The discovery of nine common denominators through 200,000 years of history yields compelling hypotheses for their anthropological scope and present social relevance. Gunnar Sevelius MD
Food transport defines three historical time period:
- hand food transport for tribal time: 200,000 - 10,000 years.
- animal food transport for agricultural time: 10,000 - 1826 (steam-engine)
- machine food transport for industrial time: 1826 - forward
The female role in society parallels the periods of food transport:
- in tribal time, she was as important as the male, contributing 70% of calories.
- in agricultural time, she was essentially politically powerless.
in industrial time, she is recovering her individual and political identity.
The Nine Pillar of History identify only two kinds of leadership:
- Democratic, based on the also eternal Golden Rule. (No society is sustainable
without the Golden Rule)
Dogmatic, based on political or religious dogma.
The Nine Historical Pillars have three inevitable traits
The Nine Pillars are all 1) eternal, 2) must all be sustainable and 3) their cost can
only be controlled through free market forces.
The Present Social Relevance of the Nine Pillars of History.
The Tragedy of the Commons: what many own, nobody owns from agricultural time 10,000 years ago has led to:
- for countries: dogmatism with 10,000 years war. Democracy is the key to peace.
- for corporations: capital drifts to the top and stockholders lose control.
- for federal, state and local government: tax waste and the public loses control.
Medical cost, the 8th Pillar, compared to GDP is presently unsustainable;
- In the US it is 17% of the GDP and unsustainable
- In the in EU it is 9% of the GDP but still unsustainable.
- In either case it limits access to the remaining Nine Pillars of History.
The Nine Pillars of History propose a solution for run-away medical cost:
- Analyzing computerized medical records for medical efficacy.
- Comparing for-profit and not for-profit medical delivery systems for efficiency.
- Mitigating medical conflicts through peer reviews instead of through litigations.
- Comparing single versus multi-payer insurance system
by Gunnar Sevelius MD
Defining the total problem of cost to access to medical care
Four major organized groups in the US medical-care complex have created a system whose cost is already unsustainably high. And that cost is a rising burden on a society that is aging and has alternative needs that also must be met.
The four groups are: a) the medical profession with its influence over hospitals and universities, b) the legal profession with malpractice lawsuits, c) the pharmaceutical industry with high-cost new drugs, and d) the insurance industry with its preference to insure only healthy individuals.. Organized groups have greater influence than unorganized patients.
Medical-care access is one of the pillars deserving collective action to provide security. Other examples are national defense, poverty reduction and old age. The private market fails to provide these services. The reasons for collective action are that:
a) individuals would not volunteer to pay for these services, because they cannot be excluded from benefiting from them regardless of whether they paid or not.
b) the expenses of long-term care for Alzheimer’s disease or cancer treatment would bankrupt most families.
c) inter-generational equity to ensure the long-term survival of the nation.
Other medical-care issues:
a) Health outcomes are certainly affected by the choice of a medical delivery system. But these outcomes are affected by many other factors, such as life style, and are not the major focus of this analysis.
b) medical expenses are extremely high for those near death those requiring extensive interventions.
I have two unique perspectives: a) background, b) I have written The Nine Pillars of History
Compared with Sweden, US medical approaches differ significantly in
b) administrative costs
c) 16% of US GDP vs. 9% of Sweden
d) national buying power used more in Sweden for drugs
Pillar lessons are:
c) competition is the primary means of cost control
1. Monopoly in each of four groups is related to a government granted license or regulation. While the individual physician may be just a pawn, the profession is the single group most responsible for the current medical care delivery system.
2. Power groups prevent competition in their area
2. Monopoly power will destroy society—dogmatic religion or politics
3. Can the public sector work? Yes, to preserve dignity
a) Dignity for intergenerational equity and long-term societal survival
b) Sustainable ratio of medical-care costs to GDP
a) Dignity: Elderly prayers, ??
1. Long term: reduce US medical-care ratio to GDP to OECD average, about 9%
2. Short term: stop the rise in the ratio within three years
I. Wait for a bigger crisis
1. Wait - Yes
a. Current financial crisis dictates delay
b. Really big crisis is necessary to attack the power concentrations. They are too powerful now.
2. Wait – No
a. Currently-passed law awaiting Supreme Court judgment could easily take another twenty years to replace
b. There are working examples of success (Sweden since 2006)
II. Medical advances in areas like Alzheimer’s and cancer treatment are occurring rapidly. Perhaps conquering these diseases will reduce the costs near death.
1. Technical advance - Yes
a. US has the world’s best medical R&D
b. Dignity and social survival (Sweden successful in both)
2. Technical advance – No
a. Power sources virtually untouched
b. Technical advance does not come cheaply
I Address each power group directly [Expand the number of physicians, a la Milton Friedman, seek malpractice caps, reduce patent protection of drugs, national regulation of insurance]
1. Direct – Yes
a. Ultimate power dispersed
b. Provides resources for other pillar needs
2. Direct – No
a. Past failure to curb such power directly
b. I am too old to fight
II. Mandate and single payer
1. Mandate and single payer – No
a. Four power groups have a stronger hold over policy than the financial industry
b. Violates state control and gives too much power to the central government
c. Supreme Court may invalidate the mandate within a month
2. Mandate and single payer – Yes
a. Return to sustainable collective burden for medical care
b. Collective action justifiable to preserve a pillar need
2. El Camino Hospital example
3. County medical review boards
4. Leverage federal support to produce tort (malpractice) reform
5. Seek researchers to study pharmaceutical prescription policie
Comments to the definition
Access to medical care in the US has become a critical part of the 2012 presidential election campaign. The situation is critical. At the same time that Congress has asked for medical coverage to be expanded to cover 50 million uninsured the cost of medical care has increased to demand 16% of the total GDP. The situation is not improved with unemployment over 8% with many long-term unemployed, which means also uninsured. Besides the big people cohorts from after WWII are retiring and entering the age of more intensive medical care. The medical support system really has its work cut out for itself.
Doctor Jeffery M. Lobosky, a board certified neuro-surgeon with a long professional experience, points out that for the last some twenty years doctors avoid to work in emergency room and within the fields of orthopedics, neurosurgery, vascular surgery and OB-GYNbecause the malpractice insurance fee in these fields today is $200.000 - $250.000/ year or greater than the cost of living for the doctor.
