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Natural Solutions to our Health Care Problems

 
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I am interested in improving the health care system. In the United States, we have a system based on expensive acute care for emergencies. It is great when you have a terrible accident and it's also great if your goal is to make huge profits off of the people.  I would be interested in developing a system that would establish better quality health for the people. A focus on prevention is a great place to start.   I am not interested in bashing doctors. Many of them are interested in more holistic, functional, and naturopathic health care, but the insurance companies won't back it.  Many would like to institute more preventative care, but that also is not profitable for the corporations to back.  Many individuals would like to have better health, but many healthy practices aren't reimbursed.  As a country, we subsidize sugar, white flour, highly processed vegetable oils, and toxic additives.  We don't subsidize organic or regenerative vegetables.   Our culture backs bad health practices.  The FDA requires patients to receive chemotherapy for cancer, but discourages natural health solutions.  Google, Facebook,  Youtube, TV, magazines, newspapers and all major media are paid mostly by pharmaceutical ads and downplay natural health solutions which are cheaper, healthier, and with fewer side effects.  What we have is not a health care system. It is a profit from sickness system.  Individuals in this system who are trying to be healthy are fighting the unhealthy culture, and blaming the individual is not really solving the problem. We have by far the most expensive system in the world, and no other country is even close.  We have the 38th best health in the world. This is a horrific outcome. Why do we fight to continue this tragic status quo? What can we do to improve our health system?

John S
PDX OR
 
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As an independent licensed health care provider I have to be be scrupulous about not diagnosing or treating any disease. That is outside my scope of practice. The best i can do is demonstrate natural methods of self care and when asked what I eat.
Clients do ask: My doctors are such nice people and they real care about my health; so why don't they tell me these things?
The answer is : They are working in a corporate structure that has guidelines that require certain actions first as a standard of care. These standards are mostly established by corporations that supply healthcare products and food corporations.  
If a person makes clear that they want to use alternative health care methods There may be a provision in your healthcare network to refer you an appropriate provider.
 
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Hans, John,


A possible sticking point but also food for discussion:  a frustration my wife has is that frequently she has patients that just want to show up to get fixed and then go about their way.  Those particular patients are not at all concerned with prevention.

Logically, she acts/thinks/tries to practice medicine along very similar lines which you just described.  But not every patient is so inclined.  Obvious examples are things like quitting smoking, losing weight and if diabetic, take insulin and adjust diet as necessary.  

The diabetes aspect is particularly troublesome.  When a person first starts insulin, they rarely like it.  They want a sugar rush.  The feel tired, drained and crabby.  These effects wear off with time, but it is a difficult adjustment and not everyone is compliant.  And permanently adjusting diet is equally hard.

My point in all of this is that much of the blame can be spread around.  The corporate nature has its share of blame.  Some (not all) doctors have a treat-em-and-street-em attitude (more common in certain specialties), but as this thread is addressing the health care system, a significant and overlooked aspect is how much we the patients don’t live up to our own responsibilities in promoting prevention.  It is terribly easy to point the finger at an organization or a specific person, but much harder to point that finger at ourselves since ultimately we the patients will bear the greatest burden and have the greatest responsibility for preventing our own health disorders.



Eric
 
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Individuals taking an active role in one's own healthcare is the biggest step towards fixing the system.

One of the things I appreciate most about living in government-funded universal health care is the way the government likes to save money.    They've done lots of long term studies and they discovered for every dollar they spend on prevention and healthy living, they save about $100,000 per year.  (approximately - based on some studies, not all of them published and on talking to people in charge of policymaking).  

The big problem is, the older doctors are trained to treat symptoms so they have to start with the newer doctors.  Prevention has been a focus in education for about 15 years now in our part of Canada.  Most of the younger doctors focus on healthy living instead of pills, but most of the patients just want a magic pill to make everything better.  So the next phase is to train the population how to take an active part in their own wellness.  

My family doctor works with us to reduce our dependence on pills.  I'm off all pills now and my family member going into his eighties is on half the pills he was at 65.  Lifestyle changes are big and laboratory tests before and after to find out what made a difference.  Even if we are feeling a little off, we are encouraged to go to the doctor before it gets serious enough to effect our daily life.  Our doctor does wellness plans for us every few years, looking at risk factors, test result trends, and ideas for where to improve our health from here.  Right now we are all doing intermittent fasting at the doctor's suggestion as an attempt to solve some problems.  Our doctor does blood work before and during and after 6 months.  One family member was type 2 diabetic (non-insulin dependent) and is now no longer diabetic because he followed the advice.  

