We used to say the two biggest lies are “The check is in the mail” and “It won’t hurt a bit.” Now, there is a third biggest lie, which is, “We have the best health care system in the world,” as Bill Clinton and George Bush uttered repeatedly during their respective terms. On the other hand, all of the standard measures of health care quality points to ours as being “the best substandard price-gouging health care system in the world”. One such measure is a comparison of cost and longevity. For example, Americans live an average of 77 years at a cost of $4,800 per person per year, while Spain, Canada and Japan respectively have life span-to-cost ratios of 79 years at $1,100, 81.5 years at $2,100, and 81 years at $2,000.Another measure is the infant death rate per one thousand live births and the U.S. has a rate comparable to third world countries at 6.9 compared to 5.3 in Denmark, 4.6 in France, 3.4 in Sweden and 3.2 in Japan. Additionally, the World Health Organization ranks the United States as 37th in the world, which puts us just behind Costa Rica.Therefore, we can see that the people of other countries get better outcomes for much less cost, suggesting that we Americans are paying more for inferior quality products and services. Although President Obama and other politicians acknowledge that health care is too expensive, they seem to be downplaying the fact that organized medicine has been giving the public a royal hosing for decades.Some of the problems with U.S. health care delivery as many other experts have also pointed out are as follows:Hospitals, nursing homes and clinics are unsafe with medical and nursing negligence being the fifth largest cause of death in the United States.Lack of access with 76 million uninsured (adding illegal aliens) and 106 million underinsured;Out of control cost with health care being 16% of gross domestic product (GDP) at $1 trillion which is a 250% increase over the last 25 years;Price gouging, with hospitals and doctors charging uninsured patients 1000% more than they accept from third party payers;HMO premium price gouging with high deductibles charging 300% more for individuals who purchase directly rather than through a group;Health care corporations are guilty of bilking billions of dollars from tax payers with fraudulent billing practices;Doctors perform unnecessary surgery with bogus diagnoses;H.M.O. members have to call for approval before going to emergency rooms with call centers outsourced to non-professional personnel in India and other countries;Administrative cost of DRG’s and CPT codes is $375 billion per year – 25% of total health care expenditures;Pharmaceutical companies obtain FDA approval for toxic drugs by paying large research grants to medical research facilities to achieve favorable results;Pharmaceutical companies pay bribes to physicians to prescribe their over-priced toxic drugs with tens of thousands falling prey to side effects.This short list of scams and rackets is really the largest, most harmful and costly criminal conspiracy in history. The perpetrators include HMO’s, pharmaceutical companies, hospital and physician groups and politicians. Additionally, with the political corruption achieved through expensive lobbying to defeat all attempts to impose regulatory standards, we can see why we pay such exorbitant prices for such shabby health care.To explain further, medical care has always been a business whereby the seller decides what the consumer will purchase and how much. Couple that control with fear of death, and the buyer will pay any price for care on any terms. Moreover, the people of our generation and the previous one grew up trusting our doctors and listening for the most part, to what they recommended. Then medicine evolved moving from cottage industry to commercial empires.However, to our disadvantage, we still had this mindset of “doctor knows best” for decades while the entire paradigm of ethics changed to acceptance of greedy commercialism with corporate executives capturing financial control of health care operations and finding ways to deny coverage for expensive services and equipment rentals with the pre-approval requirement fraud. Once a well-meaning physician prescribes a treatment, a non-professional decides whether it is medically necessary. Physicians, who became financially dependent upon their corporate “bosses”, would have to capitulate. Then Congress stepped in and gave legislative immunity to HMO’s from lawsuits for wrongful death and damages caused by withholding approval for life-sustaining treatment, thus leaving the doctors and hospitals holding the proverbial bag with malpractice lawsuits. The whole scenario was like putting a hungry shark in a pond to take care of the fish. The shark, knowing that if he swallows everyone in one gulp he won’t last long, says to each of his group members, “There is something wrong with the way your tail is functioning so I’m going to have to bite part of it off for your own good,” and the tasty fish replies, “You’re the doctor.”In conclusion, there have been some suggested health care reform models coming from various think tanks such as “public good”, which is government provided or contracted care, versus the “public utility model”, being privately owned health care with quality standards and pricing controlled by a government agency like public utilities. Although we get a lot of pundits and politicians arguing the pros and cons for both but we are lacking a viable solution.On the other hand, to come up with a workable infrastructure, we first need to abandon those policies that have ended in disaster, such as using financial incentives to control physician behavior, defining health care as providing diagnostics, drugs and surgery and autocratic corporate control of treatment plans. Furthermore, we have to stop believing in this myth called “freedom of choice” as if there was any free choice in health care to begin with. This term has become a way to placate us into accepting a crappy plan charging us more for less by saying, “We have preserved your freedom to choose.” So what if I don’t like the pond that I’m swimming in? I can look for another one with a different shark.On the other hand, there is another fiddle that came from Washington, D.C. called “health care reform”. We now have a new president and his political hacks in Congress who say they have revolutionized the health care industry by making it cheaper, better, more accessible and safer. The problem is that this administration and its pork barrel Congress has no clue as to what preventable errors cause the killing of 200,000 people annually in hospitals across the country, and even if they wanted to stop the carnage they wouldn’t be able to figure out how.As we listen to the political rhetoric about the current state of health care and how to improve it, we get a sense that health care is not so bad and we can make it better. On the contrary, when we go to a hospital as a patient or to visit and we see that people have to wait thirty minutes for a bed pan to avoid soiling themselves, we wake up to a different reality in the world of chaos. Therefore, as we examine the new health care reform schemes, we can quickly ascertain that our elected officials are planning to put more fish in the ponds and tell the sharks to take smaller bites.