The fissure in the medical access system stretches between patients who have adequate medical insurance and those who do not. Some years back this was not a major problem; doctors and hospitals just swallowed the cost. As the cost has kept on increasing this unpaid cost of access became more and more difficult to accommodate.
The Federal and the State governments now split the cost for uninsured patients but the bill that is eventually paid still just covers only 20% of what insured customer pay.
When hospitals and doctors complained the Congress responded with a law, the EMTALA law, that requires that all patients that seek help in the emergency room have to be treated, whether they have the means to pay or not. The law is enforced with a $50.000 fine. Besides the $50.000 fine a malpractice shadow is hanging over the whole scene. No doctor with any self-preservation would enter such an unfair battlefield.
Behind of his/her doctor medical license stands the four facetted economical interest zone: a hospital service with unionized workers, the pharmaceutical manufacturer for supplying medications that are patented for 16 years, an insurance company mitigating the doctor fee through a group insurance bill with an army of bill-processing people and finally a malpractice insurance company mitigating the risk of every medical procedure supported by an army of malpractice lawyers soliciting any reason to sue the medical support system. Malpractice lawyers won’t even charge a fee for the opportunity to sue a doctor, hospital or a pharmaceutical manufacturer knowing that just about all claims are settled outside of court with the major portion of the settlement going into the lawyers pockets.
The participating cost-demands are all part of the unlimited Eighth Historical Pillar need and assured to be paid in the shadow of the doctor’s medical license; the doctor is really just a pawn.
A malpractice insurance company does not have much incentive to control its abusive access because the medical need is a pillar need (the Eighth) and will always in some way be compensated. The cost of malpractice forces many young doctors to sign up and limit their work to hospital salary employment, where the hospital helps to pay the malpractice costs. This practice pressures young doctors to seek employment in only for-profit-run-hospital chains with only for-profit-incentives. Such hospital incentives make the hospital a manufacturing plant that places cost control before a personal patient care.
The malpractice game destroys the doctor/patient relationship. Already the father of medicine, Hippocrates, warned against talking bad about colleagues. The public is really not an informed judge of medical interventions. Hippocrates had newly licensed doctors promise not to talk bad about each other. But, of course, lawyers never made such a promise and live off controversy. The “law making” part of government has more lawyers than doctors, making sure that patients’ rights cannot be compromised—and the malpractice game in the US to continue.
In a June 12, 2012 the GAO office reports that the medical mal practice adds less than 1 to 2 % to the total medical bill. However the total medical bill is between 2 or 3 Trillions and therefore still adds to substantially to the cost. The main problem is that it adds very substantially to the bill insuring the doctors and hospitals, which has also other consequences like the choice for young doctors’ specialty.
Medical care should be as good as possible but to challenge any risk and to charge any cost as judged according to a layman’s jury-judgment could be abusive. In 2008 US doctors and hospitals paid $11 billion to insure themselves from malpractice claims. (The Economist Jan.16, 2010) The litigious attitude within the medical pay zone is indeed out of control.
Adult working people in the US pay for their own medical insurance from their salary, but as it is voluntary, people may choose not to. This is true and common for many young people, who think that nothing will happen to them, and is particularly common for drug addicts who certainly will have health problems, but who don’t care. People without insurance are a burden for the state Medicaid system, (still more than half Federally funded)
If the final years of one’s life end up to be a family member with a handicapped stroke or a Alzheimer’s syndrome, the cost for years of total nursing care will ruin the finances of most families in the U.S. The cost for long-term medical care in the U.S. causes elderly their most anxiety. Regular medical insurance has left out the cost of long-term insurance (Longer than 90 days) in their regular medical care contracts because cost of end of life care tends be so high. The family may steps in but few can ill afford the major cost and efforts this demands. Families give up their equities in their homes to accommodate a generation change with some dignity but many times not even this will cover the cost.
I have two unique perspectives. First, I grew up in Sweden and have worked as a licensed physician in both Sweden and the US. I have worked both as a clinical physician and a medical scientist. I have also worked as a medical director for a major US corporation. As a medical director I had an insight into the insurance side of the medical business. Together my past experiences have given me a unique knowledge of the workings of medical cost in both US and Sweden.
Second in retirement I have studied political history as revealed through nine sides of anthropology and have written a book, The Nine Pillars of History where access to medical care is Historical Pillar need number eight. (See the appendix for a narrative about how my book, came to be and about why I have a uniquely relevant background to address access to medical care)
Access to medical care is a Historical Pillar need for a society. The Nine Pillars of History share three characteristics:
1) They are eternal; the Nine Historical Pillars were all-present from the start of human society 200,000 years ago and are still critical for society.
2) They are interdependent because they are all present at the same time.
3) The cost for society of any of them cannot be controlled except by competition.
All nations in history have had as a goal a system for its citizens that would meet people’s need for security according to the Nine Pillars of History but none has so far defined all of them and recognized their influences over society. In order to survive from one generation to the next all societies have to make the Nine Historical Pillar need sustainable.
The necessary competition within each Historical Pillar need has to be recognized. It is this type of competition that is denied when considering cost of medical access. With a four faceted economical interest zone within medical cost it is still very unlikely competition, as presently organized, can control the cost in a foreseeable future. An economical market always fails to control costs due to a monopoly power. Professionals within medicine, law, indemnity and pharmacy all earn their living in the shadow of the physician’s medical license. History has shown that any monopoly-power will destroy a society, be it dogmatic religious or dogmatic political. A medical need, a life or death situation, is perceived as a situation with a monopolized need. Medical access should therefore be looked upon as a threat to society just like any threat to any of the Nine Historical Pillars.
What about the public sector? The U.S. and Sweden, or actually all of Western Europe, stand at a crossroads. Access to medical support is a Historical Pillar need. The basic question is: should the common tax base finance a Historical Pillar need that cannot be controlled without competition? The cost will take from other needs financed from the common tax fund and will eventually affect the cost of all production and therefore jeopardize production-workers’ access to their own Nine Pillar needs. This question still has to be answered with an unequivocal yes. Only a person with insight in history can answer this question with conviction. Yes, because we need to preserve dignity in generation transitions. US has done more for preserving democracy than any nation. America has earned and deserves this dignity.
