April 04, 2009 05:42 PM UTC

A General Discussion of Health Care Policy Regimes

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• by: Steve Harvey

(Perhaps the most important issue we face today – promoted by redstateblues)

With the issue of health care policy front and center right now in Colorado state politics, it seems like a good time for a general discussion of what system we, as a state and a nation, should pursue.

My contribution to the discussion is my response to a poster on another site advocating for more “alternative healing techniques” in our public health care regime. I can’t participate right now in a discussion of the legislation currently under consideration, but I would like to catalyze the collective genius of Pols participants to think about the issue of health care in general, how to provide and distribute health care services, what should be included, what is the role of government and what is the role of the private sector, and how should the two be articulated.

Here is my response to the post about alternative healing techniques:

While I am a big fan of scientific method for determining cause-and-effect relationships, and believe that beliefs should generally have to defeat the default of skepticism rather than benefit from the veneration accorded culturual assumptions (including ancient and exoitic cultural assumptions), there is no doubt that there is a great deal of accumulated wisdom from around the world and throughout human history on which to draw, especially in health maintenance and restoration techniques. The main difference between the huge mass of accumulated ancient wisdom and the more concentrated and accelerated accumulation of scientific knowledge is the ratio of noise to signal: That is, scientific method is a refinement of the age-old haphazard cultural evolutionary processes that produced all knowledge, ranging from useful through useless and on to harmful, which weeds out a far higher proportion of error by isolating and testing variables to determine whether the hypothesis (or belief) can be refuted. By refuting much that would have survived the less focused processes of cultural diffusion and inovation, the ratio of erroneous or dysfunctional information to useful or accurate information is greatly reduced.

But, despite the high noise-to-signal ration, there is an enormous quantity of wisdom accumulated by pre-scientific methodology from throughout the world and throughout human history. To reduce the noise and verify the signal, one of civilizations great projects (like the human genome project) should be to put this huge corpus of knowledge through the crucible of scientific methodology, to sort the wheat from the chaff. This is especially important because not all erroneous beliefs are harmless, and many unregulated traditional practices actually involve much more risk and unknown adverse effects than some people assume. For instance, there is a myth that herbal medicines are inherently safe. In fact, herbal medicines carry many of the same risks as refined and synthesized medicines, and those that have never been clinically tested may well have risks that have never been discovered.

Furthermore, while harmless traditional techniques that have only a placebo effect are valuable to the extent of the placebo effect, a series of complicated questions emerge about whether it is a social good or a social bad to prove their lack of non-placebo effects, and whether there are issues of fraud and exploitation involved in marketing techniques that have only a placebo effect. Is it society’s concern whether people want to buy such services, or purely a matter of individual choice? I do not know the answers to these questions, but they should be considered before assuming unreflective answers.

But, with those caveats out of the way, I completely agree that there is a place for alternative healing techniques in our health care system. Our western health care model has long been reactive rather than preventative (though efforts have been accumulating to change that), more piecemeal than holistic, and more limited than inclusive. All of these systemic choices have been counterproductive in the long run. The primary emphasis should be on maintaining health rather than waiting for the need to try to restore it, and it should employ a far larger amount of non-intrusive techniques for doing so. Emphasis on diet, exercise, and techniques for reducing stress and maintaining a complete mind-body equilibrium should be the cornerstone of our health care system, with highly intrusive interventions being the methodology of last resort when these primary techniques fail.

And I do believe that it goes beyond “health care” as normally conceived, to include psychological, intellectual, and, yes, even “spiritual” well-being. Hopefully, we will find ways to continue to incorporate these ideas into our social institutional framework, by using our agreed upon methodologies but applying them to the great pool of accumulated wisdom that precedes and engulfs those methodologies.