A Brief Introduction to Integral Medicine: Part One

I met a woman recently who had been insured by Anthem for twelve years. Within three weeks of her diagnosis of a brain tumor, Anthem notified her that they would no longer cover her. Can you imagine having to deal with the news that you have a brain tumor then have your health insurance yanked out from under your feet? This happened to her in 2010. Luckily, she’s survived her brain tumor and now Obamacare has made such reprehensible behavior by health insurance corporations illegal. Obamacare patches up a few things but Conventional medicine still has a terminal illness. If not for the dedication and humanity of most of the people working within that sick system, it would have collapsed long ago. Doctors, nurses, pharmacists and the like are carrying the burden of the healthcare system on their backs, but they are burning out at an ever increasing rate. We can’t keep propping up Medicine while medical corporations continue to run amok.

I don’t need to elaborate the symptoms of Medicine’s illness, we know them all too well: the run-away costs that are breaking the financial back of the industrialized world; going to your conventional doctor for treatment is now the third leading cause of death in the US; we spend the most per capita on our healthcare yet we rank around 40th on most measures of health, such as infant mortality and such; millions of people are uninsured…the list goes on.

We all know the symptoms of the disease. People are proposing solutions that attempt to treat the symptoms. No one is talking about the cause. Changing the way we pay for healthcare will not cure the system: that just treats some of the symptoms. When I look at the healthcare crisis, I see two causes: 1) the corporatization of healthcare and 2) the science upon which medicine is based. In this blog, I want to address the latter and come back to the former.

Clinical Medicine is not a science. It is a discipline based upon a science. Doctors are fond of saying that the practice of Medicine is both an art and a science. They are flattering themselves: the clinical practice of Medicine is engineering. The practice of medicine is not science. When that anesthesiologist is putting you to sleep, you hope the science has been done and that he’s not experimenting on you. And art is…well, how do you define art? Engineering can be defined as the artful application of scientific principles toward the solution of problems. And that is definitely what most doctors want to do with their patients if the System would just let them (see previous blog posts).

The problems that Medicine is trying to solve are those of human disease and suffering and the creation and maintenance of health. Medicine needs to be based upon a science that is appropriate to the task. The science upon which Conventional medicine is based is too limited to encompass all of human experience. Yet we have good data to support the idea that all of human experience impacts health. We need a medicine that is based upon a broader science, one that can explore all of human experience, not just the physical, biochemical level or our experience.

Integral Medicine is based upon such a science.

The purpose of science is to understand Nature (so that we can ultimately bend her to our will.) Over time, the discipline of science has developed a strategy, called the Scientific Method, which is arguably the best method we have for sifting out the truth from a lot of different possibilities. The Scientific Method is not perfect, for it is performed by human beings. But, when followed properly, it is self-correcting. Interestingly, a method of inquiry akin to the Scientific Method is one of the seven classical pathways to enlightenment.

The Scientific Method has several defined steps that we are all supposed to learn in High School science classes. The first step is to pick some part of Nature you want to study, for example, an ant hill. The next step is not mentioned much but is more or less assumed: look through the published literature and see what others have already learned about ant hills. The next step is to observe an ant hill and collect some raw data. Then you look at the data and try to make some sense out of it. You propose a theory that tries to explain as much of the data as possible. Here is where it gets interesting.

Since we don’t know Nature, we need to propose a model of Nature, or at least of that aspect of Nature that we’re studying (scientists are still working on a Unified Theory of everything). The model, by definition, needs to be a simplification of Nature. In order to make that simplification, we must make some assumptions, usually called “simplifying assumptions”, about our system of study. Every scientific discipline has its model. Conventional Medicine, for example, has its medical model.

Ideally, your theory fits within the current prevailing model for that scientific discipline. On rare occasions down through history, Science has had to make major modifications to foundational assumptions underlying the predominant model and a Scientific Revolution ensues. (http://www.amazon.com/Structure-Scientific-Revolutions-Thomas-Kuhn/dp/0226458083) But this is rare. The bulk of scientific work entails discovering new and useful details that help to “flesh out” the prevailing model.