To provide for the birth of a child is now too expensive for a young couple without insurance to even plan and to provide for an Alzheimer-sick grandmother would bankrupt any couple in the US. Health insurance has to be mitigated across generations and has to be mandated so the total population together carries the responsibility. This is what binds a nation together just as the responsibility for defense. This is the foundation on which Bismarck joined several hundred of small nations into a common Germany, how the Christian church has stayed together for two thousand of years through Its Holy Spirit and Islam through its Holy Hummah. They all have formed a community across generations, a community that generations can be proud to belong to, a community withdignity.
The family impact for long-term medical care in Sweden is mitigated through contribution from the local and federal taxes. The senior care in Sweden is housed in local, especially dedicated, well cared for, medical housing with 24/7 nursing care. This allows citizens to leave his time in this life with a dignity, adiginity to be followed in the new generation.
According to the Census Bureau’s 2011 report the US has 50 million uninsured, mostly working citizens. U.S. Congress used its mandate to include the medical coverage for all these 50 million of non-insured people. This will for sure challenge an unprepared medical support system in 2014 when these 50 million will demand care together with present long-term unemployed+uninsured and people from the large generation cohort now ready to retire.
All health workers are a selected, intelligent and exceptionally trained group of society recognized for their knowledge and integrity. In order to win the public’s trust the team has gone through extensive training, has specific licenses and has generally recognized documentation to practice informed and rationally controlled practice of medicine and also to educate the public about consequences of damaging life habits. The medical team is thereby allowed to charge a fee for its service. Hopefully competition limits the medical cost to a reasonably value within a certain national area. Inflation within the medical field still tends to be high because of limited competition and the patient’s eagerness to pursue the best possible care.
In my publication The Nine Pillars of History I compared and analyzed the cost of access to medical care in Sweden and the US. In order to limit the length of this correspondence I will here limit myself to the description of the US system. The medical care in the US is mostly on par with the medical standard in Sweden or most OECD-countries. (OECD = Organization for economic co-operation and development and essentially means Western Europe) The standard of living for medical providers is also about the same. (The GDP/citizen corrected for Purchasing Power Parity (PPP) rank Sweden in 2010 as number 8 and US as number 14.
The medical efficacy based on medical evidence such as the survival of a newborn and of its mother and the longevity of the general population are both spot-wise worse in the US than in Sweden. Despite worse results in the US, the cost corrected for PPP of both countries, the cost of access to medical care in the US is 50% greater than that in Sweden. (16%) vs. 9%). Sweden is the only Western industrialized country that actually recently decreased its medical cost. Sweden has 20% immigration and accommodated this addition of citizenships by introducing competition in medical care; Japan is a second country that also had a decrease in its medical cost but this is probably due to a specific shrinking in its large aging population. Sweden decreased its medical care cost only with 0.7% in 2011, but still it was a decrease.
As money is the cause of all evil we might take a closer look into how money for access to medical care is utilized in each country and do this from a holistic view or how people in both countries lives.
Doctors in Sweden have a lot more free time for their families and a lot more security for their employment and family. Most Swedish doctors have a salary contract with regulated 8 hours/workday, special compensation for holiday and night work, a regulated 6 weeks vacation, a one-year parent holiday (split with wife). For their children the doctors have free childcare, food and transport all through high school. The doctor has had study support for his/her higher education, medical and pharmaceutical coverage from childhood all through retirement including for long-term sickness, (Alzheimer) and including paid cost for burial. The local and federal tax base supports a “from birth to grave” social support system as originally proposed by Gunnar Myrdal. Both Gunnar and his wife Alva Myrdal were Nobel Laureates, he in Economy in 1974 and she in 1982 for her early strong stand for peace during the Vietnam War.
Sweden has for the last couple of voting periods had a right wing political coalition government. The shift from left to right is mainly driven by the imposing cost of medical care. During the present right wing leadership independent doctor services have been allowed to open medical clinics in competition with government, provided quality care is maintained.
In the US doctors have to pay for their seven-year medical school, have a minimal salary during their one-year internship and three-year residency working up to 60 (in my time 100) hours a week with no consideration for holidays. Doctors through with their residency and finally ready to start their practice do not dare to work in some areas of medicine that have high exposure to malpractice claims. The litigious atmosphere in the medical field in US has essentially broken down the access to medicine. The whole system is, if not totally broken down, at least fractured along economical fissures.
In Sweden the malpractice claims go first to a medical board of uninvolved, generally recognized competent colleagues. This professional board makes a judgment of the involved parties before the problem is addressed in a court. Most conflicts are resolved at this level without any cost. With most complaints settled here it would take a very serious claim for a lawyer to pursue a further claim.
Another explanation to the difference in medical cost in Sweden vs. the U.S. is that the government in Sweden is in control of its large national market. The buying power of a state has more negotiating strength than individual doctors and hospitals. Also in Canada, the cost of medicine is cheaper than in the U.S. The government can, at times, be a smarter buyer of medicine and medical equipment but one has look out for privilege connections.
Paying for health care in the U.S. is a labyrinth system of individual, group, state and federal resources. Two separate armies of people execute bills—one army that writes the bills and one that pays for the bills. Individuals or a myriad of more or less comprehensive group plans plus state-run “Medicaid” or federal run “Medicare” pays for the bills. Such billing system adds 30-35% to the medical bill while the one-payer Medicare bill adds only 3% - 5%.
The cost of medical insurance was a part of the U.S. car company’s financial difficulties. The same problem is now facing federal and state employees. The public will not pay for an unlimited cost of state and federal employees’ medical costs. The public request a negotiated cost control, not a free for all give away from those sitting close to the tax paid state and federal money-purse. A buyer from the common tax purse really doesn’t have much incentive for cost control.
Final long-term care at old age in the U.S. requires special insurance. Private, retirement communities attached to long-term adult medical care has been a solution for a few lucky ones to meet the cost of end of life medical cost with dignity. The private investment for this type of insurance is accomplished by selling their equity in their family home. Still the attached medical care unit is again paid for from federal Medicare plus private insurance.
Both in Sweden and in the U.S. retired people try to stay in their home as long as they physically can. Both Medicare and Medicaid give some help to pay for home care. (Google Medicare or Medicaid for information about Home care.) In Sweden all home care is supported through the local tax base with intimate knowledge of the individual’s need.