But they are always shocked we follow advice.  Apparently, out the several hundred patients they have, only a handfull try the lifestyle change suggestions.  The rest want magic make-me-better pills.  But when someone takes the time to show that they listen and ask her questions, the doctor knows they are more likely to recover than the just-give-me-pills person.

From my insights and experiences with health care, the system is changing (in parts of the world) to be prevention and care focused.  But (and this is a huge BUT) the patients are often reluctant to take an active roll in their own health.  I think a big part of permaculture medicine is to help people interact differently with their healthcare professionals.  It's not like taking your body to the mechanic and expecting it to be all better when you come back from your coffee break.  If a doctor suggests a medication that is not understood or won't work with the lifestyle, then ask them to suggest something else.  When they offer something to treat a symptom, ask them "is there anything I can change in my lifestyle that will reduce or get rid of this problem?"  If they say no, then maybe it's time for a second opinion.  
 
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As with so many things with "systems" there are so many interconnecting parts that there are no single, or simple "right answers".

One thing I found when my children were small was the huge pressure from peers and advertising for junk food - and things that really are in my opinion junk, but which people in North America seem to have been convinced aren't. Two examples of that are the average commercial "breakfast cereal" and typical commercial "cracker". So many of my children's friends ate those regularly, and to me, most of them had too many overly refined ingredients. In our house these were for special occasions or if we were travelling. One way I helped to reduce the pressure was to keep the children from advertising as much as possible. In those days, I could get videos from the library with no advertising. Now, even those have ads at the beginning.

With regard to advertising, I also taught my children early about "lack of truth" in advertising. We'd refer to certain things as "movie magic" - the ability to make something seem much more wonderful than it really is. This issue overlaps with health in sneaky ways. For example, fashion articles are frequently talking about some actor having surgical "magic" to make them "bigger" or "better". To me this does two things, 1) it pushes that attitude that doctors should be able to "just fix you", rather than you having to take responsibility for your health and 2) it pushes unrealistic views that your body should conform to other people's images, rather than what your genes have given you.

So I guess the short form of what I'm saying is that part of the "solution to our health care problem" is to educate people about how many questionable messages they get from all the images they see in the news/movies/adverts etc. Being more realistic about life in general, will help them realize what are better, more realistic options for keeping healthy.
 
John Suavecito
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I was telling my doctor about all of the things that I do to try to be healthy.  All he could say was, "You know you're going to die anyway, right?"  
I decided that that was the least inspiring thing a doctor ever told me.

I found a new doctor, who encouraged all the exercise, vegetables, fasting, etc.
On his notes, he even wrote, "Continue to play baseball. "  That was my favorite thing a doctor ever wrote on his notes.
He did that partially, I think, because it gives me socialization and something to be excited about, as well as exercise. He also encouraged the
gardening, hiking, and spending time outdoors that I do.

Dean Ornish and many others have published many studies about how important overall holistic health is, but you'll never read about it in mass media,
because the advertisers rely on ads for expensive unhealthy things and pharmaceuticals. I think we are starting to see a change,
but there is a lot of pushback.  A lot of it is from special interests.

John S
PDX OR
 
Jay Angler
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John Suavecito wrote:

I was telling my doctor about all of the things that I do to try to be healthy.  All he could say was, "You know you're going to die anyway, right?"

I strongly feel this leads into the entire "quality vs quantity" issue. I would rather live my life as a balance of those things. I can remember a couple that were on an extreme diet because they believed that evidence showed they would live longer if they did. It would have made socializing over food painful if not impossible. And yet, having a strong social aspect to your life, has shown to have enormous health and longevity benefits (not to mention, helping you keep your marbles as you age).

So as much as I feel there are plenty of natural solutions to Health Care, and that eating a nutritiously dense diet with minimal highly processed foods is an important part of that, as John above has added, social interactions and "play" are also very important, and if "play" also qualifies as exercise, even better.
 
John Suavecito
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One of the basic ideas that is mentioned as a reason why people live so long and healthfully in the Blue Zones is what you're saying, Jay.