Wow, just writing this title excites me. Partly since I have such a passion for bringing together practitioners and patients for better health outcomes. But mostly because when we add a powerful mission that inspires real action that is based around population health management, I believe we can make some real progress in creating healthier and happier lives. To me, that’s exciting because what it takes is us working together to implement a system that engages patients to become participants in their health. And this, my dear heart-centered friends, is where you as a holistic and wellness practitioner enter the traditional health care scene with your subset of skills and heart-centered characteristics that can lead health care teams toward new clinical benchmarks never before experienced in a clinical setting. Yes, that’s a bold statement but one that I am convinced is not just possible but necessary.So how does one undertake such a task? How can integrative practitioners not only be viewed as a viable part of the health care team but as a real contributor to the patients’ health outcome?I see population-based health care as a type of stone soup. If you remember the original folktale, villagers are tricked out of their greed and fear and into sharing and enjoying life with their neighbors. All thanks to a soup that didn’t even exist… until everyone, unsuspecting even to themselves, contribute their one and only ingredient; that alone wouldn’t amount to much. If each of us is truly interested in spreading our mission in which we all share the same outcome goals of healthier and happier people, then we must be willing to participate as a team. We must be willing to see, not only how our own “ingredient” brings value but how each member of the team brings value to the ultimate outcome of restored health and happiness. We must move past the “we against them” mentality that has plagued our health care system. We can no longer afford to see the split between social determinants of health and the physical manifestations of disease. The lifestyle medicine movement is already verifying the need to include what many holistic practitioners have known for decades, that individuals are not separate from their thoughts, feelings, beliefs, and habits which have a direct impact on health outcomes. We are not so different and clinicians are more open than ever to understanding all determinants of health.There are several things that we must take into consideration first before we take on such a task and one of the biggest challenges I see from holistic and wellness practitioners is the willingness to speak and understand the same language as our clinical colleagues. It would be like moving to a foreign country without knowing the language. This most often happens because in our passion and excitement for giving witness to our mission, we tend to hyper focus on the techniques of our modalities rather than on the intended health outcome. Can you imagine a surgeon giving the details and methods of using a scalpel to cut into our flesh? Ugh, who wants to hear that but another colleague? All I want to know is if I’ll get better and how! Not the details of the technique. Focus on the health outcome that your modality offers which in turn is your mission!The next thing is that we must step up and position ourselves and our scope of practice so it’s aligned within the standards of care for a specific disease state. For example, if you are a certified or licensed massage therapist and you have additional certification in lymphedema treatment then you would focus on chronic conditions that are known to cause lymphedema such as cancer treatments or diabetes among others. Obviously, your scope of practice must align with the chronic conditions in which you are certified. I’ll be discussing in greater detail how to position your scope of practice to build stronger relationships with clinicians in future postings. But for now, it’s important to know that not being clear on how your scope of practice aligns with standards of care for a specific disease state, may be the reason for your difficulty in getting clinician referrals or collaborations.Lastly, we need to get a clear understanding of the “lay-of-the-land,” of not only within the clinical health care setting but the new payment system that rewards doctors and hospitals for improving the quality of care. Pay-for-Performance is a term for initiatives aimed at improving the quality, efficiency, and overall value of health care. These arrangements provide financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients.Pay-for-performance has become popular among policy makers and private and public payers, including Medicare and Medicaid. The Affordable Care Act expands the use of pay-for-performance approaches in Medicare in particular and encourages experimentation to identify designs and programs that are most effective. I see this as another opportunity to expand your mission by demonstrating how you can help increase quality measures, efficiency in care, diminish gaps in care, and provide value in optimal health outcomes.Therefore, in part 2 of this posting, I will clarify what we mean by population-based health management within the constraints of an integrative health practice. In fact, we may need clarification on several terms that are now being used in the health care settings such as integration, quality measures and how understanding these key components within clinical settings can help establish you as a viable member of the health care team and secure your position as the expert in your field.Until then, be well my friends as you help move people towards the truth of well-being with hope, love and laughter!