NATIONAL HEALTH CARE REFORM
The Hidden History
The Hidden Costs
A talk by
Peter Barry Chowka presented at the Ninth Annual Convention
of the
American
Association of Naturopathic Physicians (AANP), San Diego, CA, September 10, 1994
© 1994 by peter barry chowka
All rights reserved.
It was almost exactly one year ago that President Bill Clinton went
up to Capitol Hill in prime television viewing time and addressed
a joint session of Congress and the nation about his proposals
for national health care reform. This process had begun in 1992,
when Clinton used the health care issue to help get himself
elected. It was actually Clinton's political handlers who came
up with this strategy. In 1991, these consultants handled the Pennsylvania
Senate campaign of Democrat Harris Wofford. In that race, Wofford
surprised almost everyone by beating George Bush's Attorney General Dick
Thornburgh. The issue that supposedly tipped the balance was
health care reform, and Wofford's advocacy of guaranteed national
health care for all.
In 1992 Clinton turned to James Carville, the savvy political operative
who had run Wofford's campaign. And virtually overnight, the whole issue of
a "health care crisis" and the supposed need for major reform
(as defined by the politicians and their hired guns) was up
and running.
This little bit of recent history suggests what is really at
stake here, and also what my theme is in this presentation:
That from the start, national health care reform was very
little about true health care reform but very much about
political strategy...about the need to amass short-term power,
maintain that power, and get re-elected in 1996. It's also
possible to see the push for mandatory federalized health care
as a grab for longer-term power and control; but more on that
a little later.
Paul Weaver has written a fascinating new book, The Culture
of Lying: How the News Media Really Works. Weaver's thesis
is that virtually all of our public discourse is misrepresented
or fabricated -- it is little more than outright lies that serve
the interests of both the politicians and the top national media.
An example of this synergy is that, for virtually anything in
the realm of public affairs to be reported on or taken seriously,
it has to achieve the level of a perceived crisis. This is particularly
obvious in foreign affairs, where we pay little attention to
the rest of the world until there are crises in places like
Somalia, Haiti, Cuba, Bosnia, and so on.
Domestically, things work much the same way. Therefore, real problems
with the health care delivery system in this country -- which
as an investigative journalist I have been reporting on for
two decades, and which form the basis, or the raison d'etre, for
the success of nontoxic healing and naturopathic medicine --
these problems went largely unreported by the big media until an
obscure Southern
politician and his wife -- Bill & Hillary Clinton -- came along
and cried "crisis." But the limited mainstream analysis that
arises, on this and most other issues, has little to do with
reality, and more to do with spin doctoring and smoke and
mirrors.
I recently came across a white paper dated September 4, 1992. It's
written by Paul Bergner [at the time the publisher of the Naturopathic
Physician] and Dr. Konrad Kail,
[past president of the AANP and a current member of the AANP board of directors]. It's
titled The U.S. Health Care Costs Crisis: A Crisis of Chronic
Disease. In its 11 pages I found more clarity, insight,
understanding -- and more potential for real reform -- than in the 1,340-
odd page Clinton health reform legislation or in most of the
other rhetoric that has been flying during the past year.
The Bergner-Kail paper says -- and I've been saying much the
same thing myself for many years -- that America's health care
crisis is more than an economic crisis: it is a crisis of chronic
disease, and of the failure of our medical establishment to
prevent and treat chronic disease successfully. It is a crisis
in the kind of medicine we have or are allowed to have -- not
just who's paying for it. The promise for true reform, then,
is to be found in reality-based solutions to problems caused
by the lack of prevention and the lack of successful
treatments. This opens the door wide to approaches like
naturopathic medicine, which is all about true prevention and
getting to the root causes of chronic, disabling, expensive
disease.
To repeat: The national health care reform plans that have been
pushed this year, especially the Clintons' plan, do not address
the core and substance of the problem -- which is, the failure
of conventional medicine to successfully prevent and treat most
illnesses.
Orthodox medicine is useful in dealing with
things like emergencies and trauma, and in performing high tech surgeries. But in terms of the increasing incidence
and death rates from cancer, AIDS, diabetes, and Alzheimers
and the persistence of heart disease, stroke, and hypertension
as the leading causes of death and disability...conventional
medicine is not doing well at all. As John Knowles, MD wrote almost
two decades ago, American Medicine is about "doing better and
feeling worse!"
Our society's organized efforts against and standard ways of
treating most chronic diseases have become Medical Vietnams
-- a series of no-win strategies and wars based on a flawed
premise and a kind of permanent war economy. The premise, like
in Vietnam, is that you can search out and destroy disease,
using toxic, even deadly, weapons. This philosophy denies how
the body actually works and how it truly can be healed, or how it can
be encouraged to heal itself. Think back to Vietnam and the unsuccessful, even insane, policy:
"Let's destroy this village in order to try to save it."
Similarly, the conventional medical model often says "Let's
destroy this body in order to try to save it."
