CHAPTER SEVEN

HEALTH/MEDICINE

The subject of global health appears to be one of the lowest agenda items in meetings of heads-of-state. Economic summits, of course, are in abundance throughout the world, but rarely do we hear of medical experts meeting to evaluate world health conditions. The U.N. lacks significant programs to eradicate diseases in third-world countries.
In the U.S. it would be rare to encounter anyone, irrespective of age, who does not suffer from a physical disorder. From asthma, diabetes, gastronomic, heart, hypertension, nervous system, to multiple forms of cancer, treatment but no cure is available except in some cases for surgical procedures. Machines make diagnosis easier and emergency hospital care prevents sudden death. Life span has increased, but quality of a drug-free, healthy life style is far from what is expected to be the “golden years of aging.”
Many states and local governments have Medicaid insurance programs for the poor with funding from the federal government. However county hospitals are over-crowded and do not always have adequate medical help.
The national Medicare program to insure seniors 65 and over is not sufficient for retirees on fixed incomes. In Plan A the monthly premium is deducted from social security benefits. The governments pays 80 percent of hospital costs after an annual deduction of $1,000 and 20 percent is co-paid by the insured. An option may be included to pay for Plan B which covers doctor’s fees after an annual deduction of $130, and is paid in the same percentages as Plan A. The annual-cost-of-living increase in social security monthly payment is almost erased by rising medical costs
The cost of medication became so expensive that many seniors on fixed income were forced to choose between medicine and food or other basic needs. A new plan (D) devised by the Bush administration was so confusing that only one-third enrolled by the May 15, 2006 deadline. A penalty has been added for those who might decide to participate later.
Seniors choose from about 50 insurance companies and pay them a monthly premium. Medicare pays a specified portion, depending upon the drug prescribed and the recipient makes up the difference. Monthly premiums vary from $10 to $50.
President Bush handed insurance and pharmaceutical companies an assured trillion dollar revenue. There apparently is no clause in this deal which would safeguard prices. In fact, he agreed to not negotiate for lower prices for medication. Despite an MBA degree he does not know that he could have dealt from the position of strength on behalf of millions of recipients.
The greed of one company, Humana who had the obligation to provide information regarding their plan went too far. When called for price information, they tried to transfer the call to an agent to set up an appointment at home to sell more insurance. When refused, they hung up without providing the requested information. By coincidence the very next day their telemarketing call urged setting up an appointment. When refused, they abruptly hung up.
More vexing, on July 2, 2006, two months after the deadline to enroll, it was reported that the elderly should expect a rise in monthly insurance premiums and in the price of medication. On September 13, 2006 an announcement was made to expect a substantial increase in monthly premiums, and seniors with over $80,000 of annual income would pay substantially higher amounts. For some on limited income or social security only, a possible $100/month addition to health care costs will be devastating. The drug plan was then in effect for only six months!
With unspeakable greed, in mid November, 2006, notices were sent to all who enrolled in the plan, that prices had increased and the option to seek other companies was offered. In other words, the process to obtain the cost of premiums and drugs must start again. Since patients do not expect cures, but rely on the national mantra, “doctors treat by reaching for their prescription pad,” there is no choice but to comply with the new plan. There has been no comment from the White House.
A glimmer of hope is in the election of November 7, 2006. Independents and many Republicans showed their disgust, so that Democrats are in control of both houses. One of their priorities is to fix this ill-conceived plan.
It has taken more than 2,000 years for the practice of medicine to evolve. Science began in the sixth century BCE in Greece. Mesopotamia (Iraq) had standardized medical procedures which the Greeks adopted. Babylonians and Egyptians made scientific discoveries in astrology and astronomy; Egyptians developed mathematics and produced surgical instruments, medication and developed medical ethics; Hippocrates’ case histories were collected in 250 BCE in which surgery was discussed.
In the second millennium BCE China had a remedy for cough and lung ailments. Ulcers and malaria were treated. They also believed that a red tipped tongue indicated heart problems. Arab-Islamic medicine was established in 832 BCE.
Public medical service originated in the early Roman empire when physicians were appointed to various towns and institutions. It was best in connection with the army where there was an adequate supply of medical attendants who were well-trained. The fall of the Roman Empire interrupted the practice of medicine as society changed into a feudal system. Hard peasant labor resulted in sickness and early death.
Church leaders became critical of medical practice, including dissections, and it was more important for the dying to be blessed by a priest than to have a doctor present. Monasteries became medical centers, more important than universities until 1300. Surgery in the middle ages was described in literature that raised standards.
Modern science started in the Renaissance and the Reformation broke the church’s hold on learning about 1315. In 1400 and 1500, Switzerland, Austria, Germany, and Turkey were finding treatments for syphilis, smallpox, and pharmacy was rediscovered. Ancient texts of the Greeks and Romans described the use of drugs, and new discoveries came from the New World.
North and South America had no outside contact for 10,000 years so that infectious disease was unknown. Transmission of disease from animals to humans became more prevalent with Europe’s discovery of America. Travel and trade with other communities became more common so that diseases were easily transmitted.
