medical care preparedness

We opted out of full-time work and it's health care coverage 3 years ago. We've been without coverage for 18 months now. Sometimes I worry about it but I resist at a deep level, participating in such a broken system. I'll spare you my long and personal rant on it. We're in our mid 40s with 2 kids. A few ideas about all this:

I was inspired to urge my husband to make the leap out of employer based health insurance and the attendant 40+ hour a week sedentary unhealthy lifestyle by a therapist I know, who left the world of physical therapy in a hospital context to do bodywork. She's in her late 50s and is thoroughly disenchanted with the health care system. She has her own lengthy rant about how patients are treated based on whether they have coverage or not (and interestingly, having coverage doesn't mean they get better treatment -- often just more invasive treatment) Her approach -- max out her car insurance medical coverage, eat well and exercise effectively, use www.planethospital.com if she needs major medical in a non-emergency situation, and enjoy her life. (I'm not sure how long planet hospital's model remains viable in a world of post-peak oil, however.) She's willing to forgo expensive, life-extending treatment if she becomes seriously ill.

 There are a few physicians out there who want out of the system as well and are setting up cash-based practices with reasonable medical fees. I think handling evening and weekend coverage for patients may get a bit tricky for them, but you might search around for an area that has a cash-based medical practice.

 I'm waiting to see what happens with the new administration -- I was deeply frustrated to read Obama's first proposal was to digitize medical records, which has nothing to do with getting affordable health coverage to people and would only allow insurance companies to continue selectively denying coverage and dropping insured patients who have medical issues.

For what its worth,

Warmly,

Sue

Jerry_Lee - those are all excellent.  You are many steps ahead of those who still look to the medical/pharmaceutical industrial complex for all healthcare. (They certainly have their place, such as when one is injured).

For economic reasons as well as fuel problems, I expect many medical services to deteriorate as we go along, including emergency services like rescue and ambulances.  I suggest taking some courses in (at least) first aid and CPR and staying current with them. 

Those of us with animals should not forget them in this.  In addition to materials covering humans, the American Red Cross has come out with excellent books on  Dog First Aid and Cat First Aid.  Their online store is here: Red Cross Store

This is a very interesting topic, and, as a physician, one I have been considering lately.  I am a thoracic and vascular surgeon in Iowa.  I own my practice, and employ four others, to include a physician assistant, an ultrasound technologist, and a nurse (my wife, who also serves as my practice manager). We run a fairly conventional practice, with most of our income from traditional private insurers, Medicare, and a trivial amount from Medicaid.  Our practice is very successful, to include from a financial perspective, but I am well aware of the many limitations of the current healthcare system in the U.S., and certainly expect that major changes are coming.  Unfortunately, our current healthcare system is so bulky and entangled (physicians, hospitals, pharmaceutical companies, insurers, the U.S. government) that change will come slowly, in fits and starts, and will likely be very poorly coordinated.  And, most are so inured with our current system, that resistance will continue to be great, even though change is clearly needed.  Still, change will come, and while the U.S. government could have played a large role in this, I think it quite likely that the change will instead come through grassroots efforts.   

I like the idea of a community-based healthcare cooperative, particularly one that focused on primary care and wellness. However, the time may not be ripe for this idea just yet.  Prior to moving to Iowa, we lived in a small community in Colorado, where the shortage of primary care physicians was particularly acute.  The idea of a community healthcare cooperative was considered, but never realized.  Again, I think this is because most people are so accustomed to our current way of doing things, that they couldn't see "outside the box" to effect true change, even though the need for a different system was very real, and the proposed solution seemed viable.  In time, though, with continued deterioration of our current financial system, the limits of our current healthcare system will become more exposed, more will lose their medical insurance, and local community efforts to support the public's health will become more appealing.

