Health and Fitness Express
October 2004
95 Health Theses
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Health and Fitness Express October 2004 |
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95 Health Theses |
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The Health and Fitness Express contains the random and organised thoughts of John Miller |
In the lead up to the election, I have to say that I object to the way money the government has collected over and above what is needed to fulfil its current budget commitments is being used to buy the votes. If there is money left over at the end of a budget cycle it should be returned to those from whom it was collected and not used as bribes, handouts, gifts, favours, gratuities and back-handers to sectional interests. It’s an unconscionable practice. In particular I object to the way both the Government and the Opposition have signalled their intention to pour more money down the medical/pharmaceutical industry black hole, for what are proving to be high cost, ineffectual treatments as though this were the principal way to promote good health in the community. It is a flawed philosophy. It's based on a number of flawed premises. I’ve drawn up a list that I’m sure is not exhaustive. a. People are concerned about their health. On the contrary, it’s not ‘health’ that’s the concern of the community, it’s ‘sickness’, or more particularly the quest of unhealthy people to convert a private expense into a public expense. b. Sickness and body system dysfunctions have the same status as accidents, coming 'out of the blue' rather than having any significant relationship with lifestyle habits. c. People don't have any control over their illnesses and dysfunctions. d. The best way to improve community health is by providing cheap access to the slash, burn and poison treatment of modern medicine. e. Complicated remedies are more likely to work better than simple ones, big is better than small, new it better than old, expensive is better than cheap, the obscure takes precedence over the obvious, selective evidence based research squashes observation. f. All people are entitled to the same level of government subsidization of treatments. g. Governments have to subsidize treatments regardless of the ability of customers to pay h. Poverty and growing older are the major causes of poor health. i. Governments have to intervene and subsidize the medical treatment of every body system dysfunction known to man, irregardless of how trivial it is, its cause, or whether in fact medical treatment is the most appropriate treatment. j. The most intelligent of all animal species cannot keep itself in as good a shape as the dumbest of wild animals without recourse to large doses of government subsided medicine. It’s ironic that the health of the community continues to deteriorate in direct proportion to the public subsidization of the medical/pharmaceutical industry. Successive governments have sloped the health playing field so far in the direction of medicine and pharmacy that the community no longer looks to itself or other modalities to improve its health and fitness. We live in one of the most affluent countries in the world. We have access to fresh food that the rest of the world envies. We’ve got one of the best education systems in the world, yet people are acting as though they don’t have a clue about how to look after themselves. Something’s wrong. There is a very fishy smell hanging over our health system. Personal responsibility for keeping oneself fit and healthy has been replaced by dependence on doctors and chemists. The fact that more and more public money is being channelled into the pockets of the medical/pharmaceutical elite suggests that either as a community we're becoming more and more unhealthy, or the medical/pharmaceutical treatments aren't working. I'd suggest it's both. It is not a good health system. Right now, more than anything else, we need to be protected from selective evidence, symptom masking, pharmaceutical based, blank cheque medicine. None of the political parties have expressed an interest in doing this. 95 THESES As the election draws near, there has never been a better time for all political parties to announce a raft of initiatives which will encourage people to keep themselves fit and healthy to the best of their ability - and to save themselves and their governments buckets of money. That they haven’t done so is shameful. While I was away I took a side trip to Wittenberg to have a look at the door on which Luther hammered his 95 theses. Well, the original door has long since been replaced but the theses have been reprinted in bronze as a permanent record of that momentous occasion. I didn’t quite make 95 theses, but I'm on the way and here are 20 that I’d like all our political parties to consider over the next three years as ways in which they can contribute to an improvement in the health of Australians. If you can think of any more that can be added to the list, send me an email. Maybe we’ll get the list up to 95. 