You have to have a reason to wake up in the morning.  Something that makes you happy, that makes you feel like you make a difference, like your life has meaning.  For some that's a spiritual or religious experience.  For others, it's a service activity, like helping the poor or people who are in institutions.  For some, it's making a type of art that makes them happy, their grandchildren, their group of friends who they hang out with.  It could be a lot of things, but you need to have a reason why your life has meaning.  In the US, the average life expectancy has decreased for the last 3 years, largely attributed to deaths of despair.  People feel like there is no point to their life.  They aren't connected to others in a way that makes life better.  Yes, nutrition and exercise are important. But they aren't the whole thing.
John S
PDX OR
 
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As a doctor, it's wonderful when a patient (or a parent of a patient) wants to work on non-prescription responses to a problem.  I'm a pediatrician, so I do a lot of "well child checks" and I get to talk about trying to create healthy habits for babies and kids.

The medical system in the United States doesn't encourage holistic care.  When the HMOs showed up in the 1990's, everybody thought that this would be the way forward to rewarding preventative care - see, they're called Health Maintenance Organizations!  There was this idea that a primary care doctor would be paid $X "per life" even if they never saw the patient (as long as the patient stayed out of the hospital?  I'm not entirely sure how that worked).  

Sadly, the HMO's quickly became horrible cost-cutting, corner-cutting machines, I think due to poor decisions at the upper management level.  The horrific failed experiment of the "drive through delivery," where new moms were being discharged from the hospital 24 hours after delivering their baby, whether or not they were ready to do home, was apparently the product of HMO policies.  A few dead babies and the resulting lawsuits brought that to a halt, and I think most of that sorry experiment was limited to California (in case you never heard of it, that's probably why).

So, we're mostly back to "fee for service," except for Kaiser, which is a closed system.  I don't know that much about Kaiser, but I've heard they're having some trouble maintaining patient numbers.

In Oregon they use a public-private partnership system to administer Medicaid.  There are multiple private, non-profit corporations that administer the Oregon Health Plan - OHP.  For over thirty years, FamilyCare did a great job at this.  It was like the folks in charge had read the research about what works for maximizing population health.  They put an emphasis on primary care, and as part of that, they paid family doctors, internists and pediatricians well for seeing their patients.  Our pediatric office is in Gresham, far from the hipster parts of Portland, and most of our patients have OHP insurance.  We encouraged them to sign up for FamilyCare, because they paid us as much as Blue Cross for sick visits, well checks, etc.  There were more barriers put up in front of specialist referrals, but we never had a problem with that, because if we were referring a kid to a specialist, they needed the special care and we could prove it.  They also made it more difficult to get surgeries and MRI's, I think.  Over the 30+ years they were in existence, the people they covered stayed healthier.  Hurray, right?  Nope.  The state's response was to pay FamilyCare less.

FamilyCare was consistently paid the lowest of all the coordinated care organizations in 2015, 2016, and 2017 before moving up a notch to second-to last for 2018 -- rates it rejected as its board voted last month to fold. Greenlick justified these low rates by arguing that FamilyCare has a patient mix that is much healthier than its lead competitor, Health Share, as well as all the other 14 CCOs across Oregon.


FamilyCare engaged in multiple lawsuits against the state agency that sets the rates.  At the end of 2017, they threatened to go bankrupt if they weren't given better rates.  The state called their bluff, and poof, FamilyCare was gone.  I was so glad I never followed through on my pipe dream of opening up a FamilyCare only clinic in the Cully neighborhood!  Our office had to lay off several employees as our income dropped precipitously.  I had to give up having a scribe, which is a young person who went with me to see patients and wrote up the note for me.  Oh, that was so nice. . .

Anyway, I guess what I'm saying is that sometimes organizations do the right thing, and when they do they don't get the reward and recognition they deserve.  I hope we can continue to develop a health system that emphasizes health rather than quick fixes for symptoms.
 
John Suavecito
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There are some new and interesting models coming out.  James Maskell has started a program that looks interesting. So has Robin Berzin.  I've listened to their podcasts.  I've got Kaiser and it's pretty cheap.  They won't let me get acupuncture right now, and you can't have a naturopathic physician as your primary doc, but they're ok.  I'm not a health professional. I'm just a dude who is trying to be healthy. I pretty much create my health on my own, without use of health professionals.

John S
PDX OR
 
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