Animal Farm Meets Health Care

By Kim Bellard, March 23, 2018 In George Orwell's classic Animal Farm, the animals revolt against their human masters, and establish a classless society with the inspiring principle, "All animals are equal."  As events play out, their society devolves into a dictatorship with a ruling elite, and the principle becomes "All animals are equal, but some are more equal than others." This, surprisingly, makes me think of health care.   I am old enough to remember when maternity coverage was at best only very limited even in employer group health plans.  It took the Pregnancy Discrimination Act (1978) to require them to treat maternity the same as any "illness," and, even then, individuals plans often did not include it until ACA required it.  Similarly, coverage for mental health was typically skimpy until the Mental Health Parity Act (2008) required parity. Preventive services were usually only available for (the small percentage of) people enrolled in HMOs, until network-based managed care plans grew more widespread in the 1990's.  The same happened with prescription drug coverage, which used to only be available to the minority of people with "major medical" coverage. It took the Affordable Care Act to standardize what "essential benefits" should be included in health plans. For services like dental, vision, or hearing, not so much.   Evidently, some services are more equal than others. We've managed to push our rate of people without health insurance to around 11%, but it's more than double that for dental insurance, and worse yet for vision coverage.  For seniors, the figures are significantly worse.  The real question should be, why do we have separate coverages for services like dental or vision, especially when many lack them? This matters.  According to NCHS, 14% of Americas report hearing trouble, 9% vision trouble -- and 7% have no natural teeth left (25% for those over 75).  There is a well documented link between oral health and our overall health, yet a study found that dental care had the highest financial barriers to care, compared to other health services. If you break a bone, you'll see a doctor; if you break a tooth, you'll see a dentist.  If you have problems with your throat, you'll see a doctor; if you have problems with your gums, you'll see a dentist.  If you want to correct your vision with glasses, you'll see a optometrist; if you want to correct it with Lasik, you'll see a physician. Specialization is understandable, as most physicians end up doing, but I have to wonder why some types of specialization start at the beginning of training, rather than after the basic medical training (see my previous article on balkanized medical education). We accept all this because, well, that's the way it always has been.  That doesn't mean it makes sense, or that it is best for our health. We each only have one body.  Although some health issues are fairly specific, we are increasingly realizing that many are systems issues involving multiple parts of the body.  It's time to stop drawing artificial distinctions between what care we get, who gives it to us, and how those professionals get trained.  Health is not equal to health care.  Health care should not be limited to medical care.  We need to get past "historical accidents" and focus on what is best for our health, and our care. Unless you actually do believe that all health services, and all health care professionals, are equal, but some are more equal than others. This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting