By James S. Gordon, M.D., Founder and Director                    
                                                                         
The accents and the perspectives were as varied as the 30-person group—men and women from their early 20’s to early 80’s, blacks and whites, Asians and Hispanics, healthcare professionals, businesspeople and policy wonks, the wealthy and the barely getting by. Still, remarkably, as each of us spoke of our greatest health care concerns, common themes, common understandings, common solutions emerged.                                                  
                                                                         
Healthcare is “too expensive,” said the first speaker, an FDA scientist calling up other countries’ statistics. “My neighbor,” a currently unemployed old friend, ventured, “gets $2600 a month in disability and pays $1500 for her insurance. How can you live like that?” “My daughter and her husband,” an active-duty Army colonel told us,“are actually getting divorced so Medicaid will cover my grandchild’s surgical bills.” “We are,” concluded a former high Clinton administration official, a serious man suddenly sad, “the only advanced country where people without insurance go bankrupt.”            

Everyone agreed that catastrophic care after a car accident or in a surgical or medical emergency was often excellent, but that the model of swift and decisive intervention had been long misapplied.       

“We have a ‘sick care’, not a health care system,” a black family physician told us, to a general nodding of heads. “I can’t bill for obesity or smoking cessation.” The current system, everyone agreed, often reimburses for expensive treatments of questionable value, instead of supporting preventive and self-care approaches. Small businesses, including doctors’ offices, we heard, cut services and raise fees to meet the escalating costs of their own employees’ healthcare—“It’s more than 15 percent a year,” a second family physician,who’d brought his budget with him, told us. Anxiety about health and coverage, our participants said again and again, contributes to the illnesses that demand coverage, and keep poorly covered people from seeking the help they need. The costs mount out of control while our national health grows worse—we spend far more money, our group members said with pain, incredulity, and outrage, live far less long and have far higher rates of infant mortality than just about any other industrial society.

Still, in spite of the pain, disappointment, and the frustration that providers, patients, and policy makers have all repeatedly experienced, that they still feel, there was, all around the circle and throughout the evening, a sense of promise and a feeling of hope in the room. Everyone deeply appreciated that the opinions of the American people were finally being asked for and that their voices would be heard. This time of crisis in our national health care, we agreed, can be an opportunity for profound change in the structure and the content of our healthcare, a time to eliminate the waste and “collateral damage” of our current system and to cut its killing costs, an opportunity to create a health care system devoted to people, not profits.

At the end of the evening, I summarized the most robust recommendations that were emerging from the rich soil of our conversation, the ones we would make to the Obama-Daschle team.
Here they are.

1. We need a coherent, rational system of National Health Care, a single-payer system that, without demeaning and destructive bureaucratic obstacles, meets the needs of all Americans. This recommendation was supported by successful, stressed-out health

professionals and beleaguered parents, by self-styled liberals and conservatives, and by policy analysts who months ago believed it was “off the table” of political discussion. In spite of any complexities in its creation, it was regarded as the “only sane” remedy. Indeed, one of our participants,a former head of mental health services for the Veterans Administration, pointed out that a majority of US physicians and nurses already favor such a plan.

The crucial task, we felt, was to examine the available models—Medicare, government employees’ insurance, and military health in the United States, and the national systems of other developed countries—and create one that was most beneficial and suitable to our population: a system that facilitated more free choice than the current one, and eliminated demeaning bureaucratic inquisitions while insuring universal coverage and cutting costs. Though all participants regarded insurance companies as obstacles, the chief proponents of profits over peoples’ welfare, all felt it was imperative that their employees be retained as workers in the single-payer system or retrained for other careers, especially in healthcare.

2. Whatever model of universal care is chosen, it must be grounded in a profoundly different point of view and practice from the current one, one in which prevention is as important as treatment and in which self-care and mutual help are understood as fundamental to both prevention and treatment.

This means that education about psychosocial and economic factors in health and illness and practical instruction in the use of nutrition, exercise, stress management, and mind-body approaches must come to be seen and practiced as the true primary care. These effective and inexpensive practices— “breathing, moving, learning how to shop,” as one mother of three put it—must be used wherever possible prior to more side-effect burdened approaches like surgery and drugs, as well as along with them. All of our group believed that this approach was absolutely essential to cost savings as well as our national health; that it should be mandated as primary care.

We realized as we listened to several military participants that we have much to learn from the Armed Forces’ emphasis on comprehensive fitness programs which include mental, emotional, spiritual, social, familial, and financial, as well as the physical, aspects of health.

This approach to wellness and prevention does not, we believe, require economic incentives and penalties as many have insisted —carrots and sticks. It can be grounded in an entire system which helps people who have felt discouraged and disrespected and alienated to become actively engaged in their own care. I and other clinicians in the room reported that when we treated our patients with respect, taught them techniques they could use to help themselves, and provided the kind of practical, emotional, and social support they needed to sustain the changes they decided to make, health care miracles were possible. Many of us, including The Center for Mind-Body Medicine staff (and many of our professional trainees), have found this approach to be highly successful with populations that are often regarded as recalcitrant and incapable of self-care, including the low-income, chronically ill elderly; delinquent adolescents; HIV-positive ex-prisoners; and war-traumatized children and adults. Respected and treated as equals who are capable of understanding and helping themselves, offered the opportunity to use tools to live healthier and fuller lives, the vast majority respond—and so will the vast majority of all Americans.

Stay Tuned for 3 - 10.

Article Courtesy: The Center for Mind-Body Medicine