Article Review on "Schlesinger Describes Four Main Themes"

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e. staff) and the health of individuals surrounding the individual. Health should be a popular 'people's movement'. Instead of health care being nested in bureaucratic and financial institutions, it should be nested in larger beneficial social groups with health care coming to the people, instead of the people seeking it, and with all (including hospital environment) designed around he needs of the patient rather than around the concerns of profit-making.

Innovation, originality, creativity, and motivation of medical institutions is stumped by the insipidity and control of the moneyed class and 'traditional' way of doing things (i.e. The classical, conservative system of disease management) instead of creating and supporting a network of original and patient-centered health care systems and alternatives to market-driven care.

The entry point will be by introducing bi-directional designing where health care providers work in sync with clients to change and shape the system and where the system, in turn, protects the relationship. Health care providers are involved in designing their practice and the system helps them to do so.

At the moment, and here Parenti quotes an excerpt from medical history (Robert Kuttner), powerful corporations control the medical profession leading to inflation and crucial medical care being out of the grasp of the less privileged. In fact, both Medicare and Medicaid came about despite the protests of the AMA that was "implacably opposed to the whole idea."

It is a small group of people who hold power in the system and all attempts to reform to provide all Americans with medical care will fail until the frame of this system has shifted from being controlled by the moneyed few to being supervised by those who should most eminently supervise it: qualified medical personnel.

Results -- and points to debate -- will be the following:

1. It is inappropriate for market capitalism to control health care, particularly since health care is an experiential good. Cutting costs and corners in health care results in cutting costs in the quality of the much-needed service itself.

2. Heath care need not be costly. These are simply frames that divert the public and that business people have placed there for their manipulation.

3. Corporation's expression of 'cutting costs in healthcare' should be treated skeptically. Cutting costs means lowering overhead in order to keep margin profits attractive to investment capital. It does not mean lowering the costs of health care so that they are available to all.

4. Health care is labeled as a "disease management system." This makes it appear cold and heartless instead of the "friend" that it should be. Disease management too is not the optimum template of care that we should naturally expect from a healthcare system. The frame should be modified here, too.

5. We can work with business people in changing the system. But beware: business people are, ultimately, opponents interested in profit rather than care. Health care systems are not Structural Adjustment programs that focus on being attractive to long distance investment capital. Rather, they should be focused on medical care.

The system should be changed in a fundamental way and this involves revising our frames from healthcare being a business-oriented scheme to it focusing around the patient. Existing players -- entrenched industries in coalition with government -- will protest, but Parenti insists that we withstand their protests and transfer health care to its rightful owners: the medical profession.

Parenti has a point: America'sEmergency Medical Treatment and Active Labor Act (EMTALA) compels emergency stabilization of an emergency health crisis, but hospitals can still pursue debtors for cost of the treatment provided, and the bill does not absolve the debtor from paying. More so, to reduce some of the pressure on uninsured U.S. citizens, several U.S. clinics provide free or low-cost non-emergency care to poor patients but these clinics are often under-staffed, poorly run, and provide insufficient care. In comparison to Canada, research indicates that U.S. residents are one-third less likely than residents of Canada to have a regular medical doctor, one fourth more likely to have unmet health needs, and more than two times unlikely to forgo needed medication (PMID, 2006).

The U.S. is the only wealthy developed country in the world that lacks some form of universal health care (i.e. providing universal coverage for all members of society, combining tools for health financing and service provision). Direct funding of health care is limited to Medicare, Medicaid, and the State Children's Health Insurance Program (SCNHIP) that covers (in a half-hearted and very poor manner) the very poor, eligible senior citizens, disabled individuals, and children. The Veterans Administration also provides care to veterans, their families, and survivors. Approximately, 25% more of such individuals are eligible, according to one study, for these programs but remain unenrolled. Covering all who are eligible remains a political and fiscal argument and challenge. Everyone else must pay for their insurance privately and, as of 2008, 59% had their health insurance covered by employers.

The Health Maintenance Organization Act of 1973 provided grants and loans to encourage and fund Health Maintenance Organizations (HMO); but by 2002, there were only 500 such plans enrolling 76 million people (National Center for Health Statistics, 2002). In 2010, America passed a bill calling for regulatory reform of the system, but since the legislation was not fundamental health care reform (only pertaining to a part of it), and since the new legislation is to be implemented in stages with the last stage actualized in 2018 and opponents opposing it every which stage, it will take several years, if at all, for its effect to be accomplished.

All in all, health care is a commercialized system and detracts attention from those who need it. It fails to provide all with sufficient care due to some being less privileged than others. Nonetheless, at the end of the day, health care is a business with doctors needing to be paid, as all of us are. Technology and services cost money and someone has to pay to maintain them. The profession itself is therefore, divided into two general categories: the service and the cost for that service. Paying doctors will also motivate them to work better. Parenti's ideas are utopian and ideal. They can work best in an ideal world. But ours is not. Someone has to pay for the medical service, and, as Goldhill showed, the national expense is orbiting out of control.

References

Brooking Institute (2008) "Meeting the Dilemma of Health Care Access" (PDF). Opportunity 08: A Project of the Brookings Institution. Retrieved on 11/26/2011

http://www.opportunity08.org/Files/FD.ashx?guid=98a417e5-5972-4031-b361-e11e00981f55

Consumer Affairs. Com. (2007). Study Finds 24% of Americans Underinsured Retrieved on 11/26/2011

http://www.consumeraffairs.com/news04/2007/08/cu_insurance.html

Goldhill, David, How American Health Care Killed My Father http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/?single_page=true

National Center for Health Statistics, (2002). "Health Care Expenditures in the U.S.A.".. Medical News Today. Retrieved on 11/26/2011

http://www.medicalnewstoday.com/articles/6225.php

OECD Health Data (2008) How Does Canada Compare (PDF). Retrieved on 11/26/2011

http://www.oecd.org/dataoecd/46/33/38979719.pdf.

Parenti, Susan, Re-Designing the U.S. Health Care System: Think Universally, Design Locally http://www.patchadams.org/re-designing_US_health_care_system

PMID (2006) "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey." American Journal of Public Health, 96 Retrieved on11/26/2011

http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf

Schlesinger, M. (2004) Reprivatizing the Public Household? Journal of Health Politics, Policy and Law, Vol. 29, Nos. 4 -- 5 READ MORE

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