As another respondent mentioned, there are some primary care physicians moving to a cash-based practice, some of which offer their own version of an HMO, in which members pay a (fairly) small monthly fee which covers basic services.  I think it is likely that we will see more of this in the future, and perhaps it is those initial efforts at change that will ultimately coalesce to become a community-based healthcare cooperative.  The physician assistant with whom I worked in Colorado, who is also a Chris Martenson fan, has begun storing some basic medical supplies, and already has excellent surgical skills, and he is contemplating the day when he might trade work at the hospital for a cash-based (or, barter-based) clinic that he could run. Again, I think this is likely to develop initially as efforts by individual healthcare providers, or small groups of providers, that in time, might develop into a larger system.

The future of physicians like me, who provide surgical services, is much less clear.  There are some simple surgical procedures that can be performed in the clinic setting, where costs can be easier to control, but major surgical procedures require more resources (an operating room, anesthesia providers, postoperative recovery, etc.), which encumbers efforts at change.  Even when I do perform surgery on a patient without insurance, willing to accept whatever they are willing or able to pay (I frequently receive no payment for such care, by the way), my surgeon costs are a very small fraction of the overall bill the patient eventually receives.  I simply do not have a clear vision of how surgical care is likely to be provided in the future.  Hospital-employed surgeons, with the hospital owned and supported by the community?  A national healthcare system, like in Canada and Europe, given the financial insolvency of our government?  Surgery done on my kitchen table?  It is an unwieldy problem.

Finally, and I apologize for the long post, but I would like to point out the success of groups like the Amish, of which we have a fairly large community in Iowa, in dealing with healthcare.  When an Amish patient is ill or requires surgery, the costs are negotiated, and the bills paid, in cash and in full, from the collective wealth of the Amish community.  It seems to be a very good system, and I have no doubt that it is much more cost-effective.  I just don't see that type of system developing on a community level in the near future.

The next 20 years will be very interesting for the healthcare profession, too!

Christopher Peters 

Thanks for all this info. jerry_lee - thanks for asking these questions.
Medical care is a big "what's the future here?" that's been rolling around in my head too.

cpetersj - Glad to hear from a surgeon. The need for your services is keeping me paying enormous monthly bills. Every time the premium is due I consider whether it's something I can do without. I look at the divot in my shoulder from cancer surgery . . . answer is currently "no". I'm 59 and so is my partner (with no insurance) and I'am really hoping the new administration comes up with some health care changes. Not being a big believer in government problem solving, I feel this is a long shot but also feel this lack of affordable care is one of the biggest "gun to head" tools that keeps US citizens towing the line. Go to work - don't rock the boat. Don't risk independent entrepreneurial adventures. I've spent some time in socialist countries and know there's a big psychological shift when this particular fear factor isn't pervasive.

On the up side - I've developed a great relationship with my G.P., who sees quite clearly the ridiculous situation many of her patients are in due solely to the insurance system they're operating under. She's willing to step outside her prescribed niche. I find this extremely encouraging about what's possible for the future. I understand specialization is the current mode but having grown up with my grandfather as my dentist and the family doctor living down the street, who handled all problems not requiring hospitalization (and some that did), I'd be very happy to see medical professionals be allowed to do more than what's currently acceptable under a "refer to specialist" system.

I know I'm bringing up several different issues here (and perhaps not too clearly), but wanted to point out that it's not only an issue to consider as part of our "what if" scenario but something that is, in my opinion, currently as broken as our financial system. Also want to say to folks younger than myself - s . . .  does happen - no amount of yoga, exercise, or healthy diet stops entropy or just plain bad luck.

Keep in mind keeping an eye on each other, especially older folks in your community. It's one of the best free currently doable preventive care prescriptions I can think of.

Having health insurance without a full time job can be costly. That’s why looking at alternative options like Medical Tourism is a good idea. At WorldMed Assist, http://www.worldmedassist.com/, they already have done extensive research on the facilities they partner with, assuring that your care is as good or better than what you'd find in the U.S. One patient save 95% on a cardiac procedure. Check out his story: http://www.worldmedassist.com/radiofrequency_ablation_india_testimonial_rand_loftness.htm

I'm sorry I can't resist saying something here. 

