency room visits and lower blood pressure as adults. They also are more likely to graduate from college than those who do not have health coverage.
It’s this penny-wise and pound-foolish mentality that has gripped a nation so enamored by and economically-smitten by these hyper millionaires and billionaires that many fellow citizens can’t see how actually the corporate welfare leaders writing policy to protect their billions should be taxed so they too pay their fair share of the pot of money needed to help make the very states they dub “my sweet home” safe, healthy and productive.
EKG’s, MRI’s, Ultra-Sounds, Bionics – Just Get the Doc to Put Healing Hands On Me
In a pre-released working draft for the Monthly Review Howard Waitzkin and Ida Hellander write eloquently and forcefully on how the entire health care system in the USA is in need of triage, resuscitation and major vital organ transplanting:
Obamacare has strengthened the for-profit insurance industry by transferring public, tax-generated revenues to the private sector. It has done and will do little to improve the problem of uninsurance in the United States; in fact, it has already begun to worsen the problem of underinsurance. Obamacare is also financially unsustainable because it has no effective way to control costs. Meanwhile, despite benefits for some of the richest corporations and executives, and adverse or mixed effects for the non-rich, a remarkable manipulation of political symbolism has conveyed the notion that Obamacare is a creation of the left, warranting strenuous opposition from the right.
The fact is more than 27 million people are uninsured still (I’ve seen higher numbers close to 32 million), and 58 million are underinsured. Add to the muck those of us “covered” with deductibles of $10,000 for a family bronze plan and $6,000 for silver, plus the co-payments reaching $200, and we see that individuals and families just do not “use” the coverage, even when health emergencies call for medical intervention. The employer-sponsored programs are heading in the same obscene direction of uselessness.
If the reader hasn’t gotten the medical memo yet, the private insurance pyramid scheme generates administrative expenses about eight times higher than public administration; waste has increased dramatically under Obamacare. We are not the number one country in the world, as other other capitalist countries with national health programs have better care and it’s less expensive and their people are healthier.
The two authors make it clear that this is system run by the administrators who are paid for marketing and billing, the denial business (finding loopholes to not cover claims), all those money-handling expenditures “for processing co-payments and deductibles, exorbitant salaries and deferred income for executives (sometimes more than $30 million per year), profits and dividends for corporate shareholders.” This hefty 100-mile long ship is anchored by the payouts to the private companies under Obamacare. So, think of the 17.4 percentage of GDP in 2013 for the health system hitting close to 20 percent by 2022.
Bombs and Bromides
Luckily, folks get into the doctoring business to heal and follow the “will do no harm to thy patient” oath. I asked David Maclanahan why he went into the profession: “Family history and values, skill and joy in working with my hands. Belief in health care is a human right – as well as all the other social justice causes.”
The other battle-line in the state is the out-of-control and highly fluctuating cost of medical care in the state’s hospitals, Teresa Mosqueda emphasized. “Costs are all over the map for the same procedure. Then thinking about the costs of prescription drugs, it’s clear the prices don’t make any sense.”
One plan for one procedure and attendant hospital care could go for $50,000 while Plan B could charge the patient $500,000 out of pocket costs for the exact same procedure in the same hospital.
A master’s in public health, working with the Children’s Alliance, and pushing for living wage jobs, toxic free neighborhoods and paid leave are just some of Teresa’s repertoire driving her to help the Labor Council hold elected officials accountable.
In the end, we have to take the bull by the horns and stop the colluding forces chaining our futures and our children’s children’s futures to a system of disease treatment versus disease prevention. I think of Doctor Patch Adams for some of inspirational ending medicine:
“It is inexcusable that the richest country in the world does not take care of all of its people. We don’t consider ourselves idealistic; we’re thoughtfully trying to make a beautiful health care model.”