One of the many issues being discussed by the business community, Congress and citizens groups are health care costs and how to contain them. In the past 20 years, health care costs have continued to rise, even during periods of recession, and now tops 750 billion dollars annually. This comes to about 11% of our gross national product and makes medicine in America cost more than a number of foreign countries annual budgets. While Americans spend more money for health care than any other nation, we rank 18th in the world in overall "healthfulness". The incidence of chronic degenerative diseases such as arthritis, cancer, diabetes and heart disease are among the highest in the world. Additionally, the U.S. possesses one of the highest infant mortality rates among industrialized nations.
Most of the health care cost increases are due to hospitalization for major illness associated with chronic degenerative disease. The top ten major diagnosis such as arthritis, cancer, diabetes, heart disease and hypertension contribute over 75% of medical expenditures for personal health care. Higher costs results from these conditions which require disproportionate amounts of specialized, long term, expensive care.
Third party payment systems financially accommodate hospital and specialized care such as surgery and advanced diagnostic technology. Because of the competition between hospital and doctor for patient dollars, a procedure oriented technology has evolved further adding to fixed health care costs. This system has evolved to compensate for the increasing number of chronic degenerative diseases now being seen in this country.
Presently, the emphasis has been on managed care organizations as a means to contain rising medical bills. The American Medical Association (AMA) has recently endorsed managed care as the method of cost containment, citing an inability of medical institutions to voluntarily control them. The "Oregon Plan" of managed resources, developed to provide coverage for those persons who fall between the cracks of health care coverage, is an attempt to allocate fairly those resources that are available.
Managed care, if examined closely, simply becomes another way of shifting health care dollars rather than lowering them. Control of health care dollars, and what they purchase, is shifted to managed care organizations rather than being decided upon by physicians who are in the best position to be making those decisions. The "Oregon Plan", while attempting to control costs and allocate fairly limited funds, does not address the lowering of health care costs. While Managed Care Organizations and health care plans may serve as somewhat of a cost savings to industry, the limited care they provide without preventive measures, will ultimately shift the burden onto the tax payer as the federal government picks up the tab. With such a system, physicians are encouraged to deliver less care, a dilemma that is incompatible with the physicians' Oath of Hippocrates. Many physicians have experienced frustration and a sense of powerless to help their patients when decisions are made by administrators rather than medical personnel directly involved with the patients care.
Insurance premiums have already risen beyond the reach of an increasing number of American families. Higher insurance deductibles and co-payments on existing policies continue to erode the health care dollar. This is evidenced by the estimated 67.5 million Americans who will do without health care insurance this year because they are unable to afford it. This group consists primarily of the elderly and poor, but an increasing number of single parents and middle class Americans have been added. The burden of health care costs then becomes the problem of the federal government as these people will inevitably need medical care at some time in the future.
While emphasis is being put on cost containment and cost shifting, little is said about prevention of disease. Our present medical system has evolved a paradigm which deals with illness after the fact; after it has developed into a problem which must be dealt with. This is largely due to a medical philosophy which views illness as something to be contained or combated rather than prevented.
Managed care does not provide the answer, nor does socialized medicine. Rather, there needs to be a shift in emphasis to treatment of the whole person and not just their disease. What is needed is a shift to preventive measures which have been shown in studies to cut costs and save dollars. It is the reintroduction of clinical nutrition into medical schools along the lines of the naturopathic model and the recommendations of the Surgeon General. It is producing more, not less, family practice, general practice physicians who know how to evaluate and treat the whole person. The emphasis on medical specialties, presently disproportionately high for the populations needs, should be rethought with physicians being encouraged to train as primary care doctors.
What has brought us to our present health care crises has been an emphasis on diagnostic technology rather than treatment of illness and a lack of alternatives from which the medical consumer may choose. A free market medical system, working correctly, with emphasis on prevention, will lower costs rather than increasing them. Allowing the public to choose what type of health care they wish to receive will allow medical systems to be evaluated not on the amount of care they provide but rather on its quality and outcome effectiveness.
Naturopathic and allopathic medical systems are compatible and mutually beneficial for the patient. Emphasizing prevention, use of non toxic medications, periodic screening and team management of illness will go a long way towards lowering health care costs and providing quality medical care.
Dr. Tom Kruzel practices in Portland, Oregon and can be reached at (503) 667-1961