I caused the problems with the healthcare system.
End the fighting, name calling, and unruly behavior at town hall meetings. Enough!
I accept full blame and responsibility for a disjointed American healthcare system and the misuse of the talents and competencies of physicians, clinicians, hospitals, health systems, insurance companies, and more. Healthcare reform has shifted from discussion to disaster throughout the United States. Accusations of being un-American, town halls disrupted by LaRouche followers with Nazi symbols waving in crowds, and cable news revved up with special titles and graphics have replaced a journey toward common ground.
I was raised to honor and respect the notion of guilt therefore accepting blame for the healthcare system is relatively easy. This philosophy was honed by nearly thirty years of marriage, raising two adult sons, and fifty years as a son. In the case of the state of healthcare in this country, there is no question that the lack of cohesion, disjointed sites of care, over testing, and a ragout of business models stems from me.
My case for responsibility to very basic. At the outset, I have been morbidly obese the majority my fifty years. My father, who also was morbidly obese, often was asked what the least amount he ever weighed was, to which he responded “9 lbs. 5 oz.” That was the beginning of using humor in lieu of dieting, words rather than weights, clothing from the end of the rack or stores for “big and tall” instead of tailored and slim cuts.
The case gets stronger considering most individuals find morbidly obese as lazy. Behind snickers, chatter, texts, and the look on teenager’s face when they realize they have to select the overweight out of shape kid for his team – there are no others left, is a notion that if s/he would simply care about themselves or their family they would lose the weight and the co-morbidities in their life.
My reasoning for accepting the blame is as follows:
1. I have always been insured, initially within my family plan and now through my/spouse’s employer. For me, healthcare is a right and not a privilege. I have made emergency department visits in the middle of the night because the physician office was not open. I have avoided going to the physician because of what I might learn. Several years ago I had chest pain which was diagnosed as angina — the cause was sleep apnea. As the physicians were explaining what was wrong all I heard was, “at least it’s not my weight.” The result of my lifestyle and behavior is an assumption care is immediate, pharmaceuticals are solutions, and a physician visits should cost my co-pay.
Reform leaders point to coverage as a key ingredient in plans; Massachusetts is touted as the model. In 2009, roughly 2.6% of the state’s population is uninsured. While the variety of plans offered resulted in large risk pools (and corresponding lower premiums), healthcare costs overall have increased more rapidly than anywhere else in the nation — Massachusetts spends 33% more per person than the national average.
2. I am an educated, informed shopper. Thanks to the Food and Drug Administration (FDA) mandate that packaged and processed foods include Nutrition Facts panels. Selections are based on fat, type of fat, sodium, hidden sodium, calories, and more. I believe portion sizes were developed by consumers with anorexia or unable to see. I have an undergraduate degree, two master’s degrees, considered relatively bright; yet, when it comes to counting portions, adding calories, or mixing food groups my understanding and learning is at an elementary school level.
3. The medical home model is not new for me – I want my physician to be my medical home. Understanding the current definition of the medical home includes becoming more clinically effective and economically efficient, as a consumer my objective is simply to feel better when and how I want. Unlike the Geisinger Health System that has a team-based model of care including aggressive use of nonphysician professionals and home-based monitoring technology, my primary care physician is employed by the health system, includes his nurse, and has an EMR but no ability to communicate by email with me. Like the Group Health Cooperative in Seattle, the medical home is based primarily on primary care physicians with small panel sizes; I rarely have an extended wait or short appointment time. The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) want me to base my decision (and relationship) on the philosophy that “each patient has an ongoing relationship with a personal primary care physician (PCP) who provides first access and comprehensive, easily accessible care.” My value for my primary care physician is being directed to specialists when needed, not being overmedicated, and a tough bedside manner.
4. My employer provided incentives for healthy lifestyle, fitness activities, coaches, and a robust health plan. None of this pushed me to live a healthier lifestyle. The first time I went through the screening, staff taking my weight looked up and uttered, “Looks like we aren’t getting our $5 for weight.” She was correct; all I could think was this underage, malnourished waif was exceptionally rude, stating the obvious, and I didn’t want that $5 anyway.
I signed up for a coach. She called at the oddest time of the day, asked silly questions about eating habits and exercise, offer a preverbal “go to it,” and a fast paced when do you want me to call you again. There was no encouragement, no understanding of what I was going through, and no recognition that this was tough. The second year there was no coach.
The program was started based on research, analytic evidence, and good intention. These are three characteristics that are very important. The program was underfunded, understaffed, under informed – but my risk factors, lifestyle, and behavior were over norms.
5. My sons are overweight and when looking at a family picture all but one share the same malady. I shared a joke from my father at the beginning; he died over thirty years at age 48 following an error during surgery – bariatric surgery. My father had diabetes from his weight, vision problems from the diabetes, hypertension, lacked any exercise routine – and died from surgical weight loss. Within the family ranks were those who smoked cigarettes, addictions to alcohol, mental health issues – elements found in all families.
I swore that the lifestyle would stop with my generation. I have not been the role model for good health habits for my sons; yet, consistently hoped it would be different. We signed up for sports, had heart healthy food among foods, spoke about do as I say and not as I do. At one point my mother looked at me following my monologue about the kids’ health and said, “And what limb of the family tree did they fall from?”
That is my case. I hear and even repeat messaging that I don’t live up to. My habits are far from heart healthy. Instead of breaking the cycle I became a link in it. I want my care now, delivered how I want it and when I want it. Pills and surgeries can handle almost anything. I will start my change…tomorrow.
Healthcare reform is all about creating a care delivery system, creating access for everyone, questioning the need for some services while implementing programs to insure services. Palliative care is not a death squad; home testing is not the end of one-to-one relationships.
A couple of years ago I decided that enough was enough and began a serious attempt to change. A diet was started, supported by some pharmaceuticals, and exercise became a hobby. As my nieces say – a big shout out to my internist, James Kluzinski, M.D.; it was his pushing, tracking, listening, tough bedside manner that helped me lose about 115 – 120 lbs. I remain an addict and will forever be an addict. When stressed I search for food. Food is consumed during down periods when hunger is absent. Each time I fall flat, it starts all over again the next moment. I can see the end of the journey and now wonder if it was too much too late?
The debate in Washington, and potential for a healthcare reform bill, is only the beginning of a cultural change required by everyone in the nation. I recognize the part I have played in creating American healthcare…have you?
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