The medical-industrial complex that has grown up around this
mindset is consistently profitable to the medical war-makers
-- in this case, the drug companies, for-profit hospitals and
chains, HMOs, government agencies, university academic research
centers, disease "charities", highly paid doctors and
specialists, and so on. As we know, this medical-industrial
complex is now costing us $1 trillion a year. It's become the
biggest business in North America.
In fact, the U.S. medical system represents the greatest
concentration of wealth and power in the history of the world.
But like all establishments, its first need is to perpetuate
itself, and not necessarily to find solutions. New ideas and
solutions tend to be overlooked and suppressed.
The statistics unfortunately prove that the $1 trillion a year
we're spending on conventional medical care is not linked with improved health. Much of the money, if not
most of it, is probably wasted. Recently, in fact, orthodox
medicine has given us a whole new category of illness --
iatrogenesis -- doctor-caused injury or death. It is an
underdiagnosed epidemic. Examples include silicone breast
implants, halcion, cancer chemotherapy drugs (which studies
show help no more than 5 percent of patients who receive them, although
that hasn't stopped chemotherapy from becoming a multi-billion-dollar industry in itself).
Continuing
the litany we have AZT (which the latest studies show to be
largely useless); 70,000 hospitalizations and 7,000
deaths every year from non-steroidal anti-inflammatory drugs
for arthritis; 60,000 deaths from unnecessary
surgeries...and on and on and on.
This little bit of history, which i know many of you have
considered or confronted in your own educational or clinical
careers, is important here -- because it is the designers of this system -- this medical-industrial complex -- who played
key roles in designing the Clinton plan and most of the other
so-called health care reform plans. We're talking here about
the pharmaceutical industry, the hospital association, leading HMOs
and managed care organizations, and the top insurance companies.
These forces represent the ideological and financial wellsprings
of national health care "reform." All of these players have
historically been opponents of natural healing, innovative
nontoxic medicine, pluralism, freedom, and alternatives.
I've been reporting, analyzing, writing, and speaking about the push for
national health care reform for the past two years. A recent article I
wrote on the topic, National Health Care Reform and Alternative Medicine:
Never the Twain Shall Meet!, goes into considerable detail. A
few quotes and citations will suffice here.
A highly-credentialed
New York City MD -- a respected leader in the field of innovative
cancer
therapies -- told me recently that national health care
reform "could be the end of alternative medicine." Interestingly,
this same MD recalled during our interview that he knew Ira
Magaziner, a key
strategist of the Clinton plan, when both of them were
undergraduates at Brown University in the 1960s. Magaziner "knows nothing about health
care -- his degree was in political science," my source reported.
Recently, i saw a quote from another aquaintance of Magaziner's, at the other end of the ideological
spectrum -- Rep. Jim McDermott, the Washington state Democrat
who supports a single payer national plan. McDermott also said
that Magaziner knows nothing about health care; and that his
arrogance and insensitivity helped to doom the Clinton plan.
I question the premise that we can ever turn to the federal
government for relief in this area. The federal government's
increasing role in health care throughout this century has
contributed to the current crisis situation. The government
has unfairly supported conventional allopathic medicine and
has helped to reshape the whole context and practice of healing,
away from centuries-old traditions to reductionist, mechanistic,
pharmaceutically-driven, high-tech allopathy. Out went attention to the
whole person -- his or her lifestyle, mindset, use of nutrition,
herbs, homeopathy. In came drugs, surgery, radiation, bone marrow
transplants and the like. The federal government helped to
encourage all of this by making loans to hospitals and academic
institutions, by its myopic research policy, by encouraging
and paying for toxic drug development, by declaring "wars" on
diseases, and by collusion or conspiracies with other
conventional forces.
Recently, added to the mix have been a series of repugnant
developments at the hands of federal agencies including,
in the words of Seattle's largest newspaper [The Seattle Post-Intelligencer], the FDA's 1992 "gestapo-style" raid on the office of Washington state holistic
clinician Jonathan Wright, MD.
In national health care "reform" we have an
attempt to bail out orthodox medicine and raise it to a new
level: one endorsed, mandated, paid for, and largely controlled
by the federal government. Left to its own devices, orthodox medicine has largely bankrupted itself. But now, we're being told
that we all have to chip in -- whether we want to or not -- to prop
up this crumbling edifice. So-called reform is really about redistributing costs,
or cost-shifting.
Consider it in this way...It's simple arithmetic: Orthodox
medicine costs $1 trillion/year. There are 250 million Americans,
which works out to roughly $4,000 per capita.
If each of us is taxed at $4,000 annually, consider how that will
cut into what we can afford out-of-pocket for prevention,
nutritional supplements, natural primary care, and other things
that a national plan will be unlikely to cover. Consider, as well, how much
high quality natural, primary care and prevention
you, as a naturopathic clinician, could offer a person for $4,000 a year!