So let’s assume that your theory about your ant hill fits within the prevailing model of life currently held by most biologists. The next step, then, would be to pose a question and make a prediction: “If I dropped some bread crumbs here, this is what I expect the ants to do.” This is called developing an hypothesis. (If this is triggering PTSD from your high school science class, I apologize. I’m laying a foundation to get to my point.) Once you construct your hypothesis, you design an experiment to test your hypothesis. In your experiment, you have to try to anticipate and adequately control possible confounding variables, that is, other things that might happen that would make interpreting your results more difficult or less reliable. For example, every time you dropped bread crumbs, you want them to be the same kind of bread crumbs.

Then you actually perform your experiment, collect the observations and see how they compare with what you predicted. You also compare your results with others who have performed the same or similar experiments to see how your results stack up to theirs. The more experiments you do that match the prediction you made based upon your theory, the more you start to have confidence that your theory actually captures and represents some important or vital aspect of Nature.

In medicine, the aspect of Nature that we’re exploring is you. Some people would use scientific information about you to bend you to their will (http://www.huffingtonpost.com/warren-adler/keeping-the-sheep-dogs-at_b_950151.html) but in Medicine we like to think that we’re high-minded enough to use science not to bend you to our will but to help you improve your health, which, hopefully, is bending yourself to your own will. In Medicine, the data that we need our model to explain is all of human experience. How is that so? Well, try to think of one experience you’ve had that has absolutely no impact whatsoever on your health. Pretty hard to do, I expect. Everything in your life influences your health. Everything in your life is fair game when it comes to looking for the root causes of your health problems. We need a medical science and a medical model that can take all this kind of information into account.

In The Structure of Scientific Revolution, Kuhn elaborates on several symptoms a particular branch of science will exhibit when the pressure for a scientific revolution is building. Conventional medicine exhibits all of them. There is a great body of human experience that lies outside, that is, cannot be adequately explained by conventional medicine. A large number of alternative models of healing and health are being put forward. More and more practitioners are becoming aware of the limitations of conventional medicine (lagging somewhat behind the awareness of the general population.) The predominant underlying assumption upon which the conventional medical model is based says that you are but a skin-bag of biochemical reactions and all diseases are an imbalance of those chemical reactions, injuries or natural aging. If we but knew what those reactions were, we could pour in other chemicals and you could then be the person you want to be or we could sew you back up, wire you together or replace worn-out parts.

More than Biochemistry

You are indeed a skin-bag of biochemistry. But is that all you are? Are you a victim of your genes and environment, merely reacting to and from them all the time, or do you have consciousness, identity, creativity, volition, free will? Do you have meaning in your life? Do you see meaning in some of the events around you? How can there ever be spontaneous creativity if we’re all locked into a physical deterministic chain of cause and effect? I think it is high time we make a new medical model.

Kuhn also elaborated some of the characteristics that the new paradigm replacing the old ought to have. It needs to first adequately explain all the data and observations covered by the old model and it ought to also be able to explain and incorporate most of the observations that were out-lying to the old model. It also ought to be amenable to the process of science fleshing it out. Integral Medicine is based upon such a science. It is able to take into account and make sense out of most human experiences that lie outside of the current medical model, such as mind-body connections, placebo effect, spontaneous healing, shamanism and such.

The framework of Integral Medicine has five parts:

  1. The Integral Worldview
  2. Broad science
  3. An expanded model of a human being
  4. A definition of health
  5. The education metaphor

Let’s explore this framework in Part 2.

