Dare or Death: It's A Game of Life Roulette
Life Roulette. The stakes soar faster than the wheel can turn. As we throw down a growing stack of cash for one more try in the game, pieces of doctors and patients dissipate among the ashes of malpractice, managed care, dwindling resources, and the needless, violent deaths. Children. Old people. No one is spared the pain of a medical system crying out for change. Perhaps it's the dwindling financial and human resources, or the mutant bacterial strains that antibiotics will no longer heal. Or is it cancer? AIDS? Violence? Guns? Gangs? Our inner city emergency rooms are turning thousands of patients away. Lined-up in halls, in waiting rooms, on park benches, their plea becomes a whisper lost in the murky residue of noise, cars, sirens and too many others. Quiet moments at any emergency room are rare, and they come suddenly, like the yellow-green stillness that falls over the trees, streets, and trailers just before the tornado's black funnel sweeps victims in its wake. While some patients are fortunate enough to have family or insurance to care for their needs, others are forced to seek solace in shelters rather than in the arms of a loved one. Others die, unnoticed, under bridges, near trash cans, in back alleys, in their cardboard beds.
Are We Managing Care, or Is It Managing Us?
Every one of us suffers for the needless excesses of our health care system. When most of our grandfathers, fathers, sons, or lovers were across the ocean fighting in World War II and women were working in factories, national health care dollars spent were about $4 billion. Half a century later, in 1992, the money spent on health care each year had soared to $800 billion, and conservative estimates indicate that number will soon exceed a trillion dollars.11
Back in 1940, most health care costs for doctors and hospitals went to cover the most serious, acute conditions. Today the situation seems to have flipped: the seriously ill are forced home in two or three days, no longer able to get well in a hospital setting. These are stays that in the past were treated in hospital settings for eight to ten days. Now, thanks to the health insurance industry, major surgical procedures for things such as mastectomies warrant a twenty-four-hour stay, while treatments for chronic conditions such as arthritis, pain, depression, and high blood pressure eat up about 70 percent of the current health care budget. According to the U.S. Department of Health and Human Services publication Healthy People 2000, more than 33 million Americans are functionally restricted from daily activities because of such chronic conditions.
Managed care has become our solution to the rising costs of health care. But insurers further muddy the waters by insisting that our care be dictated by the dollar and the day. Too many days, too much money equals time to go home. You're still sick, you say? The ever-tightening noose of managed care and its capitation system have become part of medical treatment delivery, while patients, doctors, families, government leaders—everyone—is asking, why? We are told that because as a nation we shell out $950 billion annually to care for our sick, we need to find ways to cut costs, so that everyone can be served. We can no longer afford to pay for everyone to be treated for every ailment.
We are the only industrialized nation with no comprehensive system of health care delivery. More than 37 million Americans have no health insurance, and 22 million working poor go untreated because they cannot afford adequate coverage. Others, with the right amount of money, the right job, and the best insurance, continue to enjoy the luxury of being covered for elective procedures. The health care controversy even took over the 1992 presidential campaign, placing First Lady Hillary Rodham Clinton under a microscope of public scrutiny. There were focus groups. There was testimony. There was posturing and grandstanding. And everybody was trying to get on the list of speakers: the special interests, the hospital administrators, the business leaders, the doctors, the patients, the insurers. Everybody had to have his or her story heard. But try as the First Lady might, she could not make the pieces of the puzzle fit. And now that the dust has settled after the whirlwind of a failed attempt, it's clear that no winners emerged from this damaging battle. Some favored a national health care plan. Some were vehemently opposed. Some only cared about protecting their niche in the health care arena. The patients— and when you think about it, we're all patients at some point— wanted affordable, accessible, quality care. To make matters worse, the golden crescent of scientific evidence that's all wrapped up in the double-blind bind of clinical trials and proof, kept raising its ugly head, as a few brave souls tried to consider alternative options to conventional care. And now, several years later, we're still puzzled. We ask, How did this happen? What role did we play? Many are quick to blame the other guy: the hospitals; the doctors; the insurance companies; the uninsured; the government; the gangs; the guns; the immigrants; the homosexuals. No matter who gets saddled with the blame, the questions remain: Who will pay? Who will get care, and who will die without it?
The answer may not be the cure. Perhaps the simple truth of healing is connecting or reconnecting to the inner healer within each of us. Maybe it's learning to live with grace and ease, with or without cancer, AIDS, or addiction. Or could it be that we have to unleash the power of centuries of knowledge, taking a little wisdom and a little loving and mixing it up with a lot of common sense? Many doctors today think that we have lost touch with our generational wisdom. Generations before us knew the answer. They had a special tea for this and an herb or poultice for that. Only when things seemed fairly grim was the doctor summoned. Some feel that doctors didn't always know the answers anyway. And that was OK. They, too, relied on an invisible force for the answers. But today, the practice of Western medicine has far surpassed such folksy remedies. It took the doctor out of the village and threw this once familiar healer into the vast hive of buzzing competition and technology. Our grandmothers easily diagnosed the difference between croup and pneumonia. But the post- World War II era tossed common sense out the window. And we lost a sense of generational wisdom. We invalidated the lessons of generations before us. Old people were old, not smart. We were young, hip, and strong. Times were good. We had jobs, money, and education. We had color television, and the world got smaller as technology progressed. Our families split: a brother "in California; his wife and children in Indiana; a sister in Florida; parents up North. We kept moving so fast that no one from the class reunion committee would ever be able to find us again. We were lost in the blur of express living and fun times. And now we're all alone.
A MEETING OF THE MINDS:
A NEW APPROACH TO HEALING
For thousands of years, healers have been trying to uncover the ever changing mysteries of the human body. Both the Eastern and Western traditions go back many centuries. The Eastern tradition is steeped in philosophy and spirituality, and, in its approach to healing, the body is seen as a microcosm of nature, a landscape of the seen and the unseen, whose seasons and temperatures, deficiencies and excesses need to be gauged and understood in order to promote health. At one time the Western tradition had some similar beliefs, the Greeks, for example, seeing disease as an imbalance in the four humors, but since the 1800s, a lot of that tradition has been overshadowed by the Cartesian thinking of modern medicine, which views the body as a machine, a mechanical structure that can be diagnosed based on cause-and-effect thinking, and whose parts can be removed and replaced or molded or zapped into shape; and which views disease as a separate entity with its own patterns and cycles that are to be disrupted and put out of commission through drugs or surgery. The healing wisdom of centuries in the West was overshadowed by this approach to medicine. But practitioners and patients are now regaining a sense that the systems and organs of the human body are interdependent parts of an organic whole, and that curing what ails us involves encouraging the body to fight for wholeness rather than target and destroy symptoms. Medicine is so intriguing today because the West is continuing to learn more about cells, immunity, disease, and genetics, while it eagerly explores Eastern medicine, tapping into the wealth of wisdom it offers. The prospect of our getting the benefit of all these systems, practices, and wisdom bodes well for our general health and well-being.
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