Tuesday, August 18, 2009

Health Care Reform

Famous ancient Chinese physician Hua Tuo

If you follow the news at all, you've heard something about this "health care reform" thing people seem to be all excited about. You've read the editorials, you've seen the politicians speechifying. Maybe you've seen the video clips of people shouting things like "We are ALL afraid of Obama" and crying things like "I want my country back!" (What does this have to do with health care? I don't know either.) You've heard the phrases "death panels" and "public option".

So far the debate seems to be framed as "Health Care For All - For or Against?" People on both sides loudly declare the other side stupid, or evil. I'd like to point you towards a voice that asks us to focus on a different aspect of this whole debate - the very nature of the medicine that people either want to extend or not extend to the whole country.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly. -Dr. Andrew Weil: The Wrong Diagnosis at the Huffington Post

This is an extremely important point. The health care system is broken, and getting the last 40 or 50 million uninsured Americans into this same system is not going to improve the health of our nation.

It reminds me of a story I heard during my TCM (traditional Chinese medicine) education. There was a doctor in ancient China who became famous for saving lives. He could cure diseases in their most advanced state, when a patient was near death. Everyone called him a genius, some even said he had magical powers.

The doctor laughed when people praised him. "My skill is actually quite low. I can only cure disease when it has gone nearly out of control, and I have to use severe herbs and acupuncture techniques. I have two older brothers who are much better at medicine than I am."

Of course people went in search of these brothers. When they found the middle brother he said "I'm still not very good at medicine. I can only catch diseases in their initial stage. I still have to feel the pulse and look at the tongue before prescribing mild herbs and acupuncture. If you want to know real medical skill, you should find our eldest brother."

Of course the people went to search for this wonder-worker. When they found him he said "When people come to me I use neither acupuncture nor herbs. I do not feel their pulse or look at their tongue. I diagnose them by observing the color of their face and the tone of their voice. I tell them how to eat in accord with the seasons and their locations, and sometimes I give them some simple exercises to do. However, if they could sit quietly every day and listen to the natural wisdom of their own body they would not even need my advice."

The eldest brother was the only one practicing real health care - the other two were doing different forms of disease management. Of course we can't abandon those who are already in advanced disease states, but we should put equal and perhaps even more emphasis on encouraging health - what the chinese call 養生 Yang Sheng or "nourishing life."

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