I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.
First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.
So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.
This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?
Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.
I'd love to see some data on some of the ridiculously unfounded views spouted in this thread. It's really very sad to see that health "professionals" have such views.
Data can be manipulated so why would you want to see it. And if you are so inclined as another poster told us Bing or google. Cuz I guarantee you can find most anything you think you can find.
Data of course can be manipulated, which is why you need to see it in context and evaluate for yourself. There is a lot of data about health promotion in peer reviewed journals, including outcomes if you would like to educate yourself.
Data of course can be manipulated, which is why you need to see it in context and evaluate for yourself. There is a lot of data about health promotion in peer reviewed journals, including outcomes if you would like to educate yourself.
I don't know who Diane is. I have a neice named Diane but I haven't spoken with her in yearsssssssss. I read the journals. It felt it was you who didn't understand so I just pointed you in the right direction.
I have no idea what you're talking about. I suggested data would be good to support arguments. I did not suggest looking on google, although you mentioned it. I suggest peer reviewed journals.
Perhaps you're confusing me with someone else. Or just confused. Either way....
Nice contribution, Diane.
Obviously, this is what I was referring to.
I think I'll back quietly out of this thread... it's all a bit too whacko for me!
The insurance companies charge the same for everyone when it's a group policy (employer- or union- provided coverage, for example), but they are free to charge premiums as high as they like for individuals (individuals are really screwed when it comes to shopping for insurance).
As for the high risk people, that comes down to a basic philosophical difference -- again, does one see healthcare coverage as a commodity, like a car or washing machine, where each one of us can buy however fancy a car as we can afford and we don't really care what kind of car other people drive (or if they can afford a car at all), or does one see it as a vital, necessary public service, like police or fire service -- everyone pays taxes so the service is there, and everyone gets whatever service they need when necessary. Obviously, there are plenty of posters on this site on either side of that divide.
You said a mouthful when you said EVERYONE PAYS TAXES so the service is there. So everyone should pay premiums for health care. Or don't you follow logic?
I have no idea what you're talking about. I suggested data would be good to support arguments. I did not suggest looking on google, although you mentioned it. I suggest peer reviewed journals.
Perhaps you're confusing me with someone else. Or just confused. Either way....
Obviously, this is what I was referring to.
I think I'll back quietly out of this thread... it's all a bit too whacko for me!
Ok I'll help you with your confusion. You are actually answering 2 different posters. I got that you didn't get my reply. When someone spouts a view here I don't necessarily believe their source. I tend to look for my own sources. Many don't realize that the insurance companies are behind this whole thing. They'd love to have 47 Million new customers. And another thread here chats up that fact.
Insurance companies aren't going any where anytime soon. They are a $$$$ making entity for more than their CEO's. Many are heavily invested in BIG Pharma and insurance companies and they don't even know it.
You said a mouthful when you said EVERYONE PAYS TAXES so the service is there. So everyone should pay premiums for health care. Or don't you follow logic?
My logic is just fine, thank you v. much. What I am talking about, though, is paying taxes instead of paying premiums. I would much rather pay taxes to a non-profit government entity to ensure everyone gets the healthcare they need than pay premiums to a private, for-profit insurance company that picks and chooses who it feels like insuring (who it can make the most money off of) and uses a large chunk of that money for advertising, bloated executive salaries, and bonuses for employees who figure out how to drop the most people from coverage.
Eating safe, healthy food is expensive.....but A LOT more affordable when people put down those cigarettes and 6-packs!
Disease prevention in many (not all) cases requires personal responsibility, therefore, it'll never get popular support (sadly).
I don't know from your moniker, if you teach OB to nurses or patients. As mine indicates, I teach patients, in as critic-less a way as I can. Smokers, obviously those still smoking today have poor self esteem (or they'd want better, longer lives) and a lot of anger!
One of the first things people (especially those beginning families) need to know, is that we eat far more protein in America (which is the most expensive part of any diet), than is good for us. Most other societies, including Native American/indigenous populations have considered meat, chicken, fish as condiments, embellishing fruit and vegetables and carbs. That explains the high rice intake in Asian and Mexican ethnic groups, whose fiber is consumed through the high fruit and veggies they eat. When much protein is consumed, it satisfies hunger easier, and keeps hunger at bay longer, which in turn minimizes the intake of other necessary food group, due to feeling "full". That has been responsible for cardiac disease, some cancers, adult onset diabetes, and who knows what else!
You're right that behavior modification takes time, and it is worthwhile, I think. It does require minds that think positively about themselves. That, I think, is the single most important disease preventive aspect. In childhood, we grow up feeling adequate based on others' (mostly our parents) opinions of us, and whether we have existing disease already, and how that is regarded (increasing already challenged parental roles, or bringing out the best we have in us). Yet as parents, how many of us have discredited our children as not wanting to go to school, when they claim illness (maybe because we did that?).
I remember being taught in elementary school that our bodies are like cars, requiring gas/food to do what we do. Well that went right by me, as my family didn't have a car, an we girls wouldn't mess with cars. Can you imagine kids today learning that, knowing that stopping for gas is an inconvenience, expensive and a heart wrenching degrader of budgets?
