First of all, I admit willingly that I love working through a good policy analysis. I guess that makes me a “wonk.” In my dissertation research, I spent a year reading in organizational theory, specifically in the field of Organizational Ecology. It was intellectual baptism by immersion, but gave me a set of theoretical skills that provide a perspective on how policies are developed out of an organization’s mission.
So with unbridled abandon I’ll jump in the deep end and take on one of the major crises of the 21st Century: Health care.
Here’s the question: What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?
That perhaps is not the question you expected to hear. The national conversation has focused on how much will it cost to provide all Americans with health insurance, how will the spiraling costs of health care be brought under control, will taxes have to be raised to pay for it, what will the roles of the health insurance industry, and the medical industries, and most of all the federal government be? Tough questions all around.
However, these questions are not the right place to start. Not that they aren’t relevant, but just not at the outset. What, then, are the right questions? First, you have to have a clear set of assumptions:
Health care for every American would provide a treatment plan so that :
○ Preventable diseases are prevented
○ Chronic conditions that arise from preventable diseases are prevented
○ Vision, dental, prenatal care, physical and other therapies, chiropractic, etc., will be provided
○ Labor and delivery services for hospital, birthing centers, and home birth will be provided and infants needing medical attention, or neonatal intensive care services, will receive them
○ Acute diseases that cannot be prevented will generate a treatment plan that has a goal of returning the person’s health to its baseline before the disease began
○ Acute diseases not preventable, that create a chronic health condition or disability, will generate a treatment plan with a goal of sustaining the person’s health as close to the baseline function as possible, and provide the needed rehabilitation and social services to optimize the individual’s quality of life
○ Chronic medical conditions will generate a treatment plan that optimizes the individual’s quality of life. Progression of the condition (e.g. diabetes) will be treated across the life span to preserve the individual’s quality of life and functionality as much as possible
○ Genetically based diseases (e.g. cystic fibrosis, MS) and conditions (e.g. Down’s syndrome, birth defects) will generate a treatment plan that provides corrective treatments when possible, and gives the individual the best quality of life across the person’s life span
○ Psychiatric and behavioral health disorders will have open access to care and will generate a treatment plan that balances medication regimens with the person’s autonomy, is based on a viable community support programs, and provides in-patient treatment and care on the same level as all chronic medical conditions
○ Addiction disorders will generate a treatment plan that balances in-patient and out-patient services, viable community support, quality family support, as well as a vigorous public health program to actually reduce addictions, and the involvement of the various producers such as alcohol, drugs, casino companies, sex, live and internet, to reduce the number of individuals addicted to their products. Recovery treatment programs would be available to all individuals
○ Street drug addiction disorders would receive the same level of care as the other addictive disorders but might add an element of more intensive diversion programs because of the multiple health problems drug abusers create by their high risk behavior
○ Simple injuries (not life-threatening or needing rehabilitation) will be treated with follow up to enhance rapid recovery and healing as appropriate
○ Complex injuries that need rehabilitation, and might prevent the person from working will generate a treatment plan that is directed toward recovering as much of the person’s functionality as possible and provide the needed therapies and rehabilitation for that recovery
○ Traumatic injuries (life-threatening, and/or life changing) will generate a treatment plan including intensive care services and is directed toward recovering as much of the person’s functionality as possible and provide the needed therapies and rehabilitation for that recovery
○ Cancer treatment will be provided and the treatment plan will, as appropriate, involve assessing the person’s wishes for treatment at the time of diagnosis with one’s family, physician or other medical provider, and appropriate social work and RN care management and spiritual care.
○ All end-stage diseases (e.g., cancer, cardiac, pulmonary, liver, kidneys, brain and neurological, etc.), will assess the person’s wishes to continue treatment when the disease has been diagnosed as terminal and less than six months to live, with the person’s family, medical provider, clergy/chaplain, social worker and care manager. Resuscitation status (code status) and advance directives for life sustaining treatment wishes will be in place by this time.
○ For the dying, at any age and from any condition, palliative care to keep the individual comfortable with appropriate medications, therapies (both standard and holistic), spiritual care, along with hospice, for at home, in a hospice house, or in a hospital will be provided.
This list, though long, was not meant to be comprehensive, but to give you a sense of the many different types of diseases and conditions people experience every day–Every day! As well, everything on this list is being done now. This is the normal stuff.
If you found yourself thinking, “Yeah, but how is he going to pay for all of this?” you’re still operating out of the conventional paradigm. The current paradigm is not working and the health of Americans is eroding, placing us in grave danger from a number of perspectives!
You ponder this for a few days, and I’ll be back to post Part 2. Oh, and notice the emphasis on treatment plans. That’s important!