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Our staggering national debt is due in large part to highly educated politicians and government officials making financial decisions with little or no training on the subject of money. America is the richest country on the face of the Earth and in the history of the planet. The United States is also by far the world’s leader in over-consumption; while the United States population is less than 5% of the world’s population, it accounts for 33% of the world’s consumption. The USA is likewise surely the most wasteful of populations. Along with wealth, consumption, and waste often follows debt. Politicians and physicians seem to think that bank accounts are bottomless and notes will never come due. Robert Kiyosaki knows a whole lot about debt discussing it at length in his landmark book. Personal debt is his main concern, as he wants readers to turn from creating debt to producing assets and wealth. Still, the Big Picture, to which he often returns, calls for considering Personal Debt as well as National Debt. One mirrors and symbolizes the other to a greater or lesser degree. Then, it should be no surprise to suggest that Medical Debt warrants study in the midst of such observations. As of this writing, the American National Debt stands at $38,000,000,000,000 and counting. [It has risen $2 trillion dollars during the writing of this book.] Let us try to come up with some sense of the National Medical Debt which modern laws in the form of the so-called Affordable Care Act (ACA) and others before it have been passed to make “health care a right” while pressing costs into the government’s responsibilities. • Costs of medical care supported by government programs In 2022, federal subsidies for health insurance (ACA) were estimated to be near $997 billion. Medicaid spending was $805.7 billion in that year. Medicare cost the government $944.3 billion in the same year. Social Security Disability Insurance (SSDI) totaled about $143 billion in 2022. SSDI is a program that provides benefits to people who are unable to work due to a disability or blindness and are insured by Social Security. • Costs of government supported medical research Centers for Disease Control (CDC) has a yearly budget of $10 billion. National Institutes of Health (NIH) with 27 component institutes and centers spends $48 billion annually. • Subsidies to non-governmental businesses The NIH spends around $2 billion to support research and development of drugs and vaccines. For Covid, $30 billion was dispersed through government funding. • Personal Debt accrued from illnesses, hospitalizations, redundant testing and procedures, drugs, etc. The prevalence and cost of chronic disease in the United States is growing and will continue to grow due to increased incidence among children and younger adults. Those with chronic disease and their families face both direct and indirect costs. Including indirect costs associated with lost economic productivity, the total cost of chronic disease in the United States has reached around $3.7 trillion each year, approximately 20 percent of the country’s GDP. Some estimates are that around 133 million Americans have chronic diseases – other estimates are as high as 60 percent of adults, 40 percent of school-age youth. Adverse Drug Reactions (ADR) continue on the rise – 100,000 deaths annually. Opioid deaths stood at 15,000 in 2022, which alone produce around $100 billion dollars of associated medical costs. Whatever estimates are made – financial and otherwise, the true costs are likely much higher, because many ills, reactions, and incidents are not reported but kept quiet and at home. American riches are great. But, our debts – monetary and otherwise – are unpayable and irredeemable according to usual thinking. Can we grow beyond debt to true wealth and health? Some’s Good, More’s Better
Most people given more money, only get
into more debt.
Robert Kiyosaki knows whereof he speaks in regard to finances – income and expenses, assets and liabilities. Many modern folks work and strive for more money so that then they can spend more and continue working to pay their additional bills. In a quite similar vein, many people prescribed more medicine, often end up with more health problems, symptoms, and then more medications. The reader might think the previous sentence should read, “Many sick people given more medicine.” But, there are large numbers – thousands, maybe millions every year – who are not “sick” but submit to tests which their physicians believe call for medication. Screenings of wide variety occur in the USA in testing blood pressure and bone density, searching for cancer and depression, etc. What we look for, we often find. But, is a human being or an illness or a test then treated? And doesn’t more medication, more treatment often attract more of the same and often indebtedness of various kinds? How many people does the reader know who take a pile of pills each day? Some of those folks have to use special divided pill boxes (organizers) to keep track of their assorted meds. Then, we all might wonder how many extra pills those people or the anonymous poet in a previous chapter have to take in order to counteract the side effects of their purple, orange or blue pills. If some is good, then more must be better? In fact in the present day of excess and riches, we do not merely have more medicine available on request. Our lives have been “medicalized.” Medicine has invaded vast stretches of modern western life. Read Medical Nemesis: The Expropriation of Health.  Ivan Illich’s basic premise is that modern medicine has become a nemesis. More often than most of us dare to imagine, it produces illness and disease (iatrogenesis). Illich identified iatrogenesis in three particular ways: clinical, social, and cultural. Nemesis (in ancient Greek thinking) was the inevitable punishment for attempts to be a hero rather than a human being. Society bowing to medical advancements has handed over more and more functions and powers to the heroic but very flawed medical system. “Iatrogenesis is clinical when pain, sickness, and death result from medical care; it is social when health policies reinforce an industrial organization that generates ill-health; it is cultural and symbolic when medically sponsored behavior and delusions restrict the vital autonomy of people by undermining their competence in growing up, caring for each other, and aging, or when medical intervention cripples personal responses to pain, disability, impairment, anguish, and death.” Illich also believed that “only modern malnutrition injures more people than iatrogenic disease in its various manifestations.” Illich suggested that the spread of medicine was malignant, like cancer when it turns mutual care and self-medication into misdemeanors or felonies. While pursued with good intentions in general, it has created something of a nightmare. The nightmare has produced almost a police state of lifelong medical supervision. From cradle to the grave, the whole population is now seen as “age at risk,” and has been deprived of the power to care and cure itself, live and die in natural ways. Demedicalization or deprofessionalization of medicine is necessary in order to unmask “the myth according to which technical progress demands the solution of human problems by the application of scientific principles, the myth of benefit through an increase in the specialization of labor, through multiplication of arcane manipulations, and the myth that increasing dependence of people on the right of access to impersonal institutions is better than trust in one another.” This writer is reminded of his early years in which “medicines” were laxatives and Vicks Vaporub and chicken soup. And, the “designated doctor” was the mother in many homes. People went to the clinic or the hospital but rarely. This was in part because of the cost of medical attention, but probably more so that people understood the nature of living and dying, health and illness. They lived closer to the earth and the elements, and could relate to the hills and valleys of existence. Today, it is quite common for children to go to the clinic or emergency room several times a year for all manner ills, minor injuries, and medico-legal reasons. In the writer’s growing-up years, he probably only saw a doctor a half dozen times. Those times were for physical examinations to play school sports and emergent incidents related to accident or injury – things beyond the range of Mother McNary. That way of dealing with health issues was still imaginable 40 years ago when Robert Mendelsohn wrote, “If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off.” (Confessions of a Medical Heretic) Things have changed vastly in two generations in America with regard to medicine – for good or ill. In fact, the Medical-Industrial Complex has taken its place along with the Military-Industrial Complex prominently in modern life. Day to day, the former may have greater power and influence than the latter. Demedicalization will only happen through a political, societal solution. That is likely to be a long time in the coming since the public has been seduced into believing in “the church of medical science.” Still, individuals and groups can learn about Health and Healing on their own, much as Robert Kiyosaki has been prodding them to learn about Money and Finances. The media and politicians continue to proclaim The Right to Health Care and the need for Universal Health Care, etc. Someday however distant, the public may recognize Universal “Health Care” as the Nemesis and ultimately the Expropriator of Health. However that may be, the whole of western society has evolved along with the Medical Nemesis into a fix-it system. The medical model has taken control in wide areas of our lives even though it so often fails. The Problem Oriented Medical Record (POMR) has been taught in medical schools for decades: Collect information, Name problems, Institute treatment, and Make progress notes. And more recently, using computer algorithms to turn medical consultations into staged scenarios with digital directors. Human illnesses rarely fit so neatly into lists of Problems and Diagnoses, Names and Labels as we have seen above. Ills and injuries are significant parts of every human’s life. They fit so and ask to be “read” to really understand life’s passages, challenges and opportunities. At least for those who are able and dare to contemplate their own lives and stories. More on this topic follows in a later chapter. Robert Kiyosaki talks about and sees money and finance as a game. He has even created a board game called Cashflow to teach practical financial principles. It seems to be successful in its intended goals. But life is much more than a game or a series of games. Cashflow or Name That Tune may be useful and enjoyable. But, Name That Disease as a medical model falls far short of the need – not just to treat human ills but to understand and deal with them soundly and sanely.
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Ignorance to Love and Wisdom
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Introduction - Table of Contents
Online Reading