Instruments were invented, the telescope preceded microscopes before 1294. The Dutch made eyeglasses, the stethoscope, the iron lung and catheters followed.
Inoculation against smallpox was first reported in Turkey in 1721, and was carried on in Boston at the same time. In 1768 the Royal Court of Vienna was inoculated, as were Catherine the Great of Russia and her 200 servants. George Washington insisted that all troops in the Revolutionary War in 1776 be inoculated.
Americans who studied abroad, returned to establish medical colleges in Pennsylvania, Benjamin Rush in Massachusetts 1765-1769. Edinburgh in Scotland became the principle source of educated physicians for England. William S. Hunter opened the first obstetrics school in England in 1776.
Surgery in the field of cardiology was practiced in the nineteenth century and in 1912 James Herrick of Chicago diagnosed the classic signs of symptoms of coronary arterial occlusion. In 1918 Bousfield published the first ECG designed by Enthoven of Germany which was put in use on a patient during an angina attack In 1928 Cambridge Scientific Instrument Co. of London built the first portable string electrocardiograph. Heart medication came into existence.
Bismarck established the first compulsory sickness insurance in Germany in 1883. Employers were required to pay 33 percent and workers 66 percent of the cost of medical treatment. In 1884 work accidents were included. The first pension plan was established for the retirement age of 65. People with income above minimum were not required to participate in a compulsory insurance plan, and paid for private health care. Belgium and Holland followed with plans based on the guild system. Austria adopted the German system in 1888 in answer to Marxist complaints about economic problems of the poor.
The king of Sweden decreed local parishes must sustain its sick and support its poor. By 1800, twenty-one hospitals were established and counties assumed responsibility for the sick while the parishes continued to care for the poor. A private health care system did not exist and in 1913 only two private hospitals in the country took care of the wealthy. Mandatory insurance was instituted beginning with an old-age pension. Health insurance was added to the program in 1995 and trade unions became involved in the insurance program.
Norway had a similar system. Government had provided health care for its citizens for many years. In 1953 almost 90 percent were covered, by private insurance programs for members of fraternal organizations and labor unions. In 1956 automatic health insurance was provided for the entire population. Hospital care is now free for all.
France never adopted the Bismarck system although some industries had their own health and pension plans. England eventually adopted another model after WWII. Maternity benefits now also cover the taxi ride to the hospital. Canada has had a national health program for some 40 years.
In earlier times, European countries were more compassionate in recognizing the need for medical care. The wealthy received better care while the poor had almost no attention, accept for the charitable work of social and spiritually oriented people. This greatly improved in more recent history.
The early history of medical care in the United States, far behind that of Europe, is not a source of pride. The medical profession as a whole is slow to accept new ideas and doctors carefully guarded their discoveries of successful treatments. Even today, research is kept secret from the competition to develop new drugs and the wait for government approval of a new treatment can take years. While the cultures of most of the world in the 17th, 18th and 19th centuries were highly developed, those who came to America were not the elite, the well-educated or the rich. Almost anyone could become a doctor without education. They could earn money for having apprentices observe their practice which was hardly a substitute for a formal medical education available in Europe.
Only after conditions in America began to improve by 1700 did doctors come from other countries to teach medicine. However, since the first printing press was not in use until 1639 at Harvard College and in Virginia in 1851, medical literature was not available. When printing presses were used, they were under strict scrutiny because of puritan values.
Very little attention was paid to education. Between 1607 and 1776 of 3,000 physicians, fewer than 400 had medical degrees from Europe. The first medical college was opened in Philadelphia in 1765, the second was King’s College in New York in 1767. Harvard Medical School was established in 1783 and Dartmouth in 1797. There were seven medical colleges in 1813 and a degree was the only requirement to license in most states. Students seldom had access to actual medical treatment until the Civil War. A medical degree could be obtained within one year. Diplomas were sold, the term of ‘quackery’ was adopted for those who obtained fraudulent documents.
Treatment was absent any medical discoveries in Europe and when new methods were proven to save lives, American physicians refused to follow. The example of the Semmelwiess method of merely washing hands between patients was ignored, and the laundering of surgical gowns worn in surgery took decades before it became protection against infections
In recent history, more advances were made in medicine due to war. Treating wounded soldiers has been re-organized so that there are more survivors than could have been imagined long ago. They can be treated while they are being evacuated by helicopters to the nearest hospital. Communication of new surgical techniques between doctors distant from each other has made it possible for more soldiers to survive without losing limbs or suffering permanent disability A new surgical breakthrough was announced on July 31, 2006 using robots for intricate surgery in treating soldiers wounded in battle, which will now be used in treating prostate cancer, with many new procedures due to follow
For-profit HMOs appeared on the New York Stock Exchange. The Reagan and George Bush-41 administrations were convinced that private care should be a capitalist model and made no attempts to ease medical expenses. Enormous sums would be collected from corporate employee health plans and stock market investors benefited from dividend payments. Medical groups subcontracted all health care delivery to doctors and hospitals. In 1998 some California medical groups became insolvent due to complicated plans.
