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Last spring, Democrats won a long, politically damaging fight with Republicans to enact a national healthcare reform bill. It is known by many as Obamacare, after the name of our president who pushed so hard to get it passed in the House and Senate. Although his party controlled strong majorities in both chambers, there were Democrats who did not want to vote for such a contentious bill during an election year. Their concerns proved warranted – at least initially – as Republicans destroyed Democrats in the 2010 mid-term elections.

I supported reform at the time and I still do, albeit with a bit less enthusiasm after the public option and a national insurance exchange were left out of the final law. They were in the House’s version of the bill, but the House eventually passed the Senate version, with modifications, because Democrats in the Senate lost a filibuster-proof majority when Republican Scott Brown won Ted Kennedy’s Senate seat in a special election in Massachusetts.

When the legislative “sausage making” process was over and Obama signed his healthcare reform bill into law, it looked like little more than a government welfare program with subsidies to most Americans so they can buy quality insurance at a reasonable price.

However, there is much more to the Affordable Care Act, and I am not speaking of the numerous gimmicks like allowing children to stay on their parents’ insurance until age 26 or filling in the donut hole for prescription drug coverage under Medicare. What this law does is it gives the federal government control over healthcare. In the Affordable Care Act itself, that control is exercised primarily over health insurance coverage. But the Act provides a framework for the federal government to easily exercise authority over other facets of healthcare at a later date through additional legislation or administrative rules.

This may sound unnerving to anyone who does not implicitly trust the judgment and discretion of our national government. Let me ask you a question. What other body is there in the United States that is large enough to solve the problems of our mammoth, disorganized healthcare system?

Now that Obamacare is law, the federal government has the power to try to solve a lot of the problems in healthcare. The first of these problems is the unfairness in our insurance markets, which the Affordable Care Act addresses nicely come 2014. Other equally important, and closely related, issues include rising healthcare costs, physician shortages, and hospital errors. Those are not adequately addressed by this Act so they will have to wait for future legislation or executive orders.

Of course, I must conclude by mentioning that while our government is doing what it can to address financial and administrative concerns in healthcare, we will accomplish the most good by reforming the medical profession itself. I believe there is a medical revolution on the horizon, and I encourage you to be a part of it.

Alexander Typaldos

I urge all of you who support healthcare reform to write your U.S. representative and senators. You should write even if you do not support reform, because that is how the system works. Of course, political forces can do only so much to reform healthcare, but it is a good start.

Our representatives are facing a lot of pressure from interest groups and need to know they at least have the support of their people at home. Here is the letter I sent to my congressman:

Dear Fred Upton:

Alexander Typaldos

It is easy to point out what is wrong with healthcare. It takes somewhat more thought to discover why those problems exist, and still more thought to make policy recommendations about how to solve the problems. Here is such a recommendation, one that will improve healthcare financing. If your agenda is to shrink government, you will dislike this proposal. If your agenda is to enlarge government, you also will shun this proposal. However, if your agenda is to create a system that works for most Americans and is sustainable in the long-term, you may find merit in this plan.

Auto Warranty

Health insurance is more like a car’s warranty than auto insurance. Third party liability, as exists in auto insurance, is not envisioned in health insurance. It offers only the equivalent of “collision” coverage, which covers damage to your own vehicle in an accident without regard to fault; plus a warranty covering damage to parts and systems during normal use.

There are two types of car warranties: powertrain and bumper-to-bumper. Powertrain warranties cover the engine, transmission, and drivetrain – the components necessary to “power” your car. Bumper-to-bumper warranties cover almost everything, including the powertrain.

Powertrain Health Insurance

When discussing health insurance, it would be useful to differentiate between “powertrain”-type health insurance and full “bumper-to-bumper” health coverage. Here are definitions of the terms:

Definition of Powertrain healthcare: insurance covering treatment to a person’s vital organs and systems if it is necessary to maintain the person’s life and basic functions.

Definition of Bumper-to-bumper healthcare: insurance covering the full spectrum of non-elective treatments that are reasonably expected to improve a person’s quality of life.

Details can be worked out. We may want to include treatments for Type I diabetes but not Type II, for example, in powertrain coverage. For the broader purposes of this article, the category of treatments now considered “medically necessary” is being split into two categories, vital and non-vital. These definitions disregard whether a condition is an emergency. This means regular ECGs are more likely to be covered than a fractured ankle under a powertrain plan.