Pharmacies in US are usually independent services. They may have contracts with hospitals, be small independent pharmacies, or very large corporate chains. Patients pay for the cost of filling a 30 or 90-day prescription. Pharmacies charge $10.00-$15 or more for filling a prescription. Some chains arbitrarily determined that they couldn’t be responsible for a prescription beyond 30 days — even for chronic conditions. For any longer prescription they refer to mail delivered medication. Why? What is the rational reason except for more frequent fees?
Many of the people in the U.S. without medical coverage are foreigners. If people are working legally and paying tax they should be able to have access to medical care as all legally working people. Everybody in the US does or will have access according to the so named Obama-care. The basic question is—who pays for access, specifically if the patient is unable to pay?
An open and informed discussion within a democratic system has to decide which way can be considered most fair for most people without jeopardizing anybody’s right to their own Nine-Pillars-of-History-needs even with dignity at the end of life. The eventually chosen way has to be a two-way street for a society to survive.
The purpose of tribal life was to be able to raise a family for the tribe’s survival. The purpose of modern social life is to raise a family, educate the children to be of service to our modern society and for our self to contribute our service so we leave this life with a dignified memory left for our modern society to maintain and live by. The quality of life achieved in a modern society should therefore be sustainable.
In order to accomplish these goals for the richest country in history we have to analyze the problem in a very rational way.
Our modern civilized society has implemented old age pensions, minimum salaries, and health and unemployment insurances as expressions for this effort towards our common social goal. The cost of these social services has for most modern countries landed on the common tax base.
The term Commons with capital C and ending on s stands for an economical problem affecting what I call “what many own, nobody owns” or is responsible for. The Common tax base is a “Commons”. To have the cost of access to old age pensions and the other social services mentioned is after a while taken for granted. Should cost of medicine also be placed on a Commons may have serious consequences in the long run for any nation because, as a pillar need medical cost cannot be controlled.
Medical care often covers life-maintaining and life-threatening situations that make a patient totally dependent on the medical support system - in a way a monopoly situation. The Nine Pillars of History pointed out that monopoly will lead to social destruction be it from political or religious monopoly. Here I must again recognize that the social need for medical care is a unique situation that may lead to social destruction. Medical care has to be placed on the side of defense as a common necessity but should still be controlled through competition just like defense cost.
After having described the total problem in general terms might now be ready to address it more specifically.
Give is that in 2010 the cost of access to medical care in US is rising to an unsustainable 16% of GDP and still rising; almost double that in other industrialized countries. In Sweden medical cost in 2010 was 9% of GDP when corrected for local PPP. Even at 9 % medical cost in Sweden was crowding out other social obligations. (GDP stands for gross domestic production and PPP for purchasing power parity) 16 % annual increases in medical cost will double the cost in just 4.4 years ((70: 16= 4,375). Such percentage increase is unsustainable for any organizations that subscribe to underwrite. (Klugman, Blinder) To face the problem we have the following choices:
A) Take a Passive role
1) Wait for crisis to culminate; kick the can down the road.
President Bill Clinton tried to introduce a medical care bill in 1993. I worked at Lockheed at the time. A local branch of Kaiser Permanente had provided Lockheed employees with access to medical health care for many years. Kaiser Permanente is an organized HMO, Health Maintenance Organization. President Clinton tried through a mandate to impose a plan similar to the Kaiser plan to cover medical coverage for all citizens. Pressure from insurance companies and smaller employers blocked a general plan. Lockheed still picked up on the idea and offered for other, not yet organized medical groups to get together and compete with a Kaiser-like Plan (HMO). This held back medical cost for some time while the surrounding offices matched the Kaiser plan. This was ten years ago. Now even Lockheed is requiring its new employees to help pay for medical cost.
According to the Wikipedia HenryJ.Kaiser and a Physician Sidney Garfield founded Kaiser Permanente medical group in 1945.The Permanente group operates in nine states and the DC, has 8,9 million members served by 14,600 physicians or one per 600 patients. In its recently reported year, the non—profit Kaiser Foundation Health Plan and Kaiser Foundation Hospital entities reported a combined $1.6 billion in net income on $47.9 billion in operating revenues or 4.3%. Each independent Permanente Medical Group operates as separate for profit partnership or professional corporation in its individual territory, and while none publicly report their financial results, each is primarily funded by reimbursements from respective regional Kaiser Foundation Health Plan entity.
HMO- organization has helped to have access to medical care while having access to work. Still the cost within the HMO keeps on going up. Many employers opt out for plans for new employees or ask employees to help to pay for the increased cost. This may need to renegotiate new contracts like for state employees in Wisconsin. Many employees have now lost their job and with that also lost their access to medical care.
The Federal government plans to add 50 million new citizens to have access to the same size medical provider base. This certainly accelerates the whole problem. Who will or even can pay?
2) Hope that technical advances will bails us out???
B) Take an active role
After the Swedish model England made physicians into public salary employees. France like the Kaiser health plan has made all doctors independent contractors but here medical cost is even higher ($3470 for Sweden and $3696 for France) All OECD countries have a medical cost at around 9% of GDP. In a Federal report released June 2012 on cost/ PPP corrected GDP the medical cost will climb to 20% of GDP. This report is according to Kaiser health care news and a Bloomberg financial report 2011.
The Nobel Laureate Milton Friedman addressed the cost problem for access to medicine already in the 1970s. His solution was to open more medical schools and graduate more physicians. Also Dr Lobosky is asking for “lots of more doctors and doctor extenders. This would help but would not address all facets of the medical four-facetted economic interest pyramid.
The graduation of more physicians’ extenders would also help. With physician extenders is meant physician’s assistants, nurse practitioners and nurses specialized for specific medical treatment like pregnancy, delivery, tuberculosis, diabetes and so on. Kaiser Hospital has made efficient use of physician extenders. But small independent medical offices are not apt to hire medical extenders. Most of us enjoy the personal care that individual offices provide. Medical care is indeed a very personal need filled only through a personal, confidential relationship.
Most medical situations are however not that complicated that eleven or more years of training is necessary. A triage referral system would certainly help, specifically for emergency admissions.
1)Single payer would lower administration cost from 35 to 3 or 5%
2) personally I support the president Obama’s mandate for general access to medical care.
3) I propose to measure efficacy according to the following recipe.
