The Silent Factor Balancing the Healthcare Equation : The Certainty Factor of Mortality

In a healthcare system , there are numerous variables that make predictability of a healthy life difficult. No matter how wealthy , healthy, how tall , how heavy or happy anyone is in a society; No matter how many medicines you take or supplements you consume and no matter how evolved medical technology becomes, one thing is definitely a "certainty" for all healthcare systems , mortality. It is perhaps the single largest issue we do not deal with directly on any basis including philosophical , economic, medical or even personally . It should be one of the key factors when computing a systems efficiency. No healthcare system or magical cure has been developed capable of diverting the certain probability of mortality. Since medical science in essence can not change the "certainty factor" of mortality by increasing quantity of life significantly , it can on the other hand significantly influence the quality of living, perhaps even dramatically. For the two thousand years prior to the 20th century , The average for mortality was less than 50. We've only increased quantity of life by 20 years in the subsequent years since then. So , that would be minimal in comparison to what prevention and health has done to improve life . But, this doesn't even begin to reveal the real potential the effect quality of living can still impact health for a system. So , it proves rationally, that the emphasis of health really should be strongly placed on our quality of life more as just opposed to quantity(number years lived alone). No matter how great one increases the "quantity" of life, the "certainty of mortality" will always supersede it. There perhaps is no more important a time than now to emphasize the "quality of living" in an era where a large part of the population are living a lot longer and to longer ages; people are living with multiple chronic illnesses subsequently as well. Shouldn't we then be focusing on our healthcare system's ability to effect and improve prevention to improve quality and not to put a human being through the pain that comes at the time of eventual mortality? Effecting prevention means ,

not , just doing merely a once a year annual physical or cancer check, but by performing and reaching daily life pattern-goals with a set of behaviors that effect eating and activity each day that are essential to continued quality of life. Quality of life is "hinged" on prevention. The outcome is multi-fold because not only can you improve disease and improve length of life; a health system can improve its costs, reduce spending, reduce waste, duplicity as well as improve the socio -economics and efficiency of that system . Prevention places the root of health squarely in the hands of the source where health and illness begins and ends with, the individual person themselves who must live his or her life according to nature . Morbidity and mortality are a result of daily habits directly related to eating habits and activity behavior. A Healthcare system is influenced primarily by two general factors . They are based on health maintenance and the delivery of care by improving life, but a healthcare system is also a measure of economics. Today our system is 18% of GDP which utilizes vital resources between several industries. But these two main factors over-look perhaps the biggest "silent" factor that influences outcomes, mortality. Our culture, traditions and modern society wishes to over-look too often how and when death or how long to maintain a life system(organism) will cost a community (nation) in the long run. We tend to emphasize quantity of life more as an extension of measuring an effective system; we think as if medical science alone can guarantee immortality through physical intervention. This skewed thinking in society has "cost" us in the long run. It is not easy to think of life in mathematical terms due to modern cultures inability to accept our mortality as a pragmatic matter and natural fact of life because of how sensitive the issue is. We'd prefer to believe our bodies will be there always, and that if our body breaks down temporarily, medicine will always be there to "patch us up" regardless, like driving a car into a mechanic's shop . Quantity of life is not like a car warranty, rather quality of life is closest to being it because it addresses the physical, mental and emotional well being of the human organism, by not merely dealing with a statistic. The economics of a system prefers dealing with numbers that are nice and neatly packaged representations of morbidity and mortality on a budget sheet. However , human beings are not merely numbers. This is the main difference of a "quantitative-centric" health system as opposed to the "qualitative -centric system". Healthcare systems are intimately tied to the economics of national budgets, therefore your life measured in quantity and quality is both a measure of how much of a system's available resources are utilized by consumers in the economy( medical consumption/cost of living index). Insurance acturarial experts are utilized in both private and public insurance companies(Kaiser, Blue Cross,Medicaid, Medicare, Social Security) for the very purpose of measuring an individuals "risk" of Morbidity) mortality as it impacts economics . Our current system is no different as "all" systems are mathematical equations that have to be balanced(i.e., a balanced budget).A system makes assessments of either "risks" or benefits. Morbidity represents risk as the insurance company has to utilize more of it's resources. That would mean that a longer living population with more chronic illnesses will utilize more resources. What would be the benefit of that? It means that the remainder of society , regardless of how healthy they are will have to "counterbalance" or compensate for this "over-utilization" for longer life(quantity). It is difficult for medical doctors and patients alike to look at human beings as a unit of risk assessment and calculate their disease as a economic risk unit and predict how to reduce their usage .But the actuaries at both private and public insurance companies do just that because there profession is to see the human being as a number(unit of measurement) and disease as a statistic not as a person. Neither the emotional aspect of what individuals and their families feel with loss or other intangibles are taken into account. These "qualitative" factors can never really be measured by actuaries. This would mean that it is better to issue a prevention oriented health system as the "hub" to "balance" its spending and improve quality of life with respect to quantity of use of resources. If more than 60% of medical benefits are utilized in the last 6 months of life . Quality of life will certainly become not only an ethical or economic issue, but one of national duty? That is what a quantitative oriented-economic-based( for profit) healthcare system urges as opposed to a prevention-healthcare(qualitative) based system. Sometimes a system , if it is more pragmatic than utilitarian , evolves out of being purely quantitative/economic(HMOs, PPOs/for profit) , by putting more emphasis on prevention(qualitative) methods. It begs the question if monetary value ever should or could have been placed on human life via a system(medical) that seeks to improve quality of that life. It also asks the question to our system about the paradox of how much to spend in those last six months of life as