How To Reduce Medical Costs & Help Pay Off the National Debt: Ask the Chinese
In China there is profound treasure. Marco Polo brought back small portions of it. For centuries traders carried bits of it out along the silk road. Still today there is more treasure that we can borrow from China to enhance our world.
An aspect of China's tradition that the West has completely discounted is the health care system. Science has been so busy creating new technologies for treating disease that we in the West believe that health care and medicine are the same thing. While we in the West have a fantastic and very expensive system based on treating people after they are sick, China has a very inexpensive system of health care based on keeping people well:
- In China, there is equal availability of traditional Chinese medicine and Western medicine in hospitals and clinics.
- In China, health self-reliance and self-care are prominent aspects of the national health care system.
- In China, health care is free.
- What would it be like if medical care based on natural healing methods-including acupuncture, massage, and herbal medicine, along with a strong tradition for self-care-were in place in the United States?
Collaboration between Chinese Medicine and Western Medicine
In China, Western medicine has been considered a form of alternative medicine for several hundred years. However, until 1919 AD, traditional Chinese medicine, which includes massage, herbal medicine, acupuncture, and self-care practices (Qigong), was the primary system of medicine. In the 18th and 19th centuries, some Western medical practices were available, mostly through missionaries. In 1919, when the last emperor stepped down, a number of Western medical schools were established in China, but it took until the 1990s for Western medicine to be fully integrated into the overall medical delivery system. Now, the alternative, Western medicine, has been almost completely integrated into China's mainstream system of medical practice, which is still strongly founded in their traditional system.
Today, there are few clinical situations in China where either traditional Chinese medicine or Western methods are delivered alone. For example, in many rural clinics, acupuncture, herbal medicine, and massage are easy and inexpensive to deliver, but Western medicine is difficult and expensive to provide. A few specialty institutions in large cities exclusively use technological Western diagnostic methods, and follow up with primarily Western intervention procedures. However, most institutions that focus on Western methods typically have acupuncture, massage, and herbal medicine also available to reduce pain, mediate the side effects of medications, and support patients with regulation of sleep, bowel disturbances, pain, anxiety, and nausea.
The extent to which the Chinese have absorbed "alternative medicine", that is, conventional Western medicine, into their system, is quite remarkable. It is apparent that the Chinese are proud of this collaborative, complementary, and comprehensive model. They have so completely embraced the alternatives to traditional Chinese medicine-surgical and drug based procedures-that all residents of Chinese cities have complete access to both.
One might wonder whether Chinese traditional physicians and Western physicians cooperate, and are they equally respected and equally compensated?
Everyone in China makes approximately the same monetary wage: physician, teacher, administrator, bus driver, clerk. The public holds equal respect for all physicians, whether Western or traditional. Patients may have a bias based on specific experiences, but both traditional medicine and Western medicine are equally available and paid for through government resources.
Physicians who make the professional choice to adopt either traditional Chinese medicine or Western medicine tend to have strong biases. However, many physicians have trained in both areas. These individuals are quick to express the benefits of both approaches, in spite of their final choice to practice primarily one or the other.
Dr. Zhu is a very bright, female physician who is the chief of the Oncology Department (called "head of tumor section" in China) at the Shanghai Ear, Nose & Throat Hospital. During an interview she spoke very much from the perspective of a Western trained physician. However, she was very interested in discussing her beneficial collaboration with the Shanghai branch of the Cancer Recovery Association, whose members practice traditional Qigong self-care exercises daily. In addition, her own special research interest is in the physiological mechanisms of acupuncture.
Dr. Liu, the chair of the Department of Acupuncture at the Zhejiang College of Traditional Chinese Medicine, was trained in Western medicine. During the cultural revolution, he was assigned to a project aimed at proving or disproving the traditional claims made about the benefits of Qigong self-care exercises. His research demonstrated that Qigong self-care was very beneficial. He decided to pursue the traditional approach to medicine, specializing in acupuncture and Qigong. Now, as the chair of the department and as chief editor of several books on current acupuncture research, Dr. Liu is very active in the merging of traditional Chinese and Western medicine.
The Chinese Model for Integrating Western medicine with Natural Healing Methods
At the Shanghai Traditional Medicine Hospital, the Chinese government's most current and comprehensive approach to medicine is revealed. It merges the best of traditional Chinese medicine and the best of Western medicine in a beautiful, new, 500-bed facility with an out-patient clinic that serves 1,000 patients per day. The chief administrator was asked, "Why do you combine systems of medicine in this way?" His answer was, "It is the most efficient and cost effective way to serve large numbers of people who have a broad variety of clinical needs."