Copyright 2012 Steven M. Hall, MD

A Better Way to Pay for Healthcare

The insurance mindset is the wrong perspective to use to pay for healthcare. Insurance was designed to be a way to help people, corporations (I know it is redundant to list them separate from people) and other interests “manage” risk. Insurance is for situations that are supposed to be fairly rare but would have catastrophic consequences if they happened to you, such as your house burning down or suffering a long-term disability. The idea is to spread the risk out over a large number of people, charge each person covered a defined amount of money each month and pay out when a covered loss happens. These situations lend themselves to probability theory. Statisticians calculate the probabilities of said events, their projected costs and set the rates so that the company is assured a profit. Conceivably, you could go your entire life without your house burning down, getting in a major car accident or suffering a disability. But you buy insurance to cover your bets. The job of the insurance company is to take in as much as possible in premiums and pay out as little as possible in damages. That is why they often put up so many hoops to jump through when you have to make a claim.

But what are the chances that you’ll need healthcare at some point in your life? If you include preventative services, the screening tests that we’re all supposed to get, for example, the chance is 100%. So what is the risk that is being managed? Perhaps the insurance mentality got applied to healthcare in the early days because at that time people didn’t go to the doctor that often. They were much more versed in home remedies and many believed that hospitals were places to go to die.

Early health insurance plans were almost exclusively catastrophic. Regular healthcare wasn’t that expensive and wasn’t covered. Over time, our society’s relationship with healthcare has changed, and what we want our insurance to cover has changed. Health insurance is no longer just covering catastrophic events; it is paying for regular services. By moving toward larger and larger deductibles, insurance companies are trying to move their role back to that which is more appropriate for insurance, only covering potentially ruinous catastrophes, but is that what we want?

Goals to Aim For –  

Healthcare costs have increased. People’s expectations have increased. It is time to reassess what we are doing and devise a better, more appropriate way to pay for healthcare. These are the goals I think we should aim for:

  • Universal access – that is, everyone is covered
  • Everyone has access to the same quality of care. No one gets discriminated against because of how their care gets paid for.
  • The cost gets spread out over the entire population
  • People who utilize more healthcare pay more
  • Financial incentives for everyone to be healthy are built-in
  • Competition and innovation are encouraged and rewarded
  • The system remains in the private sector and is not run by the government
  • Health insurance companies as we know them go away. They have done incalculable damage to our society and have abused too many people. For them, we need to institute a corporate death penalty.

Communal Services –  

There are several communal services that we as a society have decided to offer to each other and pay for communally. We have public roads, public education, public water, public utilities, public transportation, public libraries, police and fire protection and a public military. What would it take for us as a society to decide that healthcare is also something we are going to offer to each other?

If you look at any given stretch of road, you don’t know when or how it is going to need to be repaired, but you know that it is going to need to be repaired at some point. So government agencies in charge of that stretch of road set up a repair fund. Every time you buy gas, a certain percentage of what you are paying for the gas goes into that road repair fund. When you buy your gas, do you feel like you’re buying road insurance? (Public tax money also goes into those funds.)

A similar argument can be made for an individual. We don’t know when or how much healthcare that person is going to need, but we know that they are going to need some healthcare at some point. Instead of private health insurance companies to pay for healthcare, we ought to have public utilities that pay for healthcare.

One Idea –

One idea is to divide the country up into five or six geo-cultural regions. Within each region, three public utilities would be licensed to offer healthcare plans. The utilities would be not-for-profit and would be run by public boards and all their financial records would be open to the public. Each utility would devise plans that they think would meet the needs of people. The bare minimum plan would offer the same level of services that Congress votes for themselves and get fancier from there.

We would achieve universal access by compelling each person in each district to choose the utility and plan that best suits their needs. (Such compelling has already passed Supreme Court scrutiny.) Then each person, each month, would get their “health utility bill.” If your employer wanted to give you a perk, it could pay your health utility bill for you. If you qualified for public assistance, the government would pay your health utility bill.  There would not be different coverage for different classes of people, just as rich and poor alike drive on the same roads. We would be able to do away with Medicaid, Medicare, the VA, Basic Health and many of those similar levels of complexity that just add cost to the delivery of healthcare.