I am not a doctor, but when it comes to health - been there done that.  I grew up with chronic asthma, eczema and allergies - went to many, many doctors over the years - did allergy shots, steroids, creams and a plethora of drugs - had the top shelf medical care from Mayo clinic among others.   Diagnosed with Hodkin's in my early 20's successfully treated with radiation and several surgeries.  It has been in remission for 20 years.  At the time, I was diagnosed I was running marathons, not eating red meat, lots of vegetables/grains, fish and fowl.  Over the years, my immune system has been weak - got sick probably around 10 weeks a year.  Had hypothyroidism - probably from the radiation treatments to my neck.  Within the last year, I was diagnosed as a Type 1 Diabetic but have since been re-assessed as a Type 2 diabetic.  

As an engineer and naturally curious guy, the questions that I always asked was: 1) Why me?  2) What factors - genetic/enviromental/nutritional are at work here and, besides drugs, what can I do about it?  I owe my life to conventional medicine - no doubt about it - but with all due respect, with very few exceptions, they fall short because they protect and preserve their paradigms fiercely. 

Here are some examples: 

Asthma - Treated from early childhood with inhalers, humidifiers, oxygen tents, home filtration systems, the family moving to another area, exersise and occasional oral steroids. First, I went on an elimination diet per this book  http://www.amazon.com/Food-Allergies-Intolerance-Identification-Treatment/dp/0892818751/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1232644089&sr=8-1   And found that wheat, corn, soy and milk were profoundly affecting me. That cured about 75% of the symptoms. 

Then, I started a daily meditation practice taught by this fella:  http://www.shinzen.org.  To make a long story VERY short, at my 1st retreat, I had a full blown asthma attack that no amount of inhalers, etc could calm down.  He showed me how to meditate thru it and how to fix it for good.  Now, I have been asthma drug free for 5 years.

Allergies/cancer/Immune system - The elimination diet and meditation helped a lot here but something was still missing.  I was using herbs and homeopathics but it wasnt really helping entirely.  

I really started burrowing into this problem when my daughter was born and had the same immune system problems.  Okay, now I knew it was genetic but why?  Why didnt evolution had cull this line out a long time ago?   The final straw was when my daughter was allergic to the milk/soy based crap formulas, her mother was not producing enough milk and we had to find a nutritional formula fast!  That led me to the Price-Pottinger Foundation and later to the Weston A Price Foundation http://www.westonaprice.org   This is a fasinating group founded on the works of a dentist who studied traditional diets all over the world and the effects of the switch to the modern diet in the 1920s.  Trust me - they are completely out of any mainstream paradigms - and you will get the thousand mile stare when you talk to conventional doctors about it.  But, it makes sense - we have only had alleopathic care since the late 1800s.  The Lewis and Clark expedition relied on mercury based laxatives and blood letting to treat people. How did we survive as a species with no medical care? Answer:our ancestors had it figured out.

The answer can be found with the Weston A Price group. I have been following their guidelines for 10 years and my overall vigor has improved immensely.  I hardly ever get sick.  My skin is healthier.  I am stronger and more physically capable than when I had 10% body fat and was running 30-50 mile weeks.  Daily, I either work out or work in the garden.  Twice a year I throw on a 40 lb backpack and either hike or backcountry ski for a week or two.   At 43 yr old, I can keep up with the younger members of a martial arts club which I attend four times a week. 

Diabetes:  About one year ago to the day, I had all kinds of symptoms that I thought were some kind of flu.  I was still active as described above.  Anyway, I went to the clinic - got chewed out by the doctors for not treating my diabetes (which I had absolutely no idea I had) and they sent me home with an appointment to a specialist, a brochure from the American Diabetes Association and a blood sugar checker.   Went to the internist and he diagnosed as Type I.  They showed me how to use insulin etc, said to follow the ADA diet and asked me to come back in 2 weeks to check my progress.  The next day I went to a naturopathic doctor who told me to buy this book and follow it: http://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/03161...   Berstein, who was previously an engineer and is now an MD, explains reasons
why we have diabetes and how to treat it with alternative methods.

