Why wait for the federal government on health care?

Many people think the only solution to the "health care crisis" is a single-payer, federal system. When we think of a single solution, we often run into political roadblocks put up by others who disagree with that solution, whatever the reason.

One way around is that more and more states are coming up with their own solutions, most of them based on mandated health insurance schemes.

Let's go back to the roots of modern health care. What are the names of many hospitals? Lutheran, Methodist, Brigham and Young, St. Mary's, Our Town Community, and so on. These were local hospitals founded to provide care for people in a region, mostly the poor. The rich had care at home, with doctors sometimes on standby. As our wealth increased, more and more of us were expected to pay a larger share of our health care. By previous standards, almost all of us are wealthy. Do you think everyone had a telephone and a car and ate out at fast food restaurants one hundred years ago?

Medical technology improved dramatically over the decades. Who would have thought to give anybody with heart problems an EKG a hundred years ago? Or open heart surgery, surgery that has saved thousands of lives? Improved technology costs money.

The cost of medical care has spiraled way beyond giving the doctor a chicken for his efforts.

Maybe what we need is more structured tier service. Let's make first-line care more readily available locally. We don't need a facility with MRI and so on to treat broken bones or minor illnesses. And we don't need to rush off to Mayo because we have an easily-treated tumor.

We really need better triage care - those who can do all right with a minimum of care, those who need a high-level care, and those who are beyond care. Our first level of triage is the community clinic or hospital. We can probably make the immediate decisions at far less cost than we could at regional mega-care facilities.

We can provide this first line of medical care with local resources, be it local government, church-based, or foundation-based. These can be put in place in a small fraction of time and cost that all the squabbling over a national health care system has taken.

One model is the Green House Project, a series of senior residences for no more than 10 residents, that was started by Bill Thomas in Tulepo, Mississippi. It is more resident-centered than staff-centered. Dr. Thomas is building Green Houses in every state with the help of the Robert Wood Foundation. See "Rethinking Old Age", Atul Gawande, New York Times, May 24, 2007.

In summary, we need a lot of small, local ideas to solve our "health crisis" rather than some super-duper, bureaucratic, one-size-fits-all solution.

An apology that won't be made

Thomas Friedman wrote an excellent article today, May 2, 2007, in the New York Times about what President Bush should say to the regional conference in Egypt about stabilizing Iraq.

Not only does he suggest that Bush apologize for starting and mismanaging the war, but that Bush should call strongly on the Arab and Muslim nations to stand-up to the nihilist terrorists who bomb civilians indiscriminately. Friedman points out that they are already trying to destabilize Muslim governments with killings.

My thoughts are that the "war on terror" cannot be waged militarily but must be waged with police and propaganda. As long as some people see Al Qaeda and its ilk as glamorous for attacking the U.S., there is no hope of eliminating terrorism. The U.S. and Muslim leaders must more actively portray these nihilists as having no plan but to destroy those who try to build a civil society.