well. Real prevention in which quality of life is hinged on is itself based on five primary points. These are to always to allow the consumer the benefits of having regular physical activity, nutritional support, a wellness-based labor force, emphasize personal responsibility and prevention education . This "new era" of medical science and medical policy will begin to challenge society's views on the efficiency of a purely economic-centric system(prolongation of life regardless of costs). These issues will also include as they already now do, the definition and use of hospice care. Hospice care is where either an institution or an at at-home based care is set up where those who are diagnosed with a terminally ill disease are treated with special care. These services are tailored to the high morbidity and looming mortality of a patient. Some "unorthodox" practices in hospice care may include meditation, nutrition supplements, marijuana therapy, experimental trials and palliative care. Palliative care is of its own has also become perhaps even a bigger issue than hospice care because pain therapy(the main focus of the therapies) is a cross-between therapy of hospice care treatment for reducing pain for terminally ill patients, but palliative care also may means reducing pain up to the point of allowing the patient to "terminate" their own life. This very controversial issue is called Euthanasia. Both ethicist and physicians debate if this is really "therapy" for a patient who is in chronic severe pain and will no doubt eventually succumb due to their illness or the intensity of their pain this could be looked upon as a "slow self-suicide". Both physicians and ethicist are looking for that transcending key sublime way for patients to "exist" in the least painful way that preserves dignity and respect while seeming compassionate themselves. This area is very controversial because of the Hippocratic Oath physicians take and the "cold accounting" the economics(monetary costs) of dying has with the insurance system . So, the question remains is it just a pain relief or is it an "out" when the pain of terminal cancer or a chronic infection is unbearable and the humanity of letting someone push the morphine drip to their own determined level of alleviation is being asked. This leads us to the question of the "Do Not Recusitate Medical order(DNR Status). In the future of medical practice, historians may feel this would appear as a contradiction of terms. Again, the irony of do not therapy for a patient who is in need with the fore knowledge of knowing their mortality. In the future marijuana also will become used for pain in hospice and non-hospice related care in this new era health system. But, perhaps the greatest controversy to overhaul an already fee-for -service (for profit) healthcare system is how do we create the "socialization" of healthcare. This is the pinnacle of converting a free market health system to benefit all, because the incentive on healthcare now has to be changed to fit everyone regardless of socio-economic or class distinctions, and pre-existing conditions. How do you do that when "money has always been the incentive" behind the compassion of care-giving? Although medical doctors have been the friendly face of healthcare, it is the stern face of the medical-industrial-complex of a business enterprise and share holders that steer the ship. They are mutually incompatible. Our system has become a paradox. One way to shift the paradigm is to look at what is being done correctly with healthcare delivery in Scandanavia, England, Canada, Taiwan and France. These systems have made it easier to treat in a socialized medical system because they accept mortality as a factor of life ( reality), they are pragmatic about death, they use health more as a utilitarian approach without giving up on its humanitarian duties. But, the biggest thing that makes these systems "Cadillac Models" of healthcare systems of the world is that they pay 50% or more of their income on healthcare. Again, as the "certainty of death" ever looms in everyone's life at sometime, we must look at the cost of more people who will die at older ages with multiple chronic ailments. We will also be seeing more of "poly-pharmacy"( overuse of multiple drug prescriptions) . We will see more billion dollar price tags for the treatment of end stage diseases such as heart disease and cancer. Poly-pharmacy to infectious disease specialist means more drug resistance to antibiotics. Poly-pharmacy to chemical substances means a rise in either abuse or tolerance. The need of more multi-specialty medicine means more time spent by trainees in low wage medical residency -fellowship programs which later become very lucrative practices. We must see also how tort reform must be alleviated in the conversion of a pure economic driven medical system to a more humanitarian system. A move many lawyers are not yet willing to give into, just yet. I do not believe that whatever "change" derived purely from any economic-financial end of a healthcare system, that in the end it is better than one that promotes preventive- qualitative care as primary . Will some aspect of cutting wasteful spending and duplicity be seen as "rationing" care in converting the system? In the last five years we have seen the U.S Public Health Task Force increase the age recommendations for getting Pap smears, mammograms, colonoscopy , PSA(prostate specific antibody) for detecting prostate cancer as well as specific markers for Ovarian cancer. Why? Many clinicians refute the reasoning or data supporting these new "risk" changes to increase the age on detecting these frequent cancers. These recommendations to some lead to late or totally missed diagnosis in the natural history of a patient's disease. In the end mortality wins out overall and above anything else, but it seems the time that we are here we should have the choice of good quality health, regardless the length of time we live to enjoy it. No matter what type of system eventually takes place(Single Payer, Medicare for all, Universal Care, Socialized Care, etc...), the purpose of the insurance system's function is to produce better outcomes of the bottom line through predictability of morbidity and the valuation of mortality. This is done by determining the eventual risk of disease. With all the mathematics , predictive values, and other statistical metrics, an insurance system can not pre-determine exact mortality. However, they can assess individuals into risk stratified categories. The system asks what "burden" does one's lifestyle have on the limited resource( cumulative premium totals). In the future new forms of technology(nano-technology) the size of a human hair or smaller will be able to read every physiologic activity at the cellular level and feed it in real time to a main frame computer so that several clinicians, actuaries, underwriters, pharmacist, financial institutions and insurers can know your real time risk immediately. This will then help the "system" determine continuous "cost" to the system and guide the consumers behaviors more favorably in the direction of asset loss prevention . In the end we must all realize our own mortality, take responsibility for our own personal health more and understand the certainty and impact mortality has on all healthcare systems. It is up to the "architects" of systems and the logicians to polish up the "quality" aspect of our healthcare system before it is forgotten as an equally important factor as the quantitative.