During that next two weeks, I did not take the insulin as prescribed - all I did was cut out milk, fruits and grains from the Weston A Price diet guidelines.  Two weeks later I went back to the internist.  My sugars had gone from 350 to 125 in two weeks without insulin and only one inexpensive drug for insulin resistance.  If I HAD followed the ADA diet, I would be dependent on insulin.  In the past year, I have lost 33 lb and my sugars are normal at 80 to 95.  There is also a Canadian film called My Big Fat Diet that conveys the same results for an entire town.  http://www.cbc.ca/thelens/bigfatdiet/

So, this is a VERY long winded narrative (and I have many more success stories) but my point is that the medical community has their blind spots.  It takes some work but you can reduce your dependence on the medical system, if you keep an open mind, try some things and at the end of the day, be HEALTHIER with very little help from the medical system.  Think for yourself and figure it out....

My heart goes out to your son.

I wouldnt survive long without thyroid meds either.  My efforts with unconventional treatments have reduced my dependence from 8 meds to one med which is very significant in a shortage situation.

One can waste a lot of time and money on unconventional medicine.  My experimentations cost very little money or disruption - a few books, some time on the web, a few changes in diet, learning how to meditate and a few inexpensive herbs/homeopaths.  Compared to my medical bills, this effort cost around 100 times less.  

Our medical system exemplifes Chis' take on social complexity.  We can learn from our ancestors who survived without this complexity. 

In response to mooselick7, and others, I have the following comments.

"Conventional" medicine, in the western sense, has certain decided advantages over all competitors, but it has limitations. For example, when it comes to conditions that typically require surgery (my field), conventional medicine really has no equal, and the many advances in antibiotics, anesthesia, surgical techniques, are worldwide, and in my view, uncontested. That said, for many medical (i.e., non-surgical) conditions, a variety of options potentially exist. Let's consider some of the most common conditions, to include hypertension, diabetes, and dyslipidemia (high cholesterol, etc.). There are a variety of "conventional" medications available to treat those conditions, and most are excellent choices, with good efficacy, good safety profiles, etc. At the same time, it is clear that pharmaceutical companies have a vested interest in developing and promoting these medications. And, while physicians are typically not directly complicit in this process, we are as vulnerable to advertising as most everyone else. Further, for many medical conditions, to include those mentioned, lifestyle choices have a huge impact in their presence, and in their treatment. If I see a 100 pound overweight patient with diabetes and hypertension, and he/she manages to make the appropriate lifestyle changes and lose that weight, it is very likely I will no longer see a diabetic and hypertensive patient on follow up. And, that same individual not only has decreased his/her risk of other medical problems (atherosclerosis, for example), but has also potentially avoided the need for a variety of costly medications (and their potential side effects).

At the same time, there are both advantages and disadvantages to "alternative" medicine. For some conditions, such as chronic pain syndromes (fibromyalgia, and others), conventional "western" medicine has decided limitations, while "eastern" medicine (e.g., acupuncture) frequently may be a better choice. However, I am deeply skeptical of "homeopathic" and "herbal" remedies, simply because there is little of what I would call "proof" of efficacy. By this I mean that there are little, or no, controlled scientific trials that prove, to my satisfaction, that most of these treatments work, and are safe. And, the arguments, likely to follow, that some of these treatment have ancient traditions, is not sufficient for me, as this is simply a classical fallacy of logic (appeal to authority). Herbal medications, in particular, frequently draw my ire. If one accepts the presumedly obvious assumption that pharmaceutical companies are very, very good at making money (at least, before the current economic crisis), one can assume that they would already have "mined" any potentially useful herbal medications for the relevant medicinal components, refined them, and marketed them. And, as much as one can reasonably malign the FDA, at least we can have some degree of reassurance (not complete, mind you, as the FDA certainly has some issues with regard to funding and direction), that most "conventional" medications currently on the market have a reasonable degree of efficacy and safety. The same cannot be said for most herbal "medications", as efficacy and safety has not been established, contaminants are common, and the "active ingredients" purportedly present in many herbal "medications" are frequently not found in the dosages advertised. Would you take a pill you found on the ground? I would have a similar hesitation to taking herbal "medications".