4) Most medical situations are so common the treatment team has worked out routines to meet the need. The profession has numbered all procedures and generates its cost accordingly. This information is computerized and therefore offers a unique opportunity to check the medical efficacy of any procedure, any medication or in any medical practice. I proved medical efficacy of health education at Lockheed using such a computerized program (See my publication: Add years toy our life, and life to your years Part I)
5) A computerized test program does need not to be for a whole country. It may be limited to a geographical area recognized for excellent medical care and good computerized medical records. El Camino hospital in Mountain View, California, with its surrounding individual and group practices may together comprise such sample. The El Camino hospital is a not-for-profit hospital recognized for its superb care. The surrounding patient and doctor populations are typical for a well-planned community. This information can be used as a measuring stick to compare against for-profit medical enterprises.
6) Start a medical review board for every medical county as a first instance for patient complaint.
7) Require a legal tort program for any state receiving Federal assistance.
8) A review of medical malpractice policies.
9) A review of pharmaceutical prescription policies.
Appendix to cost control of access to medical care
I grew up in Sweden and have worked as a licensed physician in both Sweden and the US. I have worked both as a clinical physician and a medical scientist. I have also worked as a medical director for a major US corporation. As a medical director I had an insight into the insurance side of the medical business. In retirement I have studied political history as revealed through nine sides of anthropology. Together my past experiences have given me a unique knowledge of the workings of medical cost in both US and Sweden.
Professor James Sheehan, recently retired from the History Department of University of Stanford had for the last ten years mentored my work of analyzing world history of anthropology. Professor Sheehan encouraged me to make an excerpt report from my book: The Nine Pillars of History, an anthropological review of history, sexuality and modern economics, all as a guide for peace.
In the past four years we have learned that anything with a dollar sign has a floating value. What then is permanent Truth? Can a real Truth be defined? I asked myself this question some ten years ago and undertook a most extra ordinary undertaking of trying to find an answer. I went back to tribal time to find what actually mattered for a very first human social group and still is very fundamental for any society. I found what I called The Nine Pillars of History. The Nine Pillars of history have three characteristics:
1) They are eternal; they were all there from the start of human society 200,000 years ago and are still critical for society.
2) They are interdependent because they are all present at the same time.
3) The cost for society of any of them cannot be controlled but for competition just like any cost paid from the common tax base.
Which are these Nine Pillars of History? What is the pillar need they fill? The first is a group of pillar needs that are necessary for any life on earth and then the eight pillar-needs important for society.
1) food, water, air, energy, sexuality
6) community support
8) access to medical care
To prove that the Nine Pillars of History are eternal, interdependent and that their cost cannot be controlled I took on the immense challenge to review the world history for 1) political life, 2) the history of four major religions, 3) the history of the female role in society and 4) the history of economics. I used the Nine Pillars of History as common denominators to show what happens to a society if any of the nine historical pillars is abused. Because each Pillar-need is necessary for society each one can indeed use its influence for abusive social power.
Right away I could divide human social history into three main historical time-periods based on how food has been transported: handheld in tribal time, animal transported in agricultural time and machine transported in industrial time. The modern city is a product of machine-transported food.
The female role in our society through history has been distinctly different in each of these time periods. The female was at least an equal member of society during 190,000 yearlong tribal times. The female had very limited political power during agricultural time but recovered her political equality during industrial time. General and equal voting rights was first introduced in Sweden in 1909 and in the US in 1920. Exceptions from this rule are pockets of people still living in tribal groups or still living in very conservative agricultural societies.
An in depth historical review of each pillar need is presented in my book referred to above.
Today I will limit my comments to the Eighth Historical Pillar; cost of access to medical need, the cost of which can only be controlled through competition. This fact has serious consequences for any nation. Professor James Sheehan of Stanford University encouraged me to make this limited excerpt from my nine-historical-pillar review.
My background for this discussion is unique in that I grew up in Sweden, has worked as a licensed physician in both Sweden and the US. At the University of Oklahoma, in Oklahoma City, Professor Stewart Wolf mentored my work at the OU. My assignment was at first the technical work for a quantitative method to measure heart blood flow through the skin and eventually to predict and, if possibility offered itself, prevent heart attacks. For this work we, 18 scientists from the Neuro-Cardiology Center, followed 140 volunteers for seven years. The National Institute of Health (NIH) and the Federal Aviation Agency (FAA) sponsored my medical research for thirteen years. The beneficial effect of blood thinning was noted. My work had a complicated finish. The work was published in an obscure book. In retirement I asked for the publisher’s permission to republished the report: An Unpublished Medical Story, Coronary blood flow, Heart attack prediction, prevention and treatment. This bookwas recently released.
Since my academic years I have worked in the Silicon Valley area as a Medical Director, first for NASA for two years and then for the Lockheed Martin Corporation. I retired from the Lockheed Martin Corporation 1989. In Feb 2001 my wife’s family history inspired me to pursue my present interest in anthropology.
At NASA I initiated a first health education program to prevent heart attacks. This work was first quoted in, at that time, a local magazine Runners World. At Lockheed my health education efforts expanded to include all kinds of employee health education in order to control work and family stress. With help from the Lockheed computer department I developed a program to follow the health effect on the close to 30,000 working population (nation wide 100,000). In this effort I worked with scientists from SRI. The health education was presented to numerous industrial medical conventions and became a model for the Silicon Valley employers. This work I recently also published in book form: Add Years to Your Life and Life to Your Years part I and part II.
Doctor Wesley Alles PhD assigned his first sabbatical academic year to my Medical Department at Lockheed in Sunnyvale, California. After a few years working with me Wes was offered to take over the Health Improvement Program (HIP) for Stanford University.
The Stanford program became the model for a national health educational program through YMCA and also for large medical insurance companies in Japan and Brazil. Besides his work at Stanford Doctor Alles became the Chairperson for our local El Camino Hospital. Lockheed had initiated the first computerized medical records here. El Camino Hospital is now identified as one of the technically most advanced hospitals in the nation.
As a Medical Director for the largest local employer I had intimate contact with the surrounding medical community. In retirement I am now a benefiter of medical care from both Sweden and the US.
Heart attacks are the most common cause of death. A heart attack is caused by a blood clot blocking the blood flow through the two main arteries, the right and left coronary arteries, each supplying blood to its respective half of the heart muscle.
Many believe that heart attacks are caused mainly from sclerotic plaques blocking the coronary arteries. Therefore measuring the blood flow in the coronary arteries is essential.
For 13 years, I devoted my research measuring coronary blood flow using a radio-cardiogram (RCG), a recording through the skin outside the heart when the blood stream had been marked with a radioisotope.