A simple way to build in “user pay” and at the same time financially incentivize healthier lifestyles would be to add a “poor choice tax” to foods, alcohol, tobacco, motorcycles and such in the amount statisticians calculate that using that item adds to the burden of healthcare for the population. For example, the lifetime healthcare cost of a pack of cigarettes is estimated to be around $10 per pack. That tax would be added to the price of the cigarettes. Each month, the poor choice tax that was collected in each region would be divided among the health utilities proportionately to the percentage of people in that region that are signed up with that utility. This money would be used to help defray the cost of healthcare for everyone. Organic fruits and veggies would have no or low poor choice tax, while foods full of processed junk would have a higher tax. We have the data now to calculate lifetime healthcare costs of most lifestyle choices.

When we all have healthcare and it is easy to trace the money through the system, the financial incentive of the whole society would shift to real prevention. Right now, nearly every player in the healthcare system profits more the sicker you are. This is the real, unspoken reason for run-away healthcare costs that no one can seem to get a handle on.

Could something like this really work?

For a system like this to really work, though, we would have to also heal healthcare. People would need choices. I do not think it is right to compel people to participate in a system of healthcare that is currently the major cause of death in our society. That’s right. Today, going to your doctor for conventional medical treatment is now the third leading cause of death in our society. What would the medical profession look like if it were ethical to compel us all to participate in it? To be continued.

Copyright 2012 Steven M. Hall, MD

Insurance Companies and Healthcare

There are powerful and wealthy forces within the Healthcare industry that are working hard to keep your healthcare costs rising and the quality of your care substandard. And they’ll keep doing it as long as we all put up with it. Drug companies are one of those forces and it’s easy to understand their motivation. They are about sales. If you get better and don’t need to take medicine, they don’t make any money off of you. Therefore, they like treatments that reduce symptoms but don’t heal and resolve the core issues. That way, you get relief from the drug so you have good reason to take it, but then you have to keep taking it. Allergies, asthma, diabetes, hypertension, heart disease, strokes, hypercholesterolemia, osteoporosis, auto-immune diseases, thyroid problems, Alzheimer’s, depression, addictions and such fall into the category of conditions for which you would be given medications for the rest of your life even though there are proven cures and/or preventions that are steadfastly ignored (and even demonized) by conventional medicine.

As part of their business plan, the drug industry now has major control over medical research, the medical literature and medical education. It is an ingenious and very successful business plan. Train a carefully selected corps of caring practitioners to follow your every order then tightly control what information they have access to and manipulate your market to suit your purposes. Your poor health is their market.

But even though the tactics of the pharmaceutical industry are deplorable, their motivation is clear from the perspective of corporate behavior. But there are many more players in the healthcare industry who are equally responsible for the healthcare crisis but are even more devious in their tactics.

Hospitals, pharmacies, drug companies, surgical and medical supply houses, labs, physicians, naturopaths, chiropractors, rehab centers, supplement manufacturers and distributors…these are also obvious players who make more money the more people are sick and the longer they stay that way. And we wonder why healthcare costs are so hard to control.

I used to think that the only factors in the healthcare equation that wanted to cut costs and increase quality were 1) the people who bought their own insurance and/or healthcare, 2) the employers paying for insurance and 3) the insurance companies. I was wrong.

(People who get their insurance paid for have no incentive to save medical resources. As an extreme example, here in the Northwest, people with Microsoft’s Cadillac plan are at high risk for being over-tested, over-exposed to x-rays, over-scoped, over-surgerized and over-medicated. Microsoft is self-insured and they’re getting taken to the cleaners, not only by their employees and their families, but also by the medical community.)

