Monday, August 10, 2009

Another Reason Why the Health Reform Town Halls Are Not Failing to Disappoint

The Fat Lady points out that the historical and religious tension between population based care versus one-on-one care may be one ingredient in the health reform Town Hall brouhahas.

Recall it was the ‘Old’ Testament that proscribed certain dietary practices and contact with persons with communicable disease. While the basis of these laws are myriad and include public health as well as holiness, they strike the Disease Management Care Blog as being among the earliest examples of population based care: the care shown by God for a chosen people blessed by a special covenant.

Contrast this community-based hygiene with the 'New' Covenant of Jesus’ ministry in the New Testament. While He certainly personally followed Jewish law, His controversial appeal to his past and present followers seems to have less to do with the collective fate of peoples and more to do with the personal salvation of individuals. To the DMCB’s knowledge, Jesus didn’t come up with a means to diminish the prevalence of leprosy, schizophrenia, blindness or paralytic syndromes. Instead, He cured individuals one at a time. How inefficient. And how wonderful.

Say what you like about the role of the Bible in modern society, the Fat Lady thinks it continues to give great insight into today’s human condition. The insight here is that when it comes to illness, persons don’t want to have the likelihood of future complications from their chronic conditions to be diminished, they want to be cured. That was the health care gold standard uncovered approximately 2000 years ago - and it remains with us today.

Which may be part of the problem underlying the August health reform doldrums and the Town Halls discussed in yesterday’s DMCB posting. After being thoroughly pressured cooked by the dense Boston-based academosphere of D.C. health policy, our elected representatives have emerged from the Capital building spouting opaquely dense terms like ‘access’ and ‘primary care provider’ and ‘bending the curve’ and “preventative.’ They want the public to buy into quality assurance, comparative effectiveness and actuarial predictions.

The Fat Lady says good luck.

Part of the Town Hall dynamic may certainly include political grandstanding, unreasonableness, partisanship, manipulation and public inattention. However, the DMCB also thinks many persons want to hear how the electronic health record, how comparative effectiveness research, how the public plan option, red pills-blue pills, better attention to living wills and subsidies for health insurance will help cure people. Anything less just won’t do, especially if it’s going to cost $1,000,000,000,000.

As an aside, even the Fat Lady understands the difference between miracles and medicine. That being said, one allure of today’s medical-industrial complex is its promise of miraculously ‘curing’ diseases like cancer, heart disease and obesity. In fact, she wonders if the continuing business success of the disease management industry is due to its recognition of the U.S. health care system’s core appeal. They quickly changed course on marketing themselves as the best approach to chronic conditions in the 1990s to re-emphasizing their role as a supportive care strategy in the 2000s.

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