Tuesday, December 31, 2013

Awakened Intelligence

We human beings accord intelligence to our abilities to communicate, remember, reason, intend, plan, exercise free will, and to know.  Some scientific investigators of today are discovering that plants and communities of plants exhibit just such human-like brainy behaviors, including memory, decision-making, and other survival skills.
Since plants are rooted to their spots, they have highly sophisticated systems of sensations, food gathering, and protection.  Plants exhibit fifteen to twenty specific senses beyond our simple five.[2]  From root to leaf, they respond to chemicals, light, gravity, moisture, touch and other environmental stimuli, even collectively responding, communicating, and sharing resources.  Plants can change their molecules to disarm threats, can emit chemicals to repel predators and attract allies.

Some plant scientists maintain “no brain; no intelligence, no abstract thought, judgment, or reason.” In contrast, Social scientists, philosophers, and psychologists lean toward a definition of intelligence as the ability to respond in optimal ways to challenges presented by changeable circumstances. [3]  

Scientists that advocate for plant intelligence belong to an emerging group called neurobiologists.  Stefano Mancuso claims that plants show intelligence by their incredible problem-solving capabilities. [4] At the cell level, plants exchange information and network with one another, gathering and integrating environmental data.   With some form of memory they store information and use it to adapt to changing circumstances.  Neurobiologists call this consciousness of one’s surroundings “being online”, as opposed to the old paradigm of consciousness as being an inward awareness of one’s existence, and the perspective of “no brain = no pain.”  If plants adapt to challenges, as they do, then they must be responding to signals of pain or discomfort. Perhaps this belongs to the broader network of nature’s intelligent handling of environmental imbalance. [5]

Recent findings by Suzanne Simard describe how an underground plant network between trees in a “wood-wide web” employ fungal connections among their roots to wisely share information, water, and nutrients for survival.  This is an example of self-management analogous to the biological intelligence currently being discovered within the cellular and molecular systems in the bodies of higher life forms like ourselves.

If we can emulate how plants integrate themselves with their environment, it will help us human beings better evolve.  The emerging message is that, rather than being based on competition, the systems and communities of nature employ far more cooperative behavior than previously thought.  If we become extinct, the plant kingdom will survive; the opposite will not come about.  We have a lot to learn from the other ninety-nine percent of biomass on this planet.  Exploring nature will surely awaken innovative insights and advancements in human understanding and sustainability.

[1]Michael Pollan, The Intelligent Plant, New Yorker Magazine, 12/23/13 page 92
[2]Ibid page 94
[3]Ibid page 95
[4]Ibid page 95
[5]Ibid page 102

Monday, December 02, 2013

Creating More Efficient Care for U.S. Health

The overall well-being of the USA is tied to how we care for our health—individually and collectively. It’s a daunting challenge given our environment, our systems, and our willingness to overcome so many obstacles for the betterment of all. Today’s stresses, financial pressures and evolving trends do not make wellness advocacy and healthcare efficiency a paramount priority. 

A large part of my father’s life was devoted to bettering the healthcare system in the U.S. and it was indeed a challenge.   For the past three years, I have been primarily responsible for my father’s care. At the age of 90, I find it of great interest and benefit to reflect upon his efforts in this area during the major part of his life. 

Self-care is hard if you don’t care for yourself and so many neglect their own well-being. Helping others to best maintain their health requires wisdom, knowledge, compassion and determination.

Many years ago, the Washington Post referred to my Dad as “the unobtrusive shaper of law.”  He spent over four decades of his life writing major healthcare legislation as a Congressional lawyer and researcher, including being a member of staff on the House Ways and Means Committee assisting with all facets of Medicare, Social Security and other endeavors.

Presently our economy totals 15 trillion dollars.  U.S. total healthcare expenditure is $2.7 trillion or 18 percent of GDP.  It is forecast to reach 34 percent of GDP by 2040.  In 2010 Americans spent $1.3 trillion on healthcare. Multiple chronic illness cases that are just one percent of healthcare expenditure consume 21 percent of this total amount.  The last tier of 50 percent of patients accounted for 2.8 percent of spending last year.  Contrary to popular opinion only 10 percent of healthcare dollars are spent in the last year of life.  While there is increased spending in the last few months approaching death, it is not the massive percentage of medical care dollars that is widely believed.

Healthcare spending is forecast to account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021.  It’s been estimated that wasteful spending may account for between one-third and one-half of all U.S. healthcare spending.  The largest area of waste is ‘defensive medicine’, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to this excessive spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity.

A chief factor of the high costs is that in the United States-- compared with other industrialized nations--we do not monitor or intervene in medical pricing, aside from setting payment rates for Medicaid and Medicare for older people and the poor. We allow for this government waste.  Many other countries deliver healthcare on a private fee-for-service basis, as does much of the American healthcare system. We will find out if the Affordable Care Act (aka. Obamacare) act to set healthcare rates will better negotiate fees with providers and insurers in a competitive marketplace.

How is medical overspending monitored?  Who is questioning what care is of benefit and whether it is truly needed?   Whose role is it to make our medical care more efficient?   How can we determine what tests and procedures will benefit the patient in question?  Do certain operations, medications and devices add to the better quality of life of the given patient?  The bottom line is that we the people must play a key role in reducing our nation’s galloping healthcare costs.

