You probably heard about “healthcare reform” during the last few elections, and you may even remember buzz words being thrown around like “Obamacare, Affordable Care Act, insurance premiums, drug prices, insurance mandate” … the list goes on and on.
To anyone who has not been a chronic disease patient, a caretaker of one, or has worked in the healthcare system, it’s a confusing mess you hope to never really have to deal with or understand. If you do understand it and have had to deal with it, it’s even more complex and confusing.
Based on my personal experiences as a lyme disease and then amenorrhea patient, caretaker for my mother when she battled schizoaffective disorder for five years in the mental healthcare system, and then from the several years I spent working with hospitals after I lost my mom, I’m going to explain to you the three major reasons why I believe the healthcare system is so broken, and they’re probably not the reasons you’ve heard about.
3 Reasons Our Healthcare System Is Broken
1. Root cause
I could write a whole book on the history of how our current healthcare system has developed since the 1940s, but I’ll keep it brief and say it is the best in the world at treating acute, emergency situations.
Run over by a car? Ski accident? Got a stomach bug traveling in India? You bet you want the full power of the American healthcare system to save your life.
And this power — to save your life from things like polio, influenza, cholera, freak accidents – is how our whole system of medicine developed over the past century. And it has done that, really well.
But what it hasn’t done well, and didn’t take into account back in the day, is that with chronic health issues, without getting to the “why” or the root cause of say eczema, or constipation, or migraines, you’re just papering over or masking symptoms.
When you do that, sure you might reduce or even eliminate that symptom temporarily, but you are also likely causing harm by not figuring out why it’s happening (it is going to get worse), or by using steroids to suppress your immune system or by introducing drugs or surgeries with side effects, which can introduce a whole host of other health issues.
I’ve heard it described as a game of “Wack-a-mole” where you treat one symptom, and then your body pops up with another like “hey, I need help in here! I tried to tell you last week with that rash but you ignored it so here I am again with this stomach pain!”
The conventional approach to chronic health issues creates a tremendous amount of treatments, wasted money and time and at the end of it, hasn’t gotten your body back to a state where it has healed itself and can operate without some sort of crutch, like a drug, indefinitely.
2. Fee for sickness, not fee for health
You’ve probably noticed that your doctor, hospitals, labs, pretty much the whole system only gets paid when you get sick. If you stay healthy, they make a lot less money. The more treatments they do or drugs they prescribe, the more they make.
People respond to incentives, it’s human nature, we all do! Our healthcare system gives every incentive to keep treating symptoms instead of digging into root causes and enabling the body to heal itself because simply … if they did, the payments would end there.
When I worked with hospitals, there were a few programs in Medicaid (health insurance for poor people) and Medicare (health insurance for senior citizens) that attempted to incentivize hospitals and health systems to focus on health outcomes — i.e. if you can keep this person with heart failure out of the hospitals and theoretically getting better at home, we’ll give you some extra cash.
I noticed some of these programs did begin to change a few things, but the plan was mostly still “fill your medications” and “have a follow-up appointment” rather than “why did you have a heart attack? Let’s work on your diet and lifestyle to ensure you don’t have another one.”
The future of these programs is unclear due to the uncertainty of the Affordable Care Act, i.e. Obamacare, but hopefully the concept of rewarding doctors and hospitals for keeping patients healthy and getting them fully better after a health scare vs. for doing endless treatments sticks around.
3. Insurance and health freedom
Most of us have some kind of health insurance and I’m sure you’re pretty familiar with the idea of “in-network” doctors vs. “out-of-network” and the things that are “covered” vs. not. Insurance companies (or the government if you have Medicaid or Medicare) outline exactly which kinds of treatments we can get for which things, and which kinds of doctors we can see.
This system has created a situation where, if you’d like to try acupuncture to treat back pain, or a Chinese herbalist to treat a gut issue, or a new, experimental treatment for depression and you don’t have piles of cash laying around, you can’t because your insurance won’t pay for it.
Why? The whole system of paying or reimbursing the patient or a hospital for healthcare is based on disease codes so most insurance companies say “NOPE” to covering things that may be more preventative like acupuncture or chiropractic care for moderate back pain if you hope to keep it from becoming a full blown injury or require pain medications or surgery later. Without a disease code, the claim can’t even be processed.
If you are trying to prevent disease, well, for the most part, you can’t use the money you put into health insurance for that! Despite overwhelming evidence that the following things are proven to be medicinal, organic food, acupuncture, a yoga class package or supplements all would not be covered.
What this means is there is a lack of “health freedom” for people who don’t have money to spend on their health out of pocket. And sadly those are the people who are usually the sickest.
Adrienne Nolan-Smith is a board certified patient advocate, speaker and the founder of WellBe, a media company and lifestyle brand focused on bridging the large gap between the healthcare system and the wellness movement to help people prevent and reverse chronic health issues naturally. She received her BA from Johns Hopkins University and her MBA from the Kellogg School at Northwestern University. She lives with her husband in New York City. You can follow her for daily inspiration and information @getwellbe
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