Role of the Federal Government

Powertrain issues – heart problems, cancer, stroke, Alzheimer’s – destroy lives, put people out of work, and bankrupt families. This area is where Americans need help from their government. Limitations on treatments for life-threatening and disabling conditions are more often a product of availability than price. Therefore, the quality of care has little to do with who pays.

The U.S. government should provide powertrain coverage for all Americans. However, it should leave additional bumper-to-bumper coverage to businesses and individuals if they so choose. It should also make self-insurance for bumper-to-bumper conditions a viable alternative.

Big Government versus Small Government

Here is an enduring debate between fiscal liberals and conservatives. Each side would love to savor the taste of victory. Unfortunately for both sides – and perhaps fortunately for our nation – this debate is unwinnable.

Usually, when two sides are deadlocked or engaged in a back-and-forth over long time periods, it is because neither side is addressing the real issue. The question to ask in this debate is how big does government need to be to fulfill its role effectively? The size our government needs to be is the inverse of the private sector’s effectiveness plus the square of its corruption, written in the formula: Size of Government = (Size of Overall Economy – Private Sector Effectiveness) + (Private Sector Corruption)².

Corruption is squared because as it increases, it is seen as more acceptable; and there is less will within the private sector itself to discourage and expose corruption. Of course, this formula applies to government involvement in the economy only, not in social or foreign policy matters.

Problems with National Health Coverage

What turn off many Americans are anecdotal complaints from citizens of nations having a form of national healthcare. Most of these complaints center on two problems, rationing and lack of choice. The problem of rationing is really a blessing in disguise. When people think that if they become ill they can have access to quality healthcare, they are not as inclined to care for their bodies. This concept is no doubt unpopular, but it is established truth in the insurance industry. Rationing is therefore desirable in a national health plan.

Lest anyone think rationing healthcare is totally unacceptable in a modern society, understand that if we do not control rationing, the system will ration itself – and it may not be in a way that we would prefer. Healthcare’s growth as a percentage of GDP is unsustainable. Soon society, including the federal government, will no longer be able to pay, and services will diminish. And even now, the idea that Americans with health insurance have ready access to quality care is a myth. Many Americans hold onto this myth until they or a family member becomes ill. It is then that the reality of healthcare’s limitations becomes apparent; and oftentimes, prevention offers no second chance.

A Pro-Choice Policy

Perhaps the most important healthcare choices are vital in nature. However, on a practical level, the choices Americans really care about are in non-vital matters, such as who their family doctor is and whether they get access to new medications. Life and death matters requiring procedures such as kidney dialysis, appendix removal, and insulin injections are not what they think of when asking for more healthcare choices.

This proposal preserves these choices by limiting government-sponsored healthcare to matters of vital importance, where there is general agreement about proper methods. This broad outline leaves room, as well, for building choices into a government insurance plan.

Perfection is out of reach

While it is utterly impossible to develop a system that satisfies the desires of all Americans and interest groups – so long as corporations profit from bad care, and Americans live dangerously unhealthy lifestyles – it is still quite easy to create a system better than the one we have now. Therefore, you should view this proposal as a new perspective; a different, and perhaps better, way of seeing the issues. This is not a quick fix. Anyone who tells you they have found a quick fix to healthcare is lying. There are just too many factors to consider.

The foremost factor in healthcare reform is the false, illogical theories upon which the medical profession is based. Until medical theory and practice are reformed, tinkering with the financial and business aspects of healthcare will accomplish little. This does not mean we should replace “conventional” medicine with “alternative” medicine. Nor does this mean we should take the best of both schools and form hybrid practices. Rare is the person who does not subscribe to one of those two camps. Alternative or “complementary” medicine is no longer a catch-all category for rejected methods. Instead, it has become a defined, competing branch of medicine; sadly, with illogicality similar in degree to that of conventional medicine.

Instead, what this means is that we should set aside ambiguous studies and marketing claims, and go through the evidence – studies, patient testimonies, physicians’ observations – with an eye for correlations among facts. Patterns of correlations can be used to theorize. Then we test those theories, not only with double-blinded placebo-controlled studies, but by logical, rational, and reasonable analysis. Are patients responding the way we would expect them to? Are there any symptoms that cannot be explained by our theories?