Why do Americans pay more for medical care than other people in other countries?  Ironically, we prescribe more expensive procedures and tests whether or not other countries operate a private or national health system. There is a need to best account for who is responsible for controlling healthcare costs including lawyers, doctors, insurers, hospitals, drug makers, and patients.

The United States spends about 18 percent of its gross domestic product on healthcare: nearly twice as much as most other developed countries. The Congressional Budget Office has said that if medical costs continue to grow unabated, “total spending on healthcare would eventually account for all of the country’s economic output.” Federal spending on government healthcare is cited as a primary reason for long-term deficits.

American medical companies can set charges for their products without marketplace competition and government intervention. Contrary to the economic laws of supply and demand, many healthcare products can remain overpriced and even increase in price over time instead of dropping. For example, the price of a total hip implant increased 300 percent from 1998 to 2011 according to Orthopedic Network News.

Presently many payments are negotiated between a doctor, hospital or pharmacy, and an insurer. Insurers have constrained ability or incentive to get the best price, and they can raise premiums to cover costs.
Who is advocating for the consumers? While doctors may agree that they have a responsibility in containing costs, actually doing this is another matter.  They also cite awareness of the costs of tests/treatments they recommend.  

Most physicians may agree to strive in the best interests of their individual patient’s; however, what specific procedures and tests they give them is all over the board.  Whether they focus on cost management and also juggle what is in the best interests of their patients is questionable. Physicians are concerned about financial losses as a result of cost reduction efforts.  While employers are educating their patients to healthcare costs, many doctors advocate for better healthcare cost management.

Greater awareness of medical costs and understanding the true price of such care will lessen overspending.  Changing doctors, consumers’ and insurance companies’ attitudes regarding lesser costs and motivating better care given limited resources is a huge social and economic issue requiring common political will.  It appears to be nil or lacking.  

2013 marked 50 years ago when President John F. Kennedy addressed Congress about the state of mental health—and changed the way Americans view mental healthcare. However, understanding the ramifications of this on all facets of our economy, culture and society is murky. For example, how depression, anxiety and other ailments directly affect our bottom-line can only be speculated.  Also, the degree to which such mind states related to obesity and other major diseases today is difficult to track.  Loss of worker productivity and other indirect costs for mental treatment, therapy and other associated facets of mental illness are difficult to fully measure. 

The Affordable Care Act (aka Obama Care) creates more mental health mandates, by requiring all insurers who sell on the exchanges to include such treatments in their benefit packages.  In a year we will see how this will work.  Mental health spending, both public and private, more than doubled its level in inflation-adjusted terms since 1986.  However, direct mental health spending has remained roughly 1 percent of the economy since 1986, while total health spending climbed from about 10 percent of gross domestic product in 1986 to nearly 17 percent in 2009.

Today the United States spends 5.6 percent of the national healthcare spending, or $113 billion, on mental health treatment.  Most of this goes toward prescription drugs and outpatient treatment. Our country had 156,300 mental health counselors in 2010, and access to mental healthcare is pathetic compared to other types of medical services.

Mental healthcare is expensive, with 45 percent of the untreated citing cost as a barrier. A quarter of the 15.7 million Americans who received mental healthcare listed themselves as the main payer for the services according to one survey that looked at those services from 2005 to 2009.

Greater information regarding expensive treatments with no proven benefits allows the public to better evaluate their treatments options. If consumers, the patients, can see prices before services are provided, that can help create better value.  Presently patients see little of what their full medical costs are. Improved quality data on hospitals and doctors could better the medical marketplace.  Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.

Over three years ago my oldest brother, who lived with my father, contracted Class IV terminal cancer.  After several months and some preliminary treatments his pain became too extreme. We will never know fully why he bravely committed suicide. He did not want to burden the medical system and had the courage not to prolong his life since he had no healthcare and his future, from his perspective, appeared hopeless. 

After searching for over a decade for full-time work, I teach tennis part-time to cover my basic expenses.  One third of my income is devoted to my healthcare.  For many decades I worked in resource conservation.  Medical overspending today is just another reason to champion the value of waste reduction. Perhaps I can create some potential employment opportunities in advocating better healthcare management practices, just as I have done with used motor oil and paper.

I have spent thousands of hours exploring diverse areas of stress management and mental wellness. For several years I taught mindfulness meditation at my local hospital right across the street from the National Institute of Health here in Bethesda, Maryland. Every day I exercise and best focus on how to foster my own well-being.  I also do this for many family and friends.

For last 17 years I have learned to better address my anxiety and depression.  I have been fortunate to be able to cope with a more and more demanding world. I have been reluctant to share my plight with my HMO and spent out-of-pocket tens of thousands of dollars of my own money to manage my own mental health.  This exploration has been my most valuable financial investment since I have become more mindful as to how to keep appearances up and costs down. However, stress and increasing global tensions continue to augment as our population and social conditions evolve. It is wise to question how we going to fix our broken healthcare system so as to prosper in years to come.

The sooner we Americans show courage to fully address this emerging crisis, the better we all will feel. Both my depression and anxiety will be less of a problem the sooner I become the solution and agent of change.  Now I just have to be wiser in exactly what and how I care.  Caring for me and others is a delicate balance of prudence and persistence.  All Americans are mutually tied in what happens in healthcare.  Our very well-being and future prospects forces us to courageously address this current crisis-- its challenges and opportunities.  Good can lessen ill, if only we work together to address this profound challenge.