The discussions we have been having about healthcare have been extremely flawed and it important to understand why.
As the Republicans in the Senate realized they cannot get support for their replacement bill, there was some talk of “compromising” with the Democrats to get some bill passed. This would have been a fatal mistake, and the purpose of this piece is to illuminate why there can be no compromise when it comes to healthcare.
Recent reports suggested that Senate Majority Leader Mitch McConnell attempted to woo more moderate Republicans by promising more funds for issues like opioid dependence. To build a healthcare bill from a place of allocating money towards specific problems is a scientifically unacceptable solution. It also continues to set us up for class warfare, with the “haves” protesting their taxes, which appear to resolve nothing, and the “have nots” continuing to be inadequately protected.
Our healthcare system is absolutely a mess. The Affordable Care Act (ACA) continued to accept a foundation for medicine to which we should all object. The reason is that it allows insurance companies, and not medical providers, to dictate how we understand and treat disease.
Insurance companies primarily embrace a symptom reduction model of disease. They force medical professionals to identify very specific problems and then give approval to treat patients only as long as those symptoms are still present. (If you are lucky, that is. Insurance companies basically have a cap on how much treatment you can get for some specific diagnosis, and if you do not “get better” within those limits, they stop paying.)
If you talk to most medical professionals, however, we have a much different understanding of disease and well-being. Primarily, most of us have a much more holistic view of the body and mind and acknowledge external factors like social support as playing a significant role in wellness. One main implication to this model is that recovery from medical and psychological difficulties can take a longer period of time because significant change may be needed across several important domains in a patient’s life.
Consider the issue that is receiving so much publicity: opioid dependence. People who are dependent on opioids are typically struggling long before they start abusing these drugs. They may be depressed, anxious, experiencing chronic pain, lonely, isolated, unsupported, etc. If we start treatment from the time they are already dependent on opioids, we have missed many opportunities aimed at preventing this problem from developing. Our healthcare system is colossally inefficient because we do not spend enough resources on prevention.
Additionally, if you are going to treat someone who is already dependent on opioids, you have to address the problems that are maintaining the use of the drugs. This may mean helping people get trained for employment, it may mean helping them form a new social support system in which everyone around them is not also abusing drugs, it may mean helping them to find a different way to manage their chronic pain. The amount of money that McConnell offered to throw at this problem in his unsuccessful bid to win the support of Senators from states in which this is an “epidemic” was undoubtedly insufficient to address this particular problem in a broad enough manner to make a difference. It also continued to embrace a symptom-reduction based medical model to which I, and many other healthcare professionals, object. We are not a part of the conversation. The insurance companies are, but we are not.
The financial implications of this approach are just as problematic as the atheoretical model that this reflects. If we really set up our healthcare system in ways that allow all of us to be viewed as complete beings rather than a cluster of unrelated symptoms for which you are sent to various specialists (who do not communicate with each other because insurance companies do not reimburse for the time it takes to do this sufficiently), it seems likely that all of us would be willing to pay the taxes necessary to support this. But when you insist on designing a system that is not based on an actual medical model, you waste tax dollars and infuriate the American public.
At what point are we all going to insist that our politicians include medical professionals, and not insurance companies, in their discussions about healthcare? We should demand that every Senator and Congressperson have to publicly state the model of disease and wellness they believe in and describe how the healthcare system they are designing is consistent with this understanding.
Dana Torpey-Newman, Ph.D., is a licensed clinical psychologist in Colorado. She is also the founder of “Parents for Playdates and Social Justice League,” a group devoted to providing parents an opportunity to participate in social justice causes while the children play together and develop a sense of community.