After years of work a direct relationship was found between the total effort the heart muscle performs supplying the body with blood and the blood the coronary arteries require supplying blood to the heart muscle itself. The measurement of the total amount of blood the heart pumps, the cardiac output (CO), is a considerably simpler to measure than the coronary blood flow. The close relationship could be used to pinpoint a specific time with high risk for heart attack and thereby provide a chance for preventive treatment.
The cardiac output for an individual varies with the sex, age, pulse rate and body size. A normal value has to have narrow ranges or it is impossible to determine what is abnormal. Correcting it only for sex and body size has been standard for normalizing a cardiac output.
I derived two formulas for normal values for CO and correlated these for sex, age, pulse and a measured blood volume. The blood volume by itself related it to body size. To correct the determined CO to a determined blood volume made a lot of sense because an enlarged blood volume could independently affect the work-demand from the heart muscle. The new normal values for CO recognized the true risk for heart attack within a six-month time-specific window with 68% true positive and 7 % false positive results and offered possibilities to treat and prevent a heart attack.
This scientific work was first published privately in book form. It is now, with the original publisher’s permit, for the first time republished in:
“An Untold Medical Story, Coronary Blood Flow, Heart Attack Prediction and Prevention”.
My second publication contains a set of two volumes: “Add Years to Your Life and Life to Your Years Part I and II. Part I has as subtitle Heart Attack Prevention and Treatment. This parthas five specific topics for heart attack prevention but reports also on the efficacy of health education in a large industrial plant and how to follow up on the educational progress. Part II has as subtitle “Family and Work Enhancement” with information about challenges during working life.
A third health educational book: “You Are It: First Aid when Minutes Count” may also be helpful in heart attack prevention and treatment but offers also help in 17 common medical emergencies.
After referring to Professor Niall Ferguson’s 2008 historical review of The Ascent of Money, Dr. Sevelius makes his own unique analysis of the Nine Pillars of History and their effect on the economic forces within our global society.
Specifically, Dr. Sevelius intertwines an analysis of the economic concept “Tragedy of the Commons” and the Nine Pillars of History. It is his stance that the Nine Pillars of History cannot be controlled without financial competition. Therefore, they should not should not be supported by the common tax base.
The “Tragedy of the Commons” was first recognized in in ancient agricultural time when a pasture was grazed to bare ground by livestock with no forage left for other tribal member’s animals. The “Tragedy of the Commons” can lead to enormous resource tragedies, for example:
1) Large international oceans areas that are over fished and polluted.
2) Over drafted groundwater aquifers causing land subsidence with the remaining groundwater too saline for people to drink and food to be produced.
3) Air basins can become so polluted that people have trouble breathing and seeing.
All these potential environmental disasters are cases of the results of what can happen when society owns the Commons but nobody steps up to take the responsibility for the care and protection of the Commons Commons.
We must ask ourselves- Is not a national tax-base just another example of a Common resource? All services supported by the public tax base have to be scrutinized with competition in order to control the cost; if not, the services will be subject for the Tragedy of the Commons with run away costs. Dr Sevelius analyzes several examples of run away costs. Specifically„ he analyzes and compares the 8th Pillar, the access of medical cost in Sweden with that in USA.
The Commons has two sides, one side that is beneficial for everybody and one side that is a derivative of the benefit, the establishment, and that may receive special interests. The beneficial side is the creation of a community infrastructure. The other side is what economists call “Tragedy of the Commons.”, or that the Commons is a limited recourse with competing interest vying for its exploitation. Competing interest can also include dogmatic self-interest.
Looking back over 10,000 years through the view of the Nine Pillars of History it becomes evident that most wars during agricultural and industrial times have actually been due to dogmatic control of the common tax base for specific personal agendas.
Now, that the causes of war have been identified and the Nine Pillars of History been defined, it should be possible for humanity to enter a new civilized way of global life. For the first time we are living in a global world with producers and consumers connected to exchange everyone’s Nine Pillar Historical needs at a reasonable, negotiated price. This is a civilized way of life.
A short political and historical summary of religion.
(This review has nothing to do with faith.)
The book The Nine Pillars of History gives the reader a unique, anthropological review using common denominators taken from nine human needs identified from the 990,000 year long hunting and gathering time. Five word religions, Hinduism, Buddhism, Judaism Christianity and Islam are analyzed together with the eternal social rule, the Golden Rule. The author also attempts a generic explanation to the eternal need for a personal religion.
The Nine Pillars of History are:
1 food, water, and energy
6 community support
8 access to medical help
The author begins by assuming the human need for religion began when Homo Sapience started to communicate. Life survival has always been a challenge. A need for help from a higher power comes naturally to mind at the same time.
The early hunter-tribes saw a higher power at work in the annual cycle change of nature. The early tribal life had a god concept that was a non-personal concept that had started and controlled the Nature’s “machinery”. Tribal life had no heaven or hell.
Morality evolved from the human experience; from what was “right” for the tribe in social life within the tribe. This social bond between the tribe and its members was the start of the Golden Rule. The bond rested on what in the “heart” was perceived in the word concept “consciousness”. Here “con” stands for “common” and “science” stands for knowledge, the very start of the social experience of tribal morality.
In early agricultural times, some 7,000 years ago, people started to name different experiences in nature, giving them concept-names from human life. The experiences were godly because the concepts were eternal and represented great powers. These experiences controlled the outcome of harvest or people’s chance for survival. Most religions except Islam have celebrated the agricultural year. Islam celebrates events in Mohammed’s life.
The regularity in farm work led to special common places for praying and communicating to the gods and special workers for leading the communication and procedures for approaching these powerful gods. Artists created pictures of gods to use for communications and focusing thoughts.
The first large religions those within Hinduism did not have one dominating leader and created more than a million multi-god concepts. Hinduism inherited a cast system that introduced a layered social community.
The long and independent life of Hinduism is a proof that religion will live on without a singular leader like a pope or a prophet. It has met and meets all the Nine Pillar human needs for security under its democratic leadership.
Four large collections of the Indian Veda books set the cultural norm for Hinduism. (The Veda books in Indian culture correspond to the Bible in Western culture.)
Some 4,000+ years ago Judaism introduced a one non-physical, god concept similar to the tribal god concept. Moses gave it a moral god concept with social rules such as the Golden Rule and the Ten Commandments. The Jews built a first temple on a hill in the middle of Jerusalem.