To this point, it hasn't exactly been a level playing field
of free market competition between conventional and nontoxic
medicine. Still, millions of Americans -- about 85 million if
David Eisenberg, MD and his colleagues at Harvard University are correct --
85 million Americans choose natural alternatives. Nobody is
putting a gun to our heads, or mandating such expenditures.
We choose these options because they work and because they are
cost effective.
True reform, then, would involve more so-called "alternative"
medicine. True reform would entail true prevention -- not simply
mammograms or pap smears or compulsory immunizations, which
is how the Clinton plan defines "prevention." True prevention
means lifestyle modification -- diet, exercise, nutritional
supplements, herbs -- taking responsibiity for oneself...and
cleaning up the environment, which is a point that the theme
of this convention suggests.
I have to believe that if Americans are given information and
options, they will usually make appropriate and sound decisions.
Meanwhile, if the government is doing the deciding...well, just look at the track
record! Look at the disappointing performance of the NIH'S Office
of Alternative Medicine, which has been underwhelming. Remember
something called "special interests?" In case you haven't
noticed, they run Washington. Numerous studies have shown that
third party reimbursement (which would be the case in a
government health care plan) can never be cost-effective. There is simply
no incentive to control costs or for people to take personal
responsibility. Everyone would pay basically the same amount for health care, whether
they take personal responsibility or not. Such policies in the
past, as with Medicare, have led to wasteful and ineffective high-tech health care
environments and over-specialization with virtually no overall improvement
in the nation's health.
Under the current, limited free-market system, though, things are
changing, in many ways for the better. True clinical alternatives
are continuing to flourish. Even some insurance companies are
seeing the benefits of clinical alternatives and are funding
them. The Wellness Plan offered by American Western Life, for
example, covers things like naturopathic medicine, and has found
this strategy to be extremely cost-effective. Indeed, the answers
lie in true competition and in helping to ensure a more level
playing field: removing unfair barriers, stopping the suppression of clinical
alternatives, and ending restraints of trade.
For people who want
medical insurance, portability could be guaranteed, as well as ending
discrimination by insurance companies on account of pre-existing conditions.
Basic catastropic coverage could be provided for an affordable price,
and cost-effective nontoxic alternatives could be made available. In order
to find and confirm the effectiveness of new therapies, demonstration
pilot projects could be funded -- in previously neglected areas like
wellness, prevention, and
cost-effective nontoxic treatments -- using clinical centers
and practitioners who are already doing the work (such as the
clinics at the three naturopathic medical schools). The federal government
could resume its proper role of making information available to the
American public at low or no cost, so that we -- as individuals --
can make informed, better choices. Something like this was
explored in the 1970s when the McGovern-Dole Subcommittee on
Nutrition and Human Needs in the U.S. Senate published several reports
(including Dietary Goals) that
informed citizens about the dangers of the typical American
diet and how we might change our eating patterns in order to avoid
avoid degenerative diseases and live longer.
I'd like to close the prepared part of my remarks with
these observations: Our choices in health care reform come down
to two very different philosophical and practical models
of how we can progress and move forward in this critical area, as individuals and
as a society...
The first way is the requirement that we be part of a centralized,
bureacratic, compulsory/mandatory system of industrial medicine.
The second way involves a commitment to reform that respects freedom,
pluralism, choice, traditions, innovation, consensus, and building on the
better elements of the system we have.
Michael Ventura has written an interesting essay, The 21st
Century is Now in the Los Angeles Times Magazine, May 8th, 1994.
It reminds me of some of the seminal writings of E.F. Schumacher,
the British economist and author of Small is Beautiful, or the
poet/essayist Wendell Berry, particularly his book, The
Unsettling of America.
Ventura first observes -- with caution -- that "When you
change
form, you often dump the old content" -- unwittingly and too
often unfortunately. He goes on: "The distinguishing feature
of our 21st century [by which he means the present] is that
we are on our own...the helplessness of those in authority has
left us exposed to...ourselves. I am forced back upon my own
resources, on my own spirit. How that fact is met will determine
the history of tomorrow."
Michael Ventura's vision reminds me of
naturopathic medicine -- in which we rely more on our
own inner
resources,
on our
own spirit...to bring us
into closer contact with the best and truest traditions of the long
history of healing -- which are natural,
organic, experiential, grounded...and involve first do(ing) no harm.
In my view, it's in this kind of holistic philosophy and
practice
that
we will find our best opportunities for real
national
health care reform.
Peter Barry Chowka is a nationally-prominent journalist, medical-political analyst, editor and lecturer.
For over two decades his work in print, broadcasting and nonfiction films (including in the award-
winning production Hoxsey: How Healing Becomes a Crime) has documented the promise of
innovative, nontoxic approaches to healing. A 1992 appointee to several advisory panels of the
NIH’s Office of Alternative Medicine, Peter is currently writing about a variety of topics for several national publications and expanding his sites on the Internet's
World Wide Web. He is the public affairs consultant to the American Association of
Naturopathic Physicians.
© 1994 by peter barry chowka
All rights reserved.
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