Getting back to medical conditions, regardless of background, education is key. Whether your physician, or alternative healthcare provider, is as forthcoming with information as you would like, or not, you are encouraged to learn as much as you can about your health. Ask your physician every question you can come up with, seek second opinions, search the web, look at alternatives. My favorite patients are well informed, and I enjoy answering their questions. If you don't have a physician who is willing to take the time to review all options, and answer all your questions, find another. Take more care of your health than you would the care of your automobile!

Oh, and the human body is incredibly complex, so I find it very easy to understand how complex medical care may appear to be to "laypeople". Decades ago, a "general surgeon", the field in which I was originally trained, was expected to do nearly anything surgical (obstetrics, orthopedics, abdominal, chest, etc.). However, times have changed; our knowledge base expanded, new procedures and techniques evolved and specialization increased. Even given the evolving economic crisis, I don't think we will see a decrease in specialization.

Suzie,

I disagree not at all with your assessment of "western" medicine's limitations.  I see it all the time!  As Benjamin Franklin said (relative to fire prevention rather than health care, I believe, but still appropriate), "an ounce of prevention is worth a pound of cure".  It is so very true.  Most practitioners of "western" medicine, at least as I have witnessed in the United States, and limited experiences abroad, do indeed focus on "disease", and not enough on "wellness".  And, the "western" patient, I feel, is equally entrenched in this philosophy.  Oftentimes, my patients seem more interested in getting rid of whatever problem brought them to see me (lung cancer, angina, claudication, etc.), than correcting whatever lifestyle problems might have gotten them to this point (smoking, obesity, inadequate exercise, etc.).  I try as much as I can to educate my patients on these other, frequently more important, issues (a 60-90 minute consultation with me for a complicated patient is not at all unusual), but all too often, this falls on deaf ears.

A better balance between "disease-fighting" and "wellness" is long overdue!  I hope we will see that, too.

As to medicinal development by the pharmaceutical industry, I will defer somewhat to your experience, as my opinion on this is admittedly biased by my own experience, which while fairly extensive, certainly doesn't include hands-on experience with drug development.  I'm not recanting, exactly, but acknowledging that I don't know everything, and the opinions I posted were simply my opinions.  Thank you for your cordial disagreement, too, by the way!  That doesn't always happen in forums!

.

C1oudfire,

I second your vision of blending low tech and high tech healthcare.  My ideal model would be to practice clinical herbalism side by side with a well-trained western family practice MD because we would have so much more information to work with using the best of both approaches.  I can't imagine how this could be possible in this healthcare environment unless I could find an MD working largely outside the mainstream system.  I can hold the vision and see what happens.

 Cheers,

Suzie

Great disscussion.

I am a chiropractor in California currently, and decided about a year ago to move towards a cash based practice. This was before I became acutely aware of the GD2 we are currently in.

 I will probably begin to do more nutritional counsiling as i see it will needed more. As a chiropractor I see that our services could be in more demand as people begin to understand how it promotes "wellness".

 Any thoughts...?

Kaisdad,

I agree with you about nutritional counseling.  Many, many people rely on sugar, caffeine, fat and/or alcohol or other drugs to make it through their day.  When I work with a client, I try to help them set goals to bring these comsumptive practices back into balance and try to look at the root of what threw them off balance in the first place.

In my opinion a lot of the imbalances we see go back to trauma experienced some time in life whether it was from seriously abusive or simply emotionally inadequate parenting or from a specific occurence like rape, car accidents or invasive medical procedures.  I have decided to become a Somatic Experiencing practitioner in order to be able to provide additional support to help people come back into balance.  I think this sort of work will become increasingly important as people struggle to cope with job loss, investment losses and foreclosures.  Somatic Experiencing was created by Peter Levine who wrote the book "Waking the Tiger."  You can learn about it at www.traumahealing.com.  I just had the privilege of spending seven days watching Peter work with severely traumatized people, and the shifts were incredible.

 If you are interested in the medical research going on in this area, you can check out www.trauma-pages.com.  Recent studies in neuroscience indicate that particularly early childhood decreases relational ability and resiliency in adults.

Cheers,

Suzie G.

Northern California