About 4,000 years ago Zoroastrianism’s prophet, Zarathustra in Sumer (old Mesopotamia) introduced a heaven and a Hell concept, an award system for a moral life.
Nebuchadnezzar conquered Jerusalem, destroyed Jerusalem’s temple 2,500 years ago and had the Jews enslaved for 70 years in Mesopotamia, the old Sumer. Judaism was introduced to Zoroastrianism and accepted the heaven and hell award system. The new non-biblical Judaism with a heaven and hell concept is called rabbinical.
The Jews were freed from Mesopotamia, returned to Jerusalem and built a new temple on the old Temple Hill. The heretic Romans destroyed this temple in the year 70. Muslims conquered Jerusalem in year 640 and built the Golden Mosque on the ruins of the Temple Hill. Modern Jews pray to the remnants of a wall of their old temple.
Judaism is proof that religion will live on even if persecuted for thousands of years. Judaism meets all the Nine Historical Pillars when being part of a democratic society.
A third form of Judaism in industrial times is called Reformed Judaism. Reformed religion usually means an educated membership with recognition of the Golden Rule. The concentration of three religions, Judaism, Christianity and Islam within the small town of Jerusalem speaks for the closeness of all religions. Jerusalem could evolve to become a peaceful and interesting connection between all three religions, maybe all religions.
Buddha reformed Hinduism 2,500 years ago and removed the cast system from Hinduism. The monk organization became a model for Christian monks.
Buddha identified the needs that were essential in social life. Buddha created rules to follow and showed how to do it. Buddha did this through yoga focusing. Buddha-organization was a first religious movement that was totally separated from governments and whose dogma emphasized no war. Buddhism became the most widely spread religion in the world without war.
Christianity and Islam copied many of Buddha’s religious rules. First Buddha but later also Jesus and Mohammed were all tempted three time’s by the devil, members all walk around their religious focus three time counter clockwise to have the heart closest to the center, all use beads to keep track of prayers and enhancing thought focusing.
Muslims conquered pacifistic, Buddhist India and ruled India for 1,000+ years. During the Muslim occupation of India many of Indian most holy temples and schools were replaced with Mosques and Madras’s (Islam schools).
Buddhism meets all human Nine-Pillar-needs for security when living within a democratic society.
Some 50 large “Dharma” books are the cultural norm for Buddhism, just like the Bible is in the Western world.
Christianity started 2,000-years ago with the human birth of Jesus and added a god-family concept into its religion. Many social traditions were still inherited from Judaism. Paul and several of Jesus’ disciples emphasized the Golden Rule in their writings and preaching.
The leadership of Christianity combined with the king’s leadership but used two languages, Greek and Latin, for its social rules. The two languages for communication split Christianity into two branches: a Catholic branch led by the Pope in Rome and an Orthodox branch led by the Patriarch in Constantinople. Both branches use the text in the Bible as their cultural norm.
Luther reformed Roman Christianity in the 1500s. Luther used local languages for the interpretation of the Bible.
The invention of the printing press in the year 1,500 helped to spread new, local language translations of the Bible. These new translations of the Bible became the cultural norm for the reformed Christianity.
The collapse of dogmatic Christianity in Spain, Italy and Constantinople and the success of its reformed form in England, USA, Germany, Scandinavia and Holland is proof that religion will live on both with or without secular, political ambition.
Christianity in any form meets human’s Nine Historical Needs for security as long as it lives under a democratic regime.
Mohammed, Islam’s prophet in the 600s, could not read but was told about the Bible and the history in it. Mohammed had a soldier attitude and eventually became a successful general. Judaism had had difficulties to keep people faithful to their traditions. This unruliness was documented in the Torah (Old Testament)
Mohammed would not go for unruliness and added an un-compromising discipline to Islam.
Praying to a god had always been free until now. Mohammed added a death sentence for people who did not follow the Koran. Now praying became mandatory. The mandatory rule of praying became a social rule holding the Ummah (the Muslim community) together. Every Muslim would police each other.
About one hundred years after Mohammed’s death the Islamic leaders referred for the first and only time to the Golden Rule in Islam’s rulebook, the “Hadith”, The Hadith states: “Not one of you is a believer until he loves for his brother what he loves for himself”. The Hadith does not define what it is referring to by the word “brother”.
Islam is based on intense, very focused praying and has submitting attitude to rules. The word “Islam” means, “submit”. In its first 1,500 years the Muslim world started a successful religious war with given earthly rewards for its generals. The general would receive 80% of taxes of conquered land for himself and life long pensions for his soldiers. Muslim control of land became very large, reaching from Spain, across North Africa, Balkan Peninsula, Turkey, Middle and Far East. Turkish Muslims conquered Constantinople in 1453.
Arabic language and Islamic religion spread with the land conquest. It was all a mission by the sword.
Islam’s leadership re-introduced an elitist, segregated society. “Infidel Christians are allowed into its society, provided they pay an extra “protection tax”.
Mohammed claimed ownership of Jerusalem because he had had a spiritual visit to Jerusalem and its Temple Hill and from there also made a visit to Heaven.
Early Islam split into two branches based on hereditary privileges. One branch of members are referring to their bloodline with Mohammed. They are called Sunni. One branch is based on a bloodline with Mohammed’s cousin Ali. Members in this branch are called Shiite. Members from the two branches have been in war with each other since the 600s, or since shortly after Mohammed’s death or for about 1,500 years.
The text in the Koran is the norm for all Muslim cultures just like the Bible is for Westerners.
Arabic countries have locked themselves in after their successful 1,000 years military expansion. Educational news from the free world were considered infidel. As late as in the early 1,800s their most prominent teachers can be heard telling their students that the earth is the center of the of universe and the sun and the moon rotate around the Earth. (Niall Ferguson, Civilization, the West and the Rest, 2011.)
The religious and political leaders of Islam had economic personal security from the Muslim pilgrimage to Mecca and the tax from conquered and “protected people”. This locked in community started to fall apart from within in the early 1900s.
The West discovered oil in Arabic countries in the late 1900s. Because oil is part of number (1) of the Nine Historical Pillars large sums of cash entered different Arabic tribes and nations. Some of the tribes and nations clang to theocratic dominance for their security. With new oil money theocracies is now indeed a political threat to a free world.
