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
a) malpractice
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:
a) eternal
b) interdependent
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
Goals:
a) Dignity for intergenerational equity and long-term societal survival
b) Sustainable ratio of medical-care costs to GDP
Goal Measurement:
a) Dignity: Elderly prayers, ??
b) Sustainability:
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
Alternatives:
a) Passive
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
b) Active
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
Implementation Plan
1. Computerize
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.
The Problem
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
2) dwelling
3) cleanliness
4) art
5) communication
6) community support
7) religion
8) access to medical care
9) trade
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.