Earlier in my career, I used a visual aid created by psychology students for the American Cancer Society, for kindergartners. It wasn't about food or other disease coping skills, but was about self esteem. the song in it that I still can't get out of my mind (which I hope stayed with the kids, too) was repeated choruses of "I feel good about, good about, good about myself, as I should about, should about, myself". I haven't looked for one, but I sure hope they did a follow up study on that. As we know from psych patients, (not to oversimplify the etiology of their illnesses) that aspect of their psyches was all too often neglected in their childhoods.
In order to pursue health we have to feel that we deserve it, want it, can have it, and it's worth some wait time. Immediate food "fixes", like other short lived gratification, often are secondary choices forced on us by circumstances, like fatigue and inadequate time/skill for cooking, as well as habits learned earlier in life.
I also remember being taught in high school, in "Domestic Science" (for girls only, while boys took "shop" - which I thought was shopping) to make tomato soup from scratch. I know that each and every participant in that exercise, never did it again, since opening a can is easier - these days the more tasty ready-made hot soups in grocery and "health food" stores are more expensive, effortless substitutes, but today we know about advantages of abundant licenes in hot tomatoes that play an intrinsic role in preventing illness.... dried tomatoes are gourmet food with a side benefit in pasta. Add a can of tuna or salmon or chicken, more veggies, and there's a nutricious, economic dinner for a family! Put some cooked brown rice in it, and fiber a plenty results. Eat hearty, y'all.
Specializes in Critical Care, Insurance Case Management.
Well, I feel better. I was afraid no one cared about this issue, and if you ignore the personal references, I see some very good debate finally on this topic. Just a couple of things to add:
I am an RN who used to work at Blue Cross/Blue Shield, which is a non-profit and has been since the beginning, over 50 years. Someone said they would rather send their money to a "non-profit government entity" than an insurance company. Government isn't exactly non-profit, unless you accept the idea that every dime you send them goes back in to the government to make itself bigger. It certainly does not go back to the people for their benefits! I also was a case manager for Citizen's Insurance Company of America. Managing risk is essential for a viable business. I know there are stories about folks getting dropped as soon as they got sick - I have never seen it happen. You can certainly see why a for profit company may not want to give you insurance if you are already sick - bad risk. Blue cross insures everyone, regardless of pre-existing condition, it is just that your premiums are higher. Just like your car premiums go up if you get in an accident.
I think it is important to remember that just 80 years ago folks paid the Dr directly for medical care. They decided to buy insurance to offset the risk of major expenses of an illness, the same way you buy homeowners insurance in case your house burns down. How did it happen that suddenly having health insurance should be a right? You have a right to health care (you can afford) Why isn't car insurance, homeowners insurance, renters insurance, boat insurance, nursing home insurance, flood insurance a "right"? It is all about managing risk. You manage your risk by buying insurance, they manage theirs by charging more for high risk folks. That is freedom to choose.
I am only saying this because I think some have forgotten how insurance companies got their start. And having worked in them, I know they are full of good people who do their best everyday to help their customers find the help they need. I also know there are folks who feel they entitled to Cadillacs when they live in a garage, just because they paid their premiums. And there are folks who don't own a garage who file claims for Cadillacs too (figuratively speaking, of course) As a case manager, we approved many things that were questionable just for good customer relations. Every denial was based on written policy, not arbitrary decision making. The policies were negotiated by the EMPLOYER who paid for the group policy. If Weight Watchers was covered, it is because the employer agreed to put it in the agreement. By the way, states decide by legistration what insurance policies are mandated to cover, it is not the insurance company that comes up with these things. They do have the right to refuse to pay for treatments that are considered experimental; I guess that does limit off label uses of certain treatments the doctor may like to try. It will be much worse when the government makes the rules.
And to the person who said eating protein causes Adult Onset Diabetes - you got that one wrong. Higher protein (lean) diets are much better for diabetics; high carb diets have been debunked and can make it impossible to control blood glucose levels through diet alone. The research has changed on this in the past few years, and high protein diets kept type I diabetics alive before insulin was produced commercially. To many carbs makes us fat, not too much protein. I graduated 28 years ago, and just recently began buying books and reading about the current research in to diabetes - we need to make sure we stay informed and not just teach what we learned years ago. There are still a large number of practitioners who blame fat people for becoming diabetic, and then tell them to eat more carbs and less protein and fat.
Specializes in Critical Care, Insurance Case Management.
sorry, one more thing: if you have ever gone on a diet, you know that living on fresh fruits and vegetables, lean meats and salads if very expensive. For a family of four living on $35,000 a year, next to impossible. Just the milk alone in my house costs $12 a week. I also would object to protraying smokers as having low self-esteem. Please. Nicotine is highly addictive, period.
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Onekidneynurse
475 Posts
Data can be manipulated so why would you want to see it. And if you are so inclined as another poster told us Bing or google. Cuz I guarantee you can find most anything you think you can find.