Thursday, October 23, 2008

Health Care Without the Lipstick.

Another MeanMesa Lipstick Commentary! This time HealthCare!63

A little history.

As Americans, our intuitive, aggregate concept of “health care” has become, gradually, and perhaps, unavoidably, more and more complicated, more and more unexamined and more and more incomprehensible as it slowly transformed itself to present a new, modern phenomenal definition. Things have been “added” to it.

Entrepreneurial opportunities have been identified, encouraged, injected and groomed in ways which inevitably transformed it by indulgences easily betrayed by modest semantics. Masterful commercial psychology has successfully contaminated both our interest and our expectations in ways that have converted an older, more rational approach to a modern frenzy of insistence, liability and other barely manageable (again, codependent) demands.

Fifty years ago the United States was enjoying the tangible benefits of being a culture which was not burdened with resurrecting itself from recent military destruction. The proletariat economy was literally awash with good paying jobs and a highly visible population, consequently, endowed with remarkable -- at least by global comparisons -- discretionary wealth. Lingering atop this frothy “three tiered wedding cake” was the fairly widely accepted proposition that the system at play here was “the very best in the world” with respect to all sorts of things.

What kinds of things? To name only a few, our new hegemonic military; our ICBM’s, our industrial productivity, the Constitutionally guaranteed rights of our citizens, the proclaimed freedom of religion and the arguably hypnotic luxury of a vast, barbecue pit, martini drenched social extravagance. Naturally, human beings lived a bit longer in such a place. Overlooking clean water, fresh air, plenty of food and even “pretty good shoes,” we quite comfortably attributed that good fortune to our health care. Why not? It was, after all, “the best in the world.”

Doctors here had entered a developmental phase predicated on the idea that going to school longer meant earning more afterward. Hard classes, harder cash. What had previously been best described as a comfortable livelihood was reinventing itself into an economic opportunity able to compete with a new populist conception of the old robber barons.

The religionists had done very well promoting their famous “death fear,” that is, the proposition that one, by willingly servicing religion’s economic avarice in life, might have an edge at the Gates of Judgment. The militarists franchised a bit for themselves as they maximized the contemporary (and well remembered) advantages of war’s horror to extract resources dedicated to Eisenhower’s “military industrial complex.”

Interestingly, the doctors were able to also promote their own, small franchise enabled by the same happy neurosis.

“Death fear.” Our interest in controlling as much of this inevitable calamity as possible began to direct our entire economy and our cultural psychology. The religionists promised intercessionary comfort from the hands of the blindly retributive divinity. The militarists promised protection from premature death resulting from violent military aggression here before more acceptable forms of demise. The doctors promised defense from the risk of premature death resulting from preventable or remedial assault by bacteria, viruses and traditional homo sapien system failures.

Health care was slowly redefined from its original purpose. What had once been the hope of “curing what ailed me” became a promise to “live longer.” Although this change was an undetectable subtlety in any specific visit to the family’s physician, the big picture of medicine was becoming enthralled with the prospect of being able to make much greater promises and, as a result, engorge ever larger amounts of the cultural resources. This was the first new addition.

Likewise, our penchant for controlled results subcontracted a growing part of the promises of the doctors’ new found franchise to the compensatory notion of paying for failed promises. Malpractice, although hardly a medical treatment, injected itself into the already heady brew of unrealistic expectations and codependent demands for controlled outcomes. Previously, the successful treatment of some malady was accepted as a happy serendipity. Aside from outright malfeasance, with this next, new addition, medical success could finally embrace the psychotic notion that recovery was the only “fair” outcome of treatment, moving anything less to a status not dissimilar from “breach of contract.”

A third addition was the new idea of directing research toward the most marketable styles of medical problems. There is no way to speculate if the development of Viagra retarded discovering the cure for skin cancer as it diverted research cash, but Viagra is by no means the only distracted target and skin cancer is, equally, by no means the only possibly neglected, alternate break through.

The social culture had delivered all sorts of drugs and treatment regimes to the doctors as it slowly moved away from the heroin and cocaine saturated elixirs of the early 20th century. Once it became clear that a certain treatment advantage might be gained from a more educated dispensing of, say, antibiotics the die was cast. Another addition. Immediately attached to that treatment advantage came a franchised, statutory and dependable addition to direct income. Big. Direct.

In Tijuana or Juarez anyone with enough pesos can simply purchase antibiotics from a pharmacist. The right pharmacists might even offer a suggestion as to selecting the right one. The statutory self-preservation aspects of the doctor franchise will probably prevent you from legally bringing them back to the United States. Antibiotic outcomes are better here with the statutory insistence that they be dispensed by a medical doctor and blanketed by the liability promises made possible by our appetite for compensated malpractice. Those outcomes falter a bit when they include the outcomes of those who must simply suffer without any unaffordable care.