I thought it was strange that the insurance companies didn’t do what the drug companies did and take control of medical research and education, pay for studies of the preventative strategies and start to really support preventative measures that are proven to keep people healthy and reduce healthcare costs. They certainly give a lot of lip service to cost containment. But I recently had an experience that opened my eyes to another major corporate force working to increase healthcare costs and degrade care. They’ve pretty effectively stayed hidden behind the smoke screen they’re spreading with all of their advertising.

My practice is very different from most physicians’. I’ve gotten interested in getting to the root of people’s problems and searching for ways to treat those roots so that people’s issues resolve. I’m not satisfied with just helping someone limp along with their health issues if there is anything in our power that will help that person.

Over time, I’ve moved away from the regular family practice model: running madly between exam rooms; to spending an hour with each patient, deeply listening, tackling multiple, complex and interrelated issues, doing a lot of education and such. As you might imagine, my practice stood out in the insurance companies’ data mining. They audited me to see what was going on. They couldn’t understand the one hour visits. They wanted me to do the ten-fifteen minute visits like everyone else.

I told them that I was saving them a lot of money, that when these complex patients started seeing me, they often didn’t have to keep seeing their expensive panel of specialists. I thought they’d be happy to hear that. I was shocked by their response. When they heard that the way I practice might be decreasing how much their enrollees are spending, their faces actually blanched at the idea. After that meeting, they redoubled their efforts to drive me out of their networks.

In that moment I realized just how wrong I’ve been all these years. I learned that the insurance companies make a percentage of what you spend on your healthcare, especially if they just administer the plan, as with Microsoft. All of their “cost-saving procedures”, such as prior authorization, just add layers of paperwork and administrative overhead to the costs of healthcare, giving them the public image of wanting to cut costs, but in reality just giving them a bigger slice of the pie. Arguably, the most powerful and most subversive force keeping your costs high and eroding the quality of your care are the health insurance companies, not the drug companies

If you’ve ever gone to your practitioner with a list of problems and been told to pick one to work on today and come back another day for the rest, thank your insurance company. If, during your visit, your practitioner interacts more with their computer than with you, thank your insurance company. If you’ve ever felt herded through your doctor’s office, thank your insurance company. If you feel like your physician never has time to really consider the details of your case, thank your insurance company. If your physician has low morale and is over-burdened with paperwork, thank your insurance company. Short of corporate profit, there is no excuse for the damage they’ve done to the healthcare profession.

And if your insurance company calls themselves non-profit, don’t believe it for a moment. All that means is that they keep all the money for themselves. Those executives are paid exorbitant salaries and bonuses. Most insurance companies run a 26-28% administrative overhead. Obamacare is going to require them to keep it to 20% (still much higher than most other industries). That is one reason the insurance companies are fighting Obamacare so vigorously.

If your insurance company is for-profit, well…there are lots of other ways to make money in this economy, why should some investor be getting a share of your hard-earned premiums? The answer is absolutely clear in my mind: health insurance companies need to go away. There are much better ways to deliver healthcare, ways that incentivize wellness and high-quality healthcare. We’re not a third-world country. Why do so many Americans continue to suffer from a lack of quality healthcare as if we were? I see two reasons: corporate greed and a kowtowed populace.

Corporations’ primary purpose for existing is to make money. Any product or service they provide to do that is secondary. Greed is in their nature. It’s not bound to go away any time soon. But just like any good citizen of the community, corporations need to learn to control their bestiality. That’s what laws and regulations are for. If, on one side of the equation, a corporation doesn’t want to be regulated, then, on the other side of the equation, they have to choose to do the right thing. I’ve got some ideas about how to help corporations do that, but that’s a topic for another blog. Right now, I’d like to speak more about the kowtowed populace. That is something we can all do something about.

When insurance companies misbehave and screw you over, they protect themselves by throwing up as many paperwork roadblocks as possible. Millions of hours are spent each year by people just trying to get their insurance companies to meet their obligations. The insurance companies set up a gauntlet, hoping that you won’t survive the running of it and thus give up and go away.

