What Would a Reformed Health Care System Look Like?

-From Citizens for Health, November 14, 2008

We’ve written many times before that health care reform means a lot more than reform of the medical insurance industry.  Deeper, more systemic changes are needed even in the way we understand health.  One way to describe the needed changes is to say that we need more balance in the system.

In 2002, the U.S. government took a first step toward creating a more balanced health system by forming the White House Commission on Complementary and Alternative Medicine Practice (WHCCAMP).  The Commission issued a lengthy report that put together some pieces of a more effective health system.  But the picture still remains incomplete. A better understanding of the following factors will help us take the next steps:

A balanced, effective health system is now understood to include more than allopathic medicine.

There’s a continuing theme in the WHCCAMP report, captured by this quote in the Executive Summary:

  • “Wellness is defined in many ways, but all agree that it is more than the absence of disease.  Wellness can include a broad array of activities and interventions that focus on physical, mental, spiritual and emotional aspects of one’s life.”

Noted American-Israeli sociologist and academician Aaron Antonovsky – the father of salutogenetics (i.e. the study of health origins) – established this same theme in his 1987 book, Unraveling the Mystery of Health:

“We are coming to understand health not as the absence of disease, but rather as the process by which individuals create their own sense of coherence – that life is comprehensible, manageable and meaningful – and by which they find in themselves the ability to function in the face of changes . . .”

As natural health supporters, we experience a broad spectrum of health choices. That spectrum extends well beyond allopathic medicine. Our challenge lies in balancing this spectrum, and building a framework to guide the attendant rights and responsibilities.  Such a framework must embrace this concept quoted from both Antonovsky and the WHCCAMP Report.  In other words, we must create a health care system that recognizes that human beings have the resource to “create their own sense” of health and “find in themselves the ability to function.”

  • The WHCCAMP explicitly supports this goal:
  • Based on its mission and responsibilities, the Commission endorses the following [4 of 10] guiding principles:
  • 3. The healing capacity of the person. People have a remarkable capacity for recovery and self-healing, and a major focus of health care is to support and promote this capacity.
  • 4. Respect for individuality. Each person is unique and has the right to health care that is appropriately responsive to him or her, respecting preferences and preserving dignity.
  • 5. The right to choose treatment. Each person has the right to choose freely among safe and effective care or approaches, as well as among qualified practitioners who are accountable for their claims and actions and responsive to the person’s needs.
  • 6. An emphasis on health promotion and self-care. Good health care emphasizes self-care and early intervention for maintaining and promoting health.

In these words, from a Presidential Commission no less, we see an increasing emphasis on the value of responsible, autonomous health choice – an absolutely fundamental part of the self-healing process.   As philosopher and social scientist Ivan Illich wrote,  “Progress should mean growing competence in self-care rather than growing dependence [on an allopathic system].”

Rejection of allopathic medicine is certainly not called for here.  At the same time, recognition of our autonomous healing resource is alone not enough.  To complete an effective balancing of an ever-broader health care system, we must give more than recognition.  We must develop the tools that will provide overt support for the self-healing resource at every level.

We need new tools to balance and guide the full spectrum of health choices that are emerging.

We need new tools to make a balanced health system happen:

A.   New Language

Here’s what the Journal of Alternative and Complementary Medicine said about language in a 1999 editorial:

  • “Language is all important as the vehicle for these ideas [that health care is more than allopathic medicine].  Metaphors are powerful linguistic tools for understanding and comparing complex systems. . . Better healing metaphors are needed.”

Once again, we need look no further than the WHCCAMP Report to confirm this need:

  • “[T]he Commission recognizes that the term [CAM] does not fully capture all of the diversity with which these systems, practices and products are being used.”
  • “The Commission notes that lack of an appropriate definition of complementary and alternative medicine.”
  • “Even the terminology [used by NCCAM @ NIH] is unsatisfactory . . . because it does not reflect emerging models of health care.”

Appreciate what the Commission is saying here. The way we talk and even think about health is unsatisfactory, for the spectrum of responsible health choices is much broader than we often allow.  Allopathic medicine is only one part of the spectrum.

For instance, consider that we might define “allopathic medicine” as the external intervention of counter-agents or counter-methods applied in response to disease-generated conditions.

The complementary end of the spectrum from allopathic medicine might be called autonomous, innate or self-organized health. This part of the spectrum might be described as self-generated, self-organized practices and supportive natural products that benignly correspond with the structure and function of an individual’s body, mind and/or spirit.

Each healing arts modality, technique and product has a unique place in such a spectrum. Conceptualizing a health system along these lines may be the first step to re-organizing our language and our decision-making processes about health choice rights and responsibilities.

B.  New Research Concepts

A broad and balanced health system will address safety and effectiveness in a balanced way.  We need new research methods and concepts to accomplish this goal. Measurements for the safety and effectiveness for autonomous, innate & natural health products and practices deserve a different set of metrics.  The tools and concepts to measure allopathic medicine will not serve this effort. The tools needed to measure innate, natural health metrics do exist.   They are just not readily acknowledged yet.  These tools need to be embraced.

C.  Law and Regulation

Law must also adapt to the full spectrum of responsible health choices offered by natural health methods and products.  Just like science, standards of proof under the law must adapt to the changes in our understanding about health.  Harvard’s constitutional law scholar Laurence Tribe has recognized that the law must adapt to new data, instead of forcing new data into old standards.  We have some catching up to do in this regard in the areas of language, law and regulation.

  • “[O]ur vocabulary has lagged behind our intuitions; the language with which we still tend to ask legal questions and express legal doctrine has yet to reflect the shift in our perceptions.  The result has been to make it easier for [our legal systems] to couch their analysis . . in terms that are deeply out of sync . . .”

D. Market Forces

Next, market forces must be guided to energize the full spectrum of responsible health choices.  The current market has reached the limits of its effectiveness, and it is dangerously close to breakdown.  We are experiencing the effects of an imbalance at the allopathic end of the spectrum. Whether current conditions warrant the use of market protections, market incentives or other mechanisms to enliven the natural health area of the spectrum remains to be determined. Regardless, as the WHCCAMP Report makes abundantly clear, we need more equitable market support for the full range of healing modalities. This support must begin, at the very least, with consumers.

CONCLUSION

We’re on the edge of understanding ourselves as natural healers, in re-alignment with nature’s innate healing abilities. If we’re to fulfill this promise, we must organize a new framework to embrace and advance our growth.  It’s time.

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