Health Literacy – A Cry for Universal Health Care

Health care is now a business that rivals the industrial complex. Its major consumers are victims of lopsided capitalist principles that exploit weaknesses within our educational systems – mainly literacy. If literacy is at an all-time low in this country, health literacy must be virtually non-existent. But what does this mean? And more importantly, why should anyone care? These questions are made complicated by arguments that weave a moral blanket of hypocrisy which does not provide comfort – let alone security - to those most impacted by a poor health infrastructure. That is, too often we blame the sick for having sickness and the uneducated for not knowing when the real cause of either or both is mis-education combined with quests for power and, ultimately, control.

Literacy is not merely the act of reading and comprehending fragments of generic knowledge. It is a tool for understanding the constellation of knowledge that shapes our views of the world and defines our positions in it. Understanding who we are in terms of how our bodies work optimally is essential to securing a competitive advantage – particularly in a free-market economy. However, large swatches of the US population are disproportionately denied basic health needs such as potable water, adequate shelter, and access to basic health care - they do not have insurance or they have inadequate insurance which is poorly defined and, therefore, subject to intricate loopholes. The health literature is replete with epidemiologic data illustrating the link between access to basic health needs and illness while the health economic literature highlights the impact of sickness to the work force and societal growth. So wouldn’t it make sense to promote and support a healthy society if for no other reason than the well-being of our economy and securing a prosperous future? It does to me.

However, in order for this to happen we need to eliminate the barriers to access which includes class-based health insurance and, more importantly, advance a comprehensive education about the relationship of personal health to societal development. Yet, too often, we exert power by enacting laws on the basis of a sense of moral superiority; and we use oppressive means to control basic needs. This is best exemplified by the gross amounts of narcotics and pharmaceuticals that act to subdue harmless physiologic impulses and abolish the most basic human right – the right to health (as defined by the World Health Organization). Or, perhaps it is the intention of the powers-that-be to keep certain people ignorant and weak from poor health. What better way to control people than to continuously exploit their vulnerabilities while making them dependant on small acts of welfare disguised as generosity?

Five Misconceptions About Health

Here's a brief summary of an article Shannon Brownlee and Ezekiel Emanuel wrote for the Washington Post (reprinted in the Minneapolis Star Tribune):

1. America has the best health care in the world.


Let's bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name.


2. Somebody else is paying for your health insurance.


Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.


3. We would save a lot if we could cut the administrative waste of private insurance.


The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn't really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Tracking the rate of heart attacks from drugs such as Avandia, for instance, is key to ensuring safe pharmaceuticals.


4. Health-care reform is going to cost a bundle.


Only if you think that covering the uninsured is our only priority. Yes, making health care available to all citizens is the right thing to do. But it isn't the only thing to do. We also have to fix the spectacularly wasteful and expensive way doctors and hospitals deliver care.


5. Americans aren't ready for a major overhaul of the health-care system.


A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.

I strongly suggest everyone go and read the full article. It's not terribly long, and it offers some pretty eye-opening information. For example, did you realize that the average family of four spends $29,000 a year for health care via taxes, lower wages and out-of-pocket medical expenses? While I knew it was taken out of wages, taxes, etc, I had no idea it was that high.

A lot of these things are part of the broader discussion I've seen in comments on this and other health blogs, so they're worth considering as we go into what will hopefully be a new era of health care in America.
-Kelly Hills

Patient Responsibility for Medical Outcomes

Universal health care in the U.S. would be a step in the right direction toward solving some of our many problems in the area of costs and delivery. One of the numerous pressures on costs are malpractice and negligence lawsuits. Physicians pay astronomical liability premiums. A significant portion of hospitals' budgets is spent on in-house legal departments. All health care providers and facilities are at risk in our litigation-happy society.

The ideal doctor-patient relationship is a partnership. Ultimately, both parties need to agree to participate in the care rendered. Patients should hold up their end of the bargain and refrain from suing their doctors at the drop of a syringe. Tort reform regarding medical practice would provide significant relief. For example, an ombudsman-like system of board review could be implemented. If a physician's actions were deemed to have met the standards of care in her specialty, a potential lawsuit against her could not go forward. Such a system could address both malpractice and negligence.

Cost savings would be enormous and would impact bottom lines across a broad spectrum of agents and agencies. Federal, state, and local resources would be freed-up from costly courtroom expenditures on wasteful medical litigations.

In a groundbreaking example of high-level support for such proposals, the U.S. Supreme Court ruled on 2-20-08 that "makers of medical devices like implantable defibrillators or breast implants are immune from liability for personal injuries as long as the FDA approved the device before it was marketed".

A case involving similar preemption for FDA-approved drugs will be heard by the Court in its next term.

This is a welcome trend, both economically and socially. The concept of personal responsibility has been battered and broken-down in the U.S. for many decades. "It's not my fault", people claim. "Twinkie's made me do it." Yes, a doctor prescribed a drug. Yes, a medical device was used. Yes, that drug or device had a manufacturer. But the patient agreed to treatment. Medicine is an art. There are frequent unexpected outcomes. Of course, we want to uphold best practices. Given best practices, lawsuits in medicine are inappropriate and need to be reined-in.

Manufacturers of defective products will still be liable. However, quality control is not a 100% guarantee. One malfunctioning device in an otherwise successfully deployed lot should not be grounds for a multimillion dollar lawsuit. Risks need to be shared. Full disclosure and informed consent are the tools to make these lawsuits go away.

Likewise for drugs. It seems obvious that the bottom line for global pharmaceutical companies is stock price and shareholder value rather than patient welfare. It may be that ultimately, in many cases, reliance on pharmaceuticals is misguided. In Global Pharmaceuticals: Ethics, Markets, Practices, Adriana Petryna and Arthur Kleinman describe the American "fetishization of pharmaceuticals" and the "pharmaceuticalization of certain disorders".

On 2-15-08 the FDA proposed new guidelines that "would allow drug and device makers to provide doctors with copies of medical journal articles" that discuss off-label product uses. The rules also say "drug companies do not have to promise to adequately test the unapproved use discussed in the article".

These proposed guidelines represent a radical sea change in policy. On the surface, they seem to pander to the desires of big pharma. This seems very problematic. On the other hand, FDA approval is not a guarantee of development of significant side-effects, as with the COX-2 inhibitors such as Vioxx.

The reality is that most drugs are not magic bullets. The playing field has shifted. Patients need to be protected, and that protection is best offered by regulation and information. But our regulatory system seems badly broken, and off-label usage may provide great benefit. Or it may not.

Medical risks need to be shared. Patients are not merely consumers. They are obligated to do their best to make informed choices. On the other hand, physicians need to clean-up their questionable relationships with drug manufacturers and drug representatives.

We want a health care system based on best practices, not based on most money.