Spiritual_Wellness_Holistic_Health_and_the_Practic

306 Philosophical Foundations of Health Education
employers) have already or are likely to respond by either reducing benefits or shifting
more premiums or health care costs to employees. In the process, the underlying
limitations of how health care is viewed narrows our perspective of the nature of the
problem and what reform options to consider, debate, and implement.
MEDICAL CARE DOES NOT EQUAL HEALTH
In any policy debate (or put another way, a war of economics, politics, and ideology),
how an issue is framed is all - important. Success in framing the issues determines the
focus of the debate, the possible options, and the eventual outcome. Health care is no
exception. The current paradigm guiding much of health care reform is straightforward.
It is based on the premise that expenditure of resources results in health care
services that lead to improved health as measured by crude indicators such as infant
mortality and longevity. Within the framework, health care reform is debated primarily
within the context of costs and access, and to a lesser extent on quality. Certainly,
these issues are related. Many legislators; business; industry, and labor leaders; health
care providers; and policy wonks have bought into the equation that medical care
equals health care equals health.
Once this simple paradigm is accepted, it follows that if one wants to improve
health, one needs to address the cost, accessibility, and quality of medical care services.
In turn, the popular gestalt is that this is achieved by increasing medical care expenditures.
These increased resources may be in the form of increases in the infrastructure
(buildings, equipment, and so on), size, or quality of the workforce, or simply paying
more for services. Even when concerns about costs are expressed, they are usually
within the context of this paradigm. Efforts to address the concern may take many
forms such as controlling the costs, reducing administrative waste, utilization review,
and so forth. The important point is that the debate, options, and initiatives are all done
within the existing paradigm where medical care is equated with health care and health
care is equated with health.
But here ’ s the rub and why a new paradigm is needed. The previous paradigm isn ’t
true (Lamarche, 1995). Never was, most likely never will be. We have come to substitute
the words health care for medical care as if they were synonymous. As Turnock
notes, the word health is an adjective and not a noun. He asks, Shouldn ’ t the focus be on
healthy people and not medical care? That is simply not the case now. Fully 99 percent
of the current annual “ health care ” expenditure is focused on medical care. According to
the 1979 Surgeon General ’ s Report on Health Promotion and Disease Prevention
(Department of Health, Education, and Welfare, 1979), “ Medical care begins with the
sick and seeks to keep them alive, make them well, or minimize their disability ” (p. 119).
The focus of medicine and where the “ health care ” resources are spent, is the diagnosis
and attempted treatment of illness, disease, and disability. The classic 1979 Surgeon
General ’s Report “ suggests that perhaps as much as half of U.S. mortality was due to
unhealthy behavior; 20 percent to environmental factors; 20 percent to human biological
factors; and only 10 percent to inadequacies in health care ” (p. 9).