Tested theories are truth. They do not become truth because truth was present already; it was found, if you will. Various truths can be placed within a framework and cohered. When there are enough truths known in a particular branch of medicine for them to present as a mental image, they can be intellectualized into working models. Such are a physician’s most valuable assets. Technology, formal education, facilities, and skill are dwarfed in significance when compared to reliable medical models that explain why patients get sick and suggest what needs to be done to help. Penicillin would have been useless without the germ theory; or never discovered in the first place.

Many of the treatments in both conventional and alternative medicine are working for reasons other than the ones physicians think. Conversely, treatments physicians claim will work do not for reasons they cannot explain. This indicates, to those who are analyzing evidence logically, rationally, and reasonably, that their models are incorrect. All this talk about truths and models might appear abstract and even irrelevant. However, the Fascial Distortion Model reveals that once physicians correctly understand disease and injury processes, successful treatments will naturally follow. Models, theories, and philosophies ought to be discussed and debated openly, for they are the gems of healthcare reform. Financing is the gold in which they are set.

Automotive Safeguards

Here in Michigan and in other states too, auto repair shops are required to present a written estimate of repair costs. This law prevents an awkward scenario where a car owner discovers, to his dismay, that charges are far higher than he expected. A similar law would be nice in the healthcare industry. Granted states do have laws requiring doctors to post their office visit fee schedules, but this applies primarily to out-patient care.

When it comes to emergency and in-patient care – and prescription medications – patients can do little more than cross their fingers, hoping the hospital bill is not as bad as their reason for the visit. The argument for “surprise billing,” presumably, is that the patient’s health is more urgent and important than financial matters in a crisis. This may be true, but anyone who has gone to the Emergency Room with anything less than an immediate, life-threatening condition will tell you they always find time beforehand to check your insurance.

It is a principle that systems operating behind closed doors are easily subject to corruption. In the healthcare industry, openness is compromised not only by entrenched interest groups, but by the system’s sheer complexity. It is well nigh impossible for any single entity other than the federal government to oversee it. This is not to say the government is unsusceptible to similar corrupting forces. Therefore, a form of national healthcare such as powertrain coverage should be seen as merely the beginning of reform; logical, rational, and reasonable medical models as the end.

Alexander Typaldos

At the center of the healthcare industry lies a corrupted system that is the source of innumerable troubles. That core is the medical profession.

Medicine underwent a period of growth, reform, and cohesion in the latter part of the nineteenth century that formed the medical profession of today. Newly transformed, during the first half of the twentieth century medicine used advances in technology and industry to cure infections and injuries that had been previously untreatable.

Unfortunately, the medical profession failed to adapt itself to a new wave of epidemics surfacing during the second half of the twentieth century. It had served the profession well to use drugs as weapons against a deadly array of pathogenic infections. However, medicine did not change its tactics to meet recent challenges of lifestyle- and pollutant-related illnesses.

One might wonder why a profession that prides itself on being modern has stubbornly resisted change. The answer is that there is no good reason why physicians abandoned rational thought and adaptability, but there are reasons:

1. Self-preservation. Physicians fear that fundamental changes in the practice of medicine could limit their viability, jeopardize their livelihood, and require further educational pursuits.

2. Self-esteem. Too many physicians have sacrificed their families, friends, and identities for the sake of their practices. Having failed in every other area of life, emotionally it is unthinkable they have also failed in the practice of medicine.

3. Indoctrination. Strange though this sounds to the outsider, a cult-like mentality prevails within the medical profession. Members are expected to believe the tenets of medical philosophy and not think for themselves. Most American physicians are competitive, ambitious professionals who long for approbation and acceptance. Only a rigid framework of universally-held “doctrine” provides them with a concrete measurement of their achievement.

4. Unholy alliance. Why do physicians willingly cater to the business interests of pharmaceutical corporations by prescribing expensive and unnecessary medications? Drug companies ensure physicians keep their niche as gatekeepers of the medicine cabinet (see reason 1, above); drug representatives are readily available as buddies to physicians on a personal level (see reason 2, above); and drug companies determine the “standard” in medical care (see reason 3, above).

What is notable is that all these reasons have to do with the physician and none have to do with the patient. Physicians have subordinated patient results to their own interests, including their desire to feel like they are helping patients.