1. Rename the Department of Health and Aging, the Department of Health and Fitness. In our community it is a big ask for anyone to keep themselves healthy without keeping themselves fit. It is an even bigger ask for anyone to get better by having someone do something to them: sooner or later they have to do something to themselves. The emphasis on fitness would highlight a Government concern for people to keep themselves fit and healthy to the best of their ability. I estimate that if everyone kept themselves fit and healthy, the state and Commonwealth Government's health budgets would be cut by half; that’s whopping $25B. In the main, people who keep themselves fit and healthy have no need to use the medical system. If everyone took the example of the Prime Minister and had a regular and systematic fitness routine, didn't smoke and maintained an ideal weight, surgeries and hospitals would be virtually empty. At the moment, for all intents and purposes, what we've got is a Department of Sickness. A name change would go part of the way in directing the focus back to health and fitness. 2. Employ a Chief Physical Educator, a Chief Naturopath and a chiefs of Tradional (Chinese and Ayurvedic) medicine to complement the role of the Chief Medical Officer. Until there is countervailing power within the Department of Health, the medical profession will grab the money and run. A Chief of Natural Medicine should also be appointed. 3. Set up a Health and Fitness Commission to run an enquiry into the health and fitness of Australians and ban members of the medical/pharmaceutical elite from having anything to do with it. 4. Deregulate the medical and pharmaceutical industries. Government collusion with the medical/pharmaceutical industry to sustain a monopoly on health care has distorted the market for health advice and health services, and, as is usual in these circumstances, lined the pockets of the few at the expense of the many. It’s dreadful what’s happened. Based on the evidence it’s going to get worse. The Howard Government is supposedly hell bent on undermining the power of unions, but it doesn’t have the intestinal fortitude to take on the closed shops of the medical unions. In fact it legislates to support their privileged position and provides massive subsidies to support their incomes. If they ever found out, the poor burghers of Collingwood and Brunswick would be very pissed off to know that once their tariff wall was removed the free kick would be passed over to the medical/pharmaceutical industry. Tariffs on clothes; bad. Subsidies on medicine and pharmacy; good. 5. Amend the Health Insurance Act so health insurers can provide people with an incentive to keep themselves fit and healthy. Who ever thought up the idea of amalgamating the health insurance system with the welfare system and not rating premiums against risk has done this country a grave disservice. At the moment the people who bother to spend time, effort and money each week keeping themselves fit and healthy subsidize those who can't be bothered. Sounds like a very strange system to me! All other insurances are rated against risk. If you want to know what I think are the objective measures that can be used to rate the risk, just send me an email. 6. Of course none of this will work well until there is compulsory, first party health insurance, with premiums rated against risk. Risk rating could be built into the Medicare levee. 7. Deregulate the hospital system. It seems bizarre to have people paying for health insurance when they can line up at a public hospital and get served for free. Who was the genius who thought up that system? The only time I've been to a hospital in the last 50 years I didn't get an account. I wrote to them and asked for one, but never received a reply. No wonder hospitals are going broke. 8. Reduce the financial cost of the Pharmaceutical Benefits Scheme by, a. reducing the subsidies for junk pharmaceuticals, those pharmaceuticals which are being used to mask the symptoms of lifestyle induced body system dysfunctions. Access to cheap pharmaceuticals is one of the things which discourages people from making an effort to fix themselves up by changing their lifestyle habits. b. put out a public tender for the drugs appropriate for the treatment of each of the common body system dysfunctions. All other things being equal, the tender will go to the cheapest drug and this is the only one the Government will subsidize. Most of these will now be generic drugs. If people want to purchase another, more expensive drug, then that's up to them. Maybe then we won't see surgeries littered with pens, notepads, calendars and other baubles from the drug companies. c. Encourage the importation of cheap drugs from Asia. d. just as the governments of Australia are quite happy to subsidize mass transport in cities, so there may be a legitimate reason for governments to subsidize some pharmaceuticals. But governments don't subsidize taxis, airlines or private vehicles, only buses and trains. Similarly they should be subsidizing only effective, but low cost treatments for the lifestyle induced dysfunctions. Of course the pharmaceutical companies that miss out will squeal like stuck pigs, but doesn't any one who fails to win a tender? 9. Encourage people to steer clear of doctors for the things doctors are not good at treating - things like headaches, crook backs, stress and anxiety, diet, lack of energy, sleeplessness, high blood pressure, obesity, lack of physical fitness. 