Don’t give up. If you have a grievance with your insurance company, please make it your business to be the biggest burr in their bra they’ve ever seen.

  • Write formal letters to the state Insurance Commissioner (One of my patients did that during my audits and the insurance company actually wrote their own letter to the Commissioner asking him to please disregard my patient’s letter. It was groveling and pathetic. If the Commissioner received dozens of similar letters asserting the same complaint, they’d investigate.)
  • Lodge a complaint with your employer and their benefits department, if you have insurance through work.
  • Write letters to your state and national representatives.
  • Write letters to the editor of your newspaper.
  • Write a blog.
  • Post on your Facebook page.
  • Get the word out any way you can about how your insurance company is treating you.

Stories have power. You have power.

Believe it or not, medicine is a consumer-driven industry. If enough consumers demand it, eventually medicine will change.

Steven M. Hall, MD

Copyright 2012 Steven M. Hall, MD

Healthcare Crisis Solution - Letter

During President Obama’s mid-term State of the Union address, he issued a call for ideas about how to heal healthcare. The following is a letter I sent him. I have no idea who read it, all I heard back was a form letter. But this outlines the basic ideas I think could cure our healthcare system. Please let me know what you think. Thanks. 1/30/10

President Obama 1600 Pennsylvania Ave Washington DC,

Dear Mr. Obama,

You issued a challenge during your state of the Union speech that I’d like to accept. I have been in practice now for over 25 years and have spent a considerable amount of time thinking about the terminal illness that is afflicting our healthcare system and how to treat it at its root causes.

Unfortunately the root causes of the healthcare crisis, as I see them, are beyond the reach of public policy. But public policy is what we have to work with and the right public policy can create the right environment and motivation for the healing of the healthcare system.

I believe that the solutions I’m about to propose would give all Americans good coverage, fix Medicare, the VA and DSHS, lower the cost of healthcare, keep the paying for healthcare in the private sector, keep competition and innovation alive, allow everyone to have the physician and hospital of their choice and motivate Americans to live healthier lifestyles. Please bear with me as I explain because, like the solutions to most complex problems, these ideas cannot easily be reduced to sound bites.

I believe that universal access to healthcare would not only benefit individuals but also society as a whole. This puts access to healthcare into the same category of social needs that we as a society traditionally meet through social solutions, e.g., public roads, public water, libraries, public education, electricity, trash collection and the most socialist of all organizations, the Military. Most often, the solutions to challenges that we all have in common are solutions that we all share.

I propose that we move the paying for healthcare into the public utility sector of the economy. The country can be divided into five or six geopolitical regions. Within each region, three public utilities would be licensed by the government to manage healthcare payments. The regions would have to be large enough that each of the utilities could be financially sound. Three utilities would balance the need for competition and innovation without excessive duplication of administrative costs. Each utility would be not-for-profit, run by public boards, transparent to the community.

Each utility would devise perhaps three to four coverage packages, the simplest being a minimum agreed-upon level of coverage (I might suggest that be the level of coverage Congress has chosen for itself) and then other combinations of coverage the utility might think would be popular to people. Each person in each region would be required to choose one utility and one of their plans. This would achieve universal coverage. The plans would have to compete with each other to get people to choose their plan. By providing universal coverage this way, there would be no need for Medicare; we would “fix” Medicare by transcending it. The same goes for the VA and DSHS. The rates for each plan would be set by the public board of each Utility.

The utilities would then contract with providers, hospitals, labs, pharmacies, home-health agencies, etc. just as insurance companies do now. Since there would only be three organizations to contract with, providers would be highly motivated to sign up with each one, thus helping to contain costs. And just reducing the administrative duplications from so many insurance companies offering so many plans could potentially free up 10-11% of the current healthcare budget to help cover the presently uninsured.

Then, each person, each month would get their “healthcare utility bill.” (HUB) If an employer wanted to give their employees a perk, they would offer to pay their employees’ HUB. If a person was on public assistance, the government would pay that person’s HUB for the base plan. If a person were retired and needed the assistance (not all retired persons do) there could be a program to pay part or all of that person’s HUB.