The U.S., the wealthiest nation in the world, does not have national health care insurance for 46 million citizens. Catastrophic illnesses have wiped out entire family savings, and even a short illness for working-class families without insurance cannot hope to repay the astronomical bills that accumulate.
Some corporate benefits for employees include insurance, but costs are rising so fast that some are being cut. Some unions have been able to obtain health care benefits for members, but changing jobs or retirement can result in loss of insurance. Racial and ethnic bias in hiring, results in inequitable insurance coverage, with some 70 percent of whites insured, compare to 55 percent of African-Americans. To its great credit, Illinois recently passed the first program to insure all of its children by the efforts of Democratic Governor Blagojovich, who was re-elected November 7, 2006.
. A severe blow to medical progress was administered single-handedly by the president of the United States, George W. Bush on July 21, 2006. He vetoed financing of stem-cell research, admittedly based on his religious beliefs. Millions of lives could be saved and the quality of life improved which is now denied by the president who does not recognize the constitutional separation of church and state. Just as outrageous is that there were not enough votes in Congress to override his veto.
His hypocritical claim of extreme devotion to the value of life is not reflected in his invasion of Iraq. He does not know how many Iraqis died as a result of his endless war. Fortunately, with Democrats in control in January the next priority is to approve funds for stem-cell research. If Bush-43 tries a veto there will be enough votes to overcome his decision.
An interim system before a completely new global medical plan is designed, would be for the United Nations to reclaim its original promise, that is to act on behalf of the people of the world by making stem-cell research its priority. It could bring together the best medical scientists in the world, equip laboratories with the latest technology and expert staffs. Another plan could be to join forces with California governor’s Schwarzenager’s state-funded stem-cell research.
There would be no greater benefit to the world economy than the investment in the health and welfare of all of the people. Beginning with health care for poverty-stricken continental inhabitants, an entire cycle of survival would evolve into a huge marketplace administered by healthy people. Their energy will consume all manner of goods and services, recreation, and funds for preventative health care and any medical emergency.
At the same time, groups such as Doctors Without Borders, should form continental training programs to establish hospitals, clinics and medical schools for qualified graduates of secondary schools as described in the Chapter - Education. This is not a monumental task, as buildings and palaces when no longer needed to house government bureaucracies and monarchs as described in the Chapter - Governments, will be transformed into health care centers.
For decades it has been an issue that arises in Congressional hearings around the time that national elections are about to be held. The solution for national health care is to provide all uninsured citizens with at least the same Medicare plan as that for the elderly. Payment for premiums could be deducted from their wages or earned income, just as withholding taxes and contributions for social security.
Medical malpractice insurance poses a serious problem. Harking back to 1768 in England, damages were paid for injuries caused by the neglect or lack of skill of physicians and surgeons. Abraham Lincoln brought suit on behalf of a client against a medical imposter in 1851. In 1923 medical insurance cost $10 per year. It did not pay damages but provided legal assistance. In 1930 the few malpractice suits were largely from complications of the use of x-rays.
Malpractice insurance rates have increased more than 1000 percent. In 1972 insurance coverage collapsed and malpractice went from $3,500 per year to $35,000. Many insurance companies were dissolved. Doctors placed signs in waiting rooms informing patients that they did not carry malpractice insurance in order to keep their fees low.
The powerful American Medical Association has been lobbying for caps on damages, for which the Bush administration has been seeking legislation. Patients do not have much sympathy for doctors’ insurance costs because they feel that they should have been policing their own bad doctors and are aware that many doctors are stockholders in insurance companies. Nurses, however, who are underpaid for their hard work and long hours, also carry malpractice insurance because of the current rush to sue every one who might bear responsibility for damages as a result of malpractice.
What is needed is a solid plan for continental health care with exchange treatments that might be more advanced in one country, and specialties further advanced in another.
A planetary and continental system could be a marvel of combining and exchanging research programs, as well as doctors exchanging patients from continent to continent when equipment and treatment better suits the patient. New technology and instant communication is already working, so that whole groups of people needing care on one continent can be treated by a doctor on another continent. It would be a matter of re-organizing hospitals so that each tier has a specific part in the scope of all medical care.
Some doctors in the U.S. are returning to making home calls. Others are establishing what are called “concierge” privileges which limits their practice to the more affluent who pay an annual membership fee for a specified number of visits.
Interestingly, in China doctors do not have separate offices. They are hospital staff and when medical attention is needed, patients go directly to the hospital. Pre-natal care is provided as well as pediatric services. Insurance programs are available through government employment agencies. Advertising for insurance programs can be seen on billboards in Beijing.
The idea of continental plans should not be difficult to implement, considering that wealthy people have been coming to America and Americans going to Europe for treatment for many years. Nowadays many Americans are going to other countries for less costly excellent treatment, and at the same time enjoy a vacation abroad. The ultimate goal is a global system for health care of all of the people.