The profession has become so corrupt and ineffective that there is a trend toward marginalizing physicians – replacing them with nurse practitioners, physician assistants, physical therapists, nurse anesthetists, and online pharmacies. Healthcare’s rotten core must be either repaired or replaced. In other words, to reform healthcare we must also reform medicine.

Alexander Typaldos, JD

Yesterday, I ordered a personal computer with impressive specs. Featuring the new Intel® i7 processor, this system has high quality memory, hard disks, graphics, and optical drives.

It is about time for a replacement. My current pc is almost three years old, and was low-end even when new. I tried upgrading it with a new memory stick and video card, and they made the system usable . . . for a while. The problem is that when I upgraded one component, another needed to be upgraded to match, or the first could not achieve optimal performance. Eventually, limitations such as a weak power supply and outdated slots on the motherboard thwarted my upgrade ambitions.

Thus, I was resigned to purchase an entirely new system – one that is truly capable of accomplishing my demanding tasks of graphics and video editing. The components to the new pc are so superior to the old pc’s that it would have been impossible to upgrade to this level, one piece at a time. Progress required an entirely new system.

High Technology is Fun

I can easily see why careers in computer science are so popular. We are now deep into the technological revolution, where we can enjoy the practicality of many current innovations while still eagerly awaiting the next advances. High tech is a very positive field, with frequent and measurable improvements.

On the other hand, medicine as it once existed is a dying field. True, physicians still have numerous job opportunities and large salaries. But decisions about how physicians practice have fallen to third-party medical researchers, pharmaceuticals, HMOs, insurance, government regulators, and even malpractice lawyers. More disappointing than this, most doctors are deprived of seeing consistent, measurable results from their treatments – the kind of positive results tech professionals are accustomed to seeing in their line of work.

The tech field is not without problems, mentioning corporate monopoly tactics, product incompatibilities, and computer gaming addictions. However, these problems are of a type that is common to humanity. Medicine’s problems are of a different, more fundamental nature.

For example, Advanced Micro Devices (AMD) and Intel each design distinct central processing units, but they are in agreement that a successful processor design is faster, smaller, consumes less energy, and is compatible with other hardware devices. However, the healthcare industry is devoid of basic consensus as to what constitutes good, quality medical care.

Are doctors judged by their results, how personable they are, whether they can avoid malpractice claims, or how many patients they see? Is a good physician one who simply manages patient complaints cost effectively, or one who uses more resources but actually cures patients’ conditions? Should doctors try new treatments or stick to the book? Who is writing the “book,” anyway?

America’s Medical Revolution

Many Americans believe we have already undergone a medical revolution of sorts. After all, it was but a few centuries ago that bleeding – the barbaric process of removing large quantities of blood to free the patient of supposed evil vapors – was standard medical care.

True, there have been great advances. But those advances are largely the byproduct of industrial and technological advances. Of course medicine will improve when it gains access to the microscope, life support equipment, biochemical and genetic research, and diagnostics technologies such as MRI. These are advances in medical technology, not medicine itself.

If you look at medical philosophy 100 years ago, you will find surprising similarities with medicine today. Back then, doctors administered dangerous “medicines” like opium and mercury to change their patients’ biochemistry and make them look, act, and feel better. Thankfully, modern science has replaced those drugs with much safer and more effective ones, but the medical profession uses these new drugs in the same way.

This idea that we ought to take medications that reduce symptoms is outdated. Fever, runny nose, even vomiting and diarrhea are the ways our bodies kill germs as well as remove the wastes and toxins those germs create. When we suppress symptoms, in effect we suppress our immune response and increase long-term physiological damage. This is a major reason why so many 40-year-olds are weak and in pain. Aging is not the cause; these people are wearing out.

Physicians have lost control over their profession because, overall, they have failed to meet society’s demands for quality, affordable care. Granted, society can be very demanding, but when doctors claim that IBS is neither caused nor worsened by a poor diet, it is difficult to take them seriously. When physicians habitually treat depressed and mentally ill patients psychiatrically, without considering the neurological or hormonal implications, then society – in the form of its businesses and regulatory officials – must step in and look for ways to reduce the burdensome cost and improve patient outcomes.

Opportunity in Difficulty

I view the medical profession’s decline with great optimism. Although I highly respect physicians, I think the profession needs a complete reformation. Doctors will not reorder their profession voluntarily; it must be forced into something akin to bankruptcy.

Alexander Typaldos, JD