For quite some time I have been giving a lot of thought to the condition of our healthcare (really sickcare) system and what needs to be done to truly fix it. Here are some of the things I feel must be done to create a new paradigm:
1. Stop rewarding bad behavior. By this I mean stop giving free healthcare benefits to people who make bad choices. Many states have inacted laws to perform drug tests on welfare recipients in order for them to maintain their benefits (a really good idea). They also encourage "works" programs and provide daycare vouchers so people can go to school to better themselves and get off of welfare. Why can't people who are receiving disability benefits be encourged to stop being disabled? Instead of continually covering medications, treatments, and doctors visits for years and years, why not also cover nutritional counseling, gym memberships, and give incentives for getting off of disability. People have no incentive to get better when the government (really the people) continues to foot the bill. Granted, not everyone can get off of disability, but I bet a whole lot of people could get off of it if they improved their lifestyles. It always disturbs me when a patient tells me they are unable to work because of their weight as their family brings them in McDonald's and other fast foods. The other one that gets me are the people who can't work due to respiratory problems yet they continue to smoke and collect benefits...they then have the nerve to get upset when we tell them they have to pay for their prescriptions. Benefits should be reviewed twice a year and people have to provide proof that they are taking steps to get better.
2. Clearly outline what constitutes an "emergency" and penalize people for abusing emergency rooms. Make people pay for non-emergency visits to the ER...even if it is just $10 (it adds up). ER's are not primary care physicians nor are they free clinics. They do not provide continuity of care. Instead, fund clinics and urgent care centers so they can have later hours so people have options and provide care on a sliding-scale basis to those who truly can't afford it are still able to get care. However, this must be monitored and people have to provide proof that they truly cannot pay. We have to eliminate the people who are continually abusing the system and driving up costs for everyone else. Encourage people to use those clinics instead of running up bills in the ER for non-emergent illnesses. Constipation is not an emergency unless your bowel is dying as a result. Neither doctors nor nurses went through their training to unblock your bowels. We also did not go to school to rehydrate you because you didn't have enough sense to not get drunk or because you were too cheap to buy Tylenol or Motrin for your fever but could still buy your cigarettes.
3. Require medical schools to start teaching students about diet and nutrition as part of their medical training. Pills and surgery are not the only answer to treating illness. How about providing funding and training on teaching people how not to get sick. Not everything can be prevented with a better diet and nutrition, but many things can. Doctors and all healthcare professionals should be about promoting health and not just about treating illness. We have to change the medical paradigm of closing the barn door after the horse is already out. We need more upstream thinking as it relates to healthcare vs sickcare.
4. Give people more options in regard to their terminally ill loved ones. Some states have innacted assisted suicide. People with terminal illnesses should be able to make their own decisions about quality of life. Families should be able to also make decisions about the quality of life for their loved ones. Our nursing homes are overflowing with elderly people who can't eat on their own, can no longer walk, have no cognative ability, have no control of their bowel or bladder. Essentially, they are simply a human shell being kept alive because people either aren't ready to or are unable to let them go. Most Americans don't want to accept that dying is part of the life cycle. We all must die sometime and we owe it to our elders to give them a good death and not one of humiliation and suffering. Many people never see the inside of a nursing home or acute, long-term care facility. I think if more people were aware of what really goes on in those facilities, they might have different thoughts about sustaining the lives of loved ones who are alive, but no longer living.
5. Provide more funding for school lunch programs to allow them to provide children with truly healthier choices so we aren't creating sick, overweight adults. Part of prenatal care classes should cover nutrition for mother and baby that will actually promote health over the long haul. Have comprehensive nutrition classes as part of the curriculum in all public schools.
I believe that all of these recommendations are doable. They will just take some legislators having the courage to go against the status quo and realize that for our country and our economy to survive some drastic changes must be made that will benefit everyone.