10. If you are going to subsidize anything, subsidize the visits of people to fitness centres, naturopaths, counsellors and places where they can get good advice on managing stress, eating wisely, fixing up common complaints and keeping themselves fit and healthy. At the moment too many people are going to the wrong place for advice, simply because the medical and pharmaceutical industries are the only ones that are subsidized. They end up becoming dependent on pharmaceuticals which mask the symptom, not fix the problem - at an enormous cost to themselves and the Government. By subsidizing other health modalities the government will stop people going to doctors for trivial complaints and free the doctors up to use their superior medical expertise for more serious medical complaints. The lack of distinction between what is a health matter and what is a medical matter is the root of much of the over crowding of our surgeries and hospitals. 11. Discourage bulk billing. It was designed for the needy, not the greedy. It encourages too many people to rush off to the doctor for complaints which, in the past, they treated themselves. It discourages the provision of good service. The great legacy of Michael Wooldridge is seven minute medicine. Get in, get a prescription and get out as quick as you can, without paying. It’s a dreadful way to improve health. If people get something for free they don’t appreciate it, take it for granted and increase usage. Whoever thought that one up wants his or her head read. And why should access to medical advice be free any more than access to fresh vegetables and fruit, or transport to and from work, or mental health outings to the pictures … Visits to the doctor have grown dramatically since bulk billing was introduced - without a commensurate improvement in community health – and at great expense to the taxpayer. If you want to know what’s powering bracket creep, look no further than the subsidization of poor health habits. Free medicine leads to dependence on the selective evidence of the medical/pharmaceutical industry to the exclusion of all other treatments. Finally, it devalues the role of any service when it comes without a fee. Every doctor is worth his or her hiring. Probably the best system would be for people to pay the full cost of the first half a dozen visits to the doctor each year. After that there could be a safety net for those who are financially strapped. 12. Divorce the medical system from the welfare system. The welfare safety net is there to support those who fall on it. It’s a net, not an inner spring mattress! 13. Encourage doctors to run seminars for their clients - where a group of people can get advice about common complaints, like headaches, diet, colds and flu, musculo-skeletal, lack of energy, feeling dreadful ... all in one go. Having one on one consultations is a very expensive and time-consuming business. 14. Encourage people to go to non-medical health and fitness professionals who can provide simple, non-medical advice and treatments outside the medical system. It will save the government an absolute poultice. It doesn’t take a degree in medicine to check someone’s blood pressure or blood glucose level, show them the exercises they can do to fix up a crook back, make suggestions about what they can do to get rid of headaches, or get a good night’s sleep … It can include nurses, members of the fitness profession, naturopaths, counsellors … A couple of years in TAFE would set people up to provide simple advice for about 80% of body system dysfunctions. Leave doctors free to use the full weight of their medical education to treat serious medical conditions. 15. Improve doctor education. The best most doctors can think of when treating a customer is to give them a tablet, creme or syrup. It is tawdry form of health engagement. Doctors are notorious for not sending people off to places where they can get themselves fit and healthy. 16. Get rid of the GST on visits to fitness centres, naturopaths, counsellors and personal development programs. 17. Improve access to psychologists and counsellors. If 80% of things going wrong in the body have an association with things going wrong inside the mind, then ready access to counselling should be high on the Department of Health's agenda. There is an epidemic of stress, anxiety and depression (ie an inability to effectively cope with the living) that is being poorly addressed through the selective medical/pharmaceutical model. Seven minute medicine makes mockery of the holistic nature of health. 18. Money spent on sickness is a cost. Money spent encouraging people to keep themselves fit and healthy is an investment. For any political party wanting to find money to spend on productive enterprise, improving community health and fitness is the first place to look for savings. 19. Finally, when it's all boiled down, the Government has to confront the issue of how much responsibility it is going to take for the cost of the treatment of common lifestyle induced body system dysfunctions, and how much responsibility it believes individuals need to take for dysfunctions that they can, by and large, prevent and fix up themselves. It has to cap the percentage of outlays that can be spent on sickness. Otherwise we're going to see well over 20% of our taxes being poured down the medical/pharmaceutical black hole and taxation levels going through the roof. So, when it comes to your health, don’t ask what your Government can do for you, ask what you can do for yourself.
John Miller
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