An American reality: Treating the whole person in a broken health care system

“I’d rather get shot again than come off that medication,” a young soldier explains, after years of prescription drug misuse to treat his anxiety, depression and PTSD from his tour in Afghanistan. He explains that he now uses meditation and talk therapy as a way to work through his nightmares about losing two-thirds of his troop in battle.

A primary care physician describes her mixed feelings of leaving the clinic she has called home for many years. The fee-for-service payment model the clinic uses – the standard approach for most health care systems in the United States, rewards how many patients are seen and how many procedures are carried out, not human conversations to help with behavioral changes. Her overwhelmed patient asks for prescription medication during an appointment to help with the uncontrolled feelings she is experiencing. The physician wishes to address the blatant underlying issue, but she frustratingly does not have time and must continue her rounds. The patient later revisits the clinic after cutting herself.

The documentary, “Escape Fire,” follows several patients, physicians and even a corporate manager on their unique journeys through the health care system. However, there are common themes: The health care system in the United States is broken, it is based on the number of patients seen rather than actual outcomes, healthy patients are waiting until they are sick to be treated, and health care providers – some of the most humanitarian, intelligent people in this world – have their hands tied.

At the root of conversation, at the foundation and its core, is the truth that health is everything, for everyone.

Life is not enjoyable without health. Most would argue that health is a fundamental need. It is basic, just as safety, food, water, warmth and rest. Yet, in the United States, the health care system has not adequately established an objective of equitability. It is health care for some, influenced by socioeconomic factors, and maybe at life’s end. In addition, we have a culture of unhealthy behavior.

More than a dozen different proposals for national health insurance have been submitted in Congress, and most often, the ultimate cost falls on families and individuals. Aside from how people pay for care and how these taxes are administered, is the other question of how providers are paid. The traditional system of fee-for-service has been challenged under the medical foundation system, as physicians can potentially receive a salary from an organization. Take Cleveland Clinic, for example, a thriving health care system that pays physicians a salary as to not steer them away from complex, behavioral – or “whole person” – cases. This salary ensures that medical decisions about the patient are for the patient. When the price is reasonable and salary is taken off the table, there is an element of being highly regarded among colleagues, finding solutions for the patient and being the best steward of health that incentivize physicians to perform quality care. In short, physicians can spend more time with a patient. Conversations surrounding universal health coverage, including who pays for it and how physicians are paid, illustrate that many believe that health is for everyone.

Aside from an inclusive approach, primary care helps ensure a patient is cared for on a continuum, and in many ways, it helps control the cost of care through preventative measures. Moderating hospital costs can be accomplished through eliminating unnecessary admissions and reducing long stays which can be directed both by the physician, and through an emphasis on maintaining health when patients are healthy. In fact, it is important to note that physicians play a role that spans much deeper than simply reducing mortality and morbidity – they serve a function of caring, sympathizing with patients and validating their health.

Treating the whole person starts with primary care. The rational mind would assume that the most effective way to treat a patient is to start at the beginning of the funnel, before they get in too deep.

It should also be noted that treating the whole patient does not start and end with health care. As individuals, we have a lot more power over our own health than we tend to accept. The notion of having the “right to health” can be misleading as it suggests that health care is not a scarce resource. Conversely, the reason economics is so tightly linked to conversation is its scarcity. Nevertheless, despite elements like access, there is always the factor of choice and alternatives. Even if access were improved for all, would health outcomes for the impoverished, for example, be improved? Health status is dependent on many things, like genetics, environment and lifestyle.

Indeed, physiological processes, socioeconomic influences and even fetal programming affect health. This suggests that there are behavioral changes that need to occur for health care reform to be successful. Not only does the broken health care system need to be fixed, but perhaps there should be more emphasis on education, diet and other preventative measures that would ultimately assist in controlling spending and caring for the entirety of an individual.

Treating the whole person in a broken health care system is a daunting task for health care providers. Reform starts with universal insurance coverage and a focus on primary and preventative care. However, there is more to the story. Individuals are responsible for their own health. When there is this notion of accountability, and effort to make healthy choices, the whole person wins.

References

Fuchs, V. R. (2011). Who shall live? Health, economics, and social choice (2nd expanded ed.) World Scientific Publishing Co. Pte. Ltd.

Heineman, M. & Froemke, S. (Directors). (2012). Escape fire: The fight to rescue American healthcare. https://tubitv.com/movies/300834/escape-fire-the-fight-to-rescue-american-healthcare

Smith, J. P. (1999). Health bodies and thick wallets: The dual reaction between health and economic status. Journal of Economic Perspectives, 13(2), 145-166. file:///C:/Users/lnolan/AppData/Local/Temp/Healthy_Bodies_and_Thick_Wallets_article.pdf