That Islamic communions successfully are living in a democratic world and meeting their Nine Pillars need of History is proof for that the political theocratic bond that now threatens surrounding tribes and nations is not important for its own security.
In early agricultural time the most successful farmer, the king, attributed his success to his connection with his god and his god’s power. The King eventually combined his person with his religion, in other words he started a national, elitist, theocratic social concept. This elitist belief lived on through history and has caused war between different religions and nations for the past 7,000 years. Some religious leaders still encourage a warrior behavior and, conveniently for them, forgetting that the Golden Rule is the basic social rule since tribal time.
Religions are just different metaphysical concepts that have been tried over time. When trying to impose and rule a large group of people religion is disastrous for security for it’s members. Seven thousand years of war is proof o this statement.
A summary of gender history.
In the 190,000-year long tribal time females and males were equally dependent on each other and had equal influence over family life. The female added 70% of calories from gathering fruits and vegetables and males 30% from hunting. Both were individually dependent on each other in maintaining their ambulatory family life.
In the Middle East seven thousand years ago, where major stationary agriculture started, the king, the most successful farmer, became rich and hired many males and females for his large household.
The king and also other rich farmers soon used their power over workers to serve themselves. This self-serving attitude caused a general depravation of the female’s individual image. She became a sex object with very limited personal and economical rights. The king on the other hand revived the animal flock instinct and actually collected females into large harems with hundreds of females serving him. The king used eunuchs to serve as male workers in his immediate household.
The female image as a sex object followed her all through agricultural time and lasted far into industrial time, particularly in areas that stayed agricultural.
Industrial time arrived very fast into some of ag- areas and caused the agricultural cultural female image to collide with the old free and equal female image from tribal time. The collision of cultures led to a total cultural shock in the area.
In industrial times the female had learned to write and read, had become educated and recovered her equal individual rights to the male.
Here is where we are today. Some traditional cultures are still hanging on to their old agricultural female image with very limited education, legal and economic power actually physically colliding with the now educated female with equal rights to her male friend.
I grew up in peaceful Sweden with Sweden surrounded by WWII. My wife came to Sweden as one of thousands of refugees from the war-torn European Continent, in her case from the Soviet occupied Estonia. Her family history kept me interested in finding a cause of war and challenge the often claimed saying: “war has always been and always will be part of life on earth”.
I have a promising idea. I have been using only nine common denominators to evaluate 200.000 of world history. Using Common denominators will make me free from any religious or political affiliation.
I selected nine pillar needs that were equally fundamental for a group of males and females living in the Hunting and Gathering time, as they are for people living in our modern society. Being pertinent for a 200.000-year time frame would make the Nine Pillars of History close to the ultimate Truth.
The Nine Pillars of History:
- food, water, and energy
- community support
- access to medical help
Now the premises for evaluating of history are set without any racial, national or religious bias.
The study grew to expand into studies of the some 20 nations, five world religions, the female role through history and finally to the history of economics. The economic studies were called for because both the nine pillars as a unit and the economics address family security. This final study of economics led to the recognition of the forces that cause war.
The material covers a lot of ground, how did you use the experts?
Professor James Sheehan introduced me to different departments at Stanford University and his name opened the doors so I was taken as a serious student. I attended colloquia at the Department of Anthropological Science regularly for several years.
Many experts from Stanford University and from University of Sweden in Lund volunteered and gave me references to read, had my writing reviewed and critiqued. They are all, some 15, listed with their expertise in the book.
This work could never have been completed without their help. Actually no one can be an expert in so many fields that this work touches on.
Are these nine pillars common to all civilizations and cultures?
No, the Nine Pillars only exist in democratic cultures. As we see in current world events, when any of the pillars are abused or absent there is a tendency for insecurity and war.
For example, An Arab spring has started and reaches out for, free communication and trade; hence the needs of the people are not being met and dictatorships are falling. In Soviet Union almost all pillars were abused. It collapsed by itself in 1989.
The Nine Historical Pillars are so fundamental that no society can stay together if not all nine are met. They are based on the human right to make a living or in other words his or her access to his or her Nine Historical Pillars. Legislators have to ensure free competition for the control of the cost of the Nine Pillars and for the individual freedom to access them. The Nine Pillars cost can never be controlled. When dogmatically controlled the Nine Historical Pillars will always be abused and cause war, civil or between nations.
We are in an early state of an evolution towards a global society. The Nine Pillars of History will help to define, explain and educate a voting public about the forces that cause war in my hope for a global peace.
The fate of my wife’s family inspired me to start the Nine Pillars of History. I am very thankful to my wife, son and daughter for their support, critique, and encouragement through the many years it has taken me to formulate the Nine Pillars of History.
As the future unveils I pray that the Nine Pillars of History will help us to focus on these basic human needs so that all communities can partake in the building of a new, global, and peaceful society.
Human Society, as we know it, goes back some 200,000 years to a time when we learned to speak and communicate our thoughts. The ”Nine Pillars of History” are derived from nine basic requirements for a healthy and prosperous society during the following 190,000 years of Hunting and Gathering.
Sexuality, a fundamental human need that in history goes back much further than society, had to be mitigated with the first social rule: The Golden Rule. The “Nine Pillars of History” are used as non-political common denominators to judge the political evolution of some thirty major countries or cultures. In addition, the same Pillars are partnered with the Golden Rule to explore five world religions, Hinduism, Buddhism, Judaism, Christianity and Islam.
Since about 5000 years beck economy joined the Nine Pillars of History in order to secure our places in society. The history of the evolution of economy into an integral part of our modern society is analyzed in a final and upcoming part of the book. Economy has a floating value while the Nine Pillars are of eternal value. This difference has deep and given consequences as explained in this final printing.
The relevance of “The Nine Pillars of History” are proven by the fact that they exist intergraded across multiple societies since the dawn of time and are still relevant for our modern world. This historical review reveals that dogmatic religions and harsh politics have caused 10,000 years of war by repeatedly challenging the relevance of “The Nine Pillar of History”.
Doctor Sevelius gives his view as non-political, non-religious thoughts. Each paragraph in his new book has been numbered to offer an easy to use reference system for community discussion of specific statements.
"The Nine Pillars of History” gives you, Dear Friend and Reader, a unique vision for peace as Dr. Sevelius respectfully borrows President Lincoln’s enduring truth, “that government of the people, by the people and for the people shall not perish from this earth.