Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board... more
Epidemiologic studies of addiction, gun violence, disease outbreak, cancer, etc are of enormous value to citizens of any nation including ours. The resources to pursue such issues are hard to come by and the auspices for this pursuit, or lack thereof, vary hugely. Health, education and welfare are constitutionally the responsibility of the states. Thus, the DHS, formerly DHEW before creation of a separate Education in the 1970s, is an initiator and supporter although its USPHS is responsible for the Armed Services. Cabinet officers, Congressional, and Supreme Court appointees and the Office of the President, are supported by other Federal Employee legislation. The separation of delivered health care follows the separation of powers, which is fundamental to the definition of the political situation in the USA. Medicare and Medicaid account for about 53% of the health care budget (this includes the ACHA act and fedcare for congress and the judiciary about 23.5% while VA. and the military account for the remaining 23.5%).The health care budget is 1/5 of the total budget and is 1/5 to 1/3 in industrialized countries. Maneuvering the Federal budget seems impossible without altering the allocation to either the military or the health allocation.
A Public Health approach to the health needs of the U.S. population informs about the relationship of social isolation to health broken down by race, ethnicity, rural or local location, geographical location, the relationship of the availability of recreational facilities and the degree of their usage to crack cocaine, vaping and other addictions, gunshot wounds, stabbings etc. In short this approach provides an intricate latticework informative of the daily processes of living and dying. The harvesting of this data is expensive and requires a clear purpose .The harvesting of life data is taking place at many levels and under many guises. The harvesting of data by social media for advertising purposes and for sale to advertisers and entrepreneurs is now an issue of legal and ethical proportions. The gathering of health related data is particularly sensitive. Who and or what can be trusted with it? If your answer is government then at what level and for what purpose? If one of the purposes of government is to provide opportunity for life, liberty and the pursuit of happiness then purpose is clear but mechanisms are still unclear. This unclarity has not prevented a spate of "Happiness" books and periodicals from appearing. Most of these are using the ability to live maximally in the "now" sans drugs and apprehension about moving into the future as their definition of happiness. Thus security and therefore happiness is not actively transactional, but does involve the ability to move into an anticipated future without undue financial, physical, or mental concern.Thus anxiety, depression, hypochondriasis, addictions etc. become the targets of "happiness ' endeavors. Should the ability to pursue happiness becomes an acknowledged purpose of government. ( Along with the preservation of life and liberty) definitions need to be established and cost redistribution in the budget acknowledged.
Health care is expensive. Health care costs are 1/5 to 1/4 of the budgets of industrialized countries, while the public health approach can be pursued in a private practice environment, it is likely that delivery of care mechanisms will have to change, perhaps it will only represent an acceleration in the time rate of inevitable changes. The cost of care is likely to increase regardless of system.
The delivery of secure health care (along with the education needed to utilize it) would give the political party offering it an advantage for all time. Thus the many flawed efforts to remove the issue from the political process. Perhaps a better solution is to test what party can adopt a public health approach as one of the essential defining factors in the purpose of Government rather than a vague constitutional objective.
It is easier for me to think about the derivation of appropriate algorithms for moving between informational levels in this future living latticework than for me to conceptualize the effect on democratic liberalism that this might cause. Authoritarianism and autocracy are certainly risks.
Who or what will regulate the regulators? A single payer system? If so, the attempt at doing so on a state level will be enormously costly. What then a regional level? A national level? How will the happiness people think of affect these projections? Romney's state care and Obama's ACA only expose the extent of the darkness!