Perhaps the next addition is the idea that, although prescribing medicine is still left under a doctor’s discretion, commercial advertisements can openly seek to direct a potential patient’s interest toward certain pharmaceuticals. The proposition is that this possible, future patient may not know what to tell his doctor so as to initiate this line of necessary, successful and profitable treatment. The infomercials solve that.

Also added are certain psychological presumptions. Departing briefly from the death fear, the capitalists have managed to successfully suggest to doctors (and insurance companies, and pharmaceutical companies) that any diversion from the current system would inevitably curtail what are presently claimed as reasonable, capitalistic profits. The countering view is that these reasonable, capitalistic profits are actually another one of our famous capitalistic “bubbles,” that is, reasonable, capitalistic profits probably not that reasonable after all. This addition survives on innuendo, but it survives.

Another almost subconscious addition has found its way into the mix. It seems that these highly ethical doctors have a habit of “milking” treatment costs in certain situations. In many cases, this has successfully been blamed on the patients. It turns out that extremely low income and minority patients simply don’t know how to consume health care as cost effectively as more well-to-do sick folks. The concept is not too hard to swallow. If these ne’er do wells were smarter, they would find themselves in the more prosperous category.

The obvious conclusion is that health care for these “lower class” patients is far more likely to be unreasonably expensive. The unreasonably expensive idea arises from several origins. The first is, simply, that the more prosperous are paying for it. From that point of view, any treatment at all may as well be unreasonably expensive. We see that brutally manifested in modern political dogma. It has never been easier to “jerk the knee” of an illiterate neocon with even the most innocent mention of an alternate medical economy.

Another important side effect which must be avoided in that argument is the possibility that less than ethical doctors are encouraged to haul their medical franchises to these, well, less desirable neighborhoods where special opportunities for excessively profitable treatment seem to abound. The down side possibility of this neo-conservative, self-fulfilling prophecy is lubricated by maximum resource extraction until the happy day when that dire prediction becomes fact. Poor people love to consume unnecessary medical care when rich people are forced to pay for it. Unethical, lower class doctors love to bill this into existence so long as they are held harmless from criticism, prosecution or Medicare review. This concept has definitely been added to the mix.

Finally, we arrive at the elephant in the living room. Again. Except in this case, the elephant is better cast as a six hundred pound hog. A hungry one. Not directly attaching Sara Palin to the argument, the lipstick issue rises up front and center. This, of course, is the matter of medical outcomes. The question of medical outcomes, inevitably joined at the hip to the question of medical costs, immediately casts its shadow on the question of medical profits and the comparative value of alternative medical economies, not neglecting the strange taint of medical economic ideology. All the feathers swirling around this headless chicken fly right in the face of the “best in the world” axiom describing our health care.

U.S. health care outcomes suck compared to those of comparably prosperous other countries. U.S. health care costs also suck when compared to the same alternative programs. Pay more. Get less.

It isn’t glorious, expensive new inventions that justify our health care costs. Nor waste. Nor welfare fraud. Nor chiropractors. Nor herbalists, accupuncturists or midwives.

It’s profit. You know, profit like the profit buried in the pharmaceutical bill that was authored by the pharmaceutical lobbyists and passed by the, well, pharmaceutical congress at 3 o’clock in the morning.

"Lawzee! Peddlin' these pills turns a better profit than sellin' whores in a lumbercamp!"

At this juncture, our cultural rip current of Marxist paranoia instantly enters the fray at full power. Who, exactly, is getting all this money? Who, exactly, is convincing us that our meager medical outcomes are actually the “best in the world?” What voice keeps telling us that, if we think a social medicine system is so great, to simply visit Canada? Canada, where everyone hates the national health care? Canada, where hordes of sick people flood into the U.S. every day, trying desperately to save their lives? Canada, where pharmaceuticals exploit the huge, honest investments we make here making their socialized price there attractive enough for elderly Americans to ride buses across the United States for a chance to buy them? With uninsured cash? Please.

If not Canada, then Europe. England. South Korea. Japan.

If the elephant in the living room is hard to ignore, discover the pig. Aside from being huge, it also stinks. Hogs also have a famous insistence on eating everything that isn’t bolted down, and this one is no exception.

Quick! Apply the lipstick! The good old “best in the world” lipstick.

Had enough? Remember this medical-pharmaceutical-insurance monopoly franchise on November 4th. Vote.

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