By spreading the cost of healthcare over everyone, the cost for each person goes down. People who can’t afford it could then get public assistance to pay for the lowest-tier plan. I don’t have access to the financial data to do the calculations, but my gut sense tells me that this approach would not cost the government any more than it now pays for Medicare, DSHS, the VA, State health insurance pools and the like. Perhaps many of the people now employed by private health insurance companies could work for the utilities.

There is currently a grotesque and horrific form of discrimination being practiced in the United States that is receiving very little discussion: people are treated very differently by the healthcare system depending upon their insurance coverage or lack of it. This discrimination results in many preventable deaths and untold levels of human suffering. Also, I watch as my patients spend dozens of hours of their time just trying to get their insurance companies to meet their contractual obligations. In this plan, everyone from the homeless to the wealthy would have nearly the same insurance. Veterans, the elderly, rich or poor, everyone would be treated nearly the same by the medical profession. This plan would free practitioners to focus on caring for patients, not worrying about reimbursement rates. Since the health payment utilities would be not-for-profit and the rates they charge and pay would be publicly and transparently set, there would be no financial incentive for them to try to wriggle out of paying for care. This would save millions of hours of people’s time and the administrative costs in every doctor’s office would decrease, realizing further savings.

The defined benefit packages would be de facto rationing of care, but no different than we have in our current system. To avoid the need for further rationing, we need real wellness throughout the entire population. How to accomplish this? By my observation, the threat of potential disability and disease is not, by itself, enough to motivate many Americans to take good care of themselves. We Americans are more motivated by our wallets.

We now have the actuarial data to calculate the lifetime healthcare costs of many products and practices. For example, the last figure I heard, the lifetime cost of a pack of cigarettes is around $7. Similar costs could be calculated for beer, wine, Twinkies, donuts, motorcycles, etc. This amount would then be added to the purchase price of the product as a “poor choice tax.” I envision the poor choice tax posted on the grocery shelf on the same label that says how much per ounce, etc. so people can make informed decisions at the point of product selection. No poor choice tax would be levied on products such as organic produce. The numbers could be calculated to level the playing field between junk food and nutrient-rich food. One might also consider stopping the public subsidies to crops that make junk food so cheap. Suddenly…eating well would make financial sense to people.

Then, the money within each region that is collected from the poor choice tax would be divided among the three Utilities proportionally to the percentage of the population from that region that is signed up with that utility. That money would go to lower the cost of everyone’s HUB. This system builds in a statistical probability of “user pay.” As the population starts making healthier lifestyle choices, the revenue from the poor choice tax would decrease, but so would the level of healthcare utilization thus decreasing the cost of healthcare for everyone.

Once we commit to universal access, then society is suddenly motivated to optimize everyone’s health. Right now, there is no financial incentive within the healthcare industry for wellness. I think that the medical profession would respond by being less reliant on the pharmaceutical industry to tell them what to do and more become more interested in pursuing real preventative medicine. Currently, most physicians think preventative medicine means immunizations and statin drugs. During my career I’ve been led to explore not only conventional medicine but also the wide range of concepts and treatments encompassed by what we refer to as “alternative medicine”. Believe me, there are some valid concepts not currently embraced by conventional medicine that, if they were, would save the national healthcare industry billions of dollars. I believe universal access would give us the social will we need to overcome the profit-motive grip that healthcare corporations have on the practice of healthcare and really heal the healthcare crisis. The cure is out there. We just need to take it.

Thank you for listening. I realize that eliminating private health insurance companies and instituting something like the poor choice tax would mean that you’d be fighting a third war, but it is one that is worth fighting. I would love the opportunity to discuss these ideas further with anyone you think might be able to help use them.


Steven M. Hall, MD

Copyright 2012 Steven M. Hall, MD