This model, which is from the Shanghai Traditional Medicine Hospital, is typical of the integration of traditional Chinese Medicine and conventional Western medicine throughout China:
Step 1. All patients are diagnosed using traditional methods: pulse, tongue, and questioning. This requires no technological equipment and is therefore extremely inexpensive and immediate. This diagnostic strategy is sufficient in over 50% of cases, encompassing both in- and out-patient groups.
Step 2. Only when necessary, confirmation of diagnosis is provided through Western diagnostic methods. This combination is utilized in less than 50% of all cases. If needed, the latest technology is available: complete laboratory for all currently standard, body chemistry studies, X-ray, CT Scan (computer topography), and MRI (magnetic resonance imagery).
Step 3. In almost all cases, the first layer of treatment uses traditional Chinese natural healing modalities (acupuncture, massage, herbs) and self-care (Qigong) training. Even individuals who have taken step 2 into Western diagnostic methodologies generally receive traditional medical treatment.
Step 4. Western medical treatment is given generally when traditional treatment is not sufficient. Because of their recognized value in managing the side effects of drugs and radiological intervention and in mediating symptoms of insomnia, nausea, aches and pains, constipation, anxiety, and depression, the traditional modalities (acupuncture, massage, herbal formulas, and Qigong practice) are almost always added to Western medical treatment programs.
On the first floor of the hospital, between the emergency room and the x-ray/CT scan department, is an immense herbal pharmacy. The uplifting fragrance of hundreds of different kinds of health-giving plants is prevalent in the hallway just outside the x-ray department. The director of the hospital stated with pride, "We dispense over a thousand herbal formulas per day; frequently, that is as much as a ton of herbs." Is there a warm handshake, a true collaboration between Western and traditional medicine in China? The answer is an unqualified "Yes."
Self-Care in China
In China, the true definition of health care is to care for one's health. The rationale for self-care is that if citizens can do self-applied health enhancement methods (SAHEM), in the comfort of their own home for no cost, then health care is free. An ancient Chinese tradition encourages citizens and physicians to take great pride in healthy longevity. One of the most ancient and revered codes of traditional medicine states, "The superior physician teaches people to sustain their health." In the health crisis (of cost and quality) in the U.S., what could be more useful and cost effective than "free" health care? In China, this variety of free health care is being utilized by millions of people every day, and it is actively supported by the Chinese government.
Chinese self-care, called Qigong, combines careful regulation of breath, deep states of relaxation, specific regulation of bodily movement and posture, and, in certain forms, self-applied massage to generate a physiological state termed the Qigong state. This state is unique in its comparison to aerobics, jogging, and muscle-building, because of the simultaneous application of deep states of relaxation. Qigong requires no special equipment. While aerobics, jogging, and even walking require that the individual be relatively fit, people who are very sick and incapacitated can still practice Qigong.
There are many varieties of Qigong self-care practice. Some are very mild and aimed at the severely unwell. Taiji (t'ai chi), with which most Americans are familiar, is a moderate level of Qigong that is both curative and preventative. Certain types of wu shu and gung fu (martial and athletic forms) are very dynamic. However, when breath regulation and deep relaxation accompany the movements, the Qigong state can be attained. The Qigong state is characterized by a balanced coordination of the healing and health-sustaining resources in the body, including immune function, oxygen distribution, lymphatic flow, autonomic balance, and the ample and free-flowing activity of the body vitality, which the Chinese call Qi.
Throughout China exists numerous large institutes for research and clinical application of Qigong, as well as for training of Qigong students, patients, and trainers. In all parts of China it is clear that Qigong is a high profile aspect of China's official health care system. The institutes in Beijing, Shanghai, and Guangzhou are large, five to six story buildings with lots of activity. People may either be participating in large classes, seeing particular Qigong teachers for special teaching, or receiving acupuncture, Tui Na (massage), or Qigong-based treatment. The government-supported institutes are also training centers where Qigong teachers, trainers, and Qigong doctors receive instruction.
The Qigong institutes present classes on a daily basis where participants learn general forms of Qigong for overall self-care or specific forms that have been perfected to address specific diagnostic areas such as: particular cancers, arthritis, asthma, hypertension, immune deficiency, etc. Herbal remedies are generally available, as well, to supplement the benefits of the self-care practices.
The Wu Lin Qigong Institute in Hangzhou is more like a retreat where patients and students actually reside. The design of the program is somewhat like a non-acute care hospital, somewhat like a school, and somewhat like a retreat center, but without the luxuries of sufficient hot water, tennis courts, swimming pool, or Jacuzzi. The Qigong schedule begins at 6:30 am, with Qigong practice, followed by a class at 9:00 am to learn and refine techniques, a 2:00 pm lecture, and an evening meditation at 8:00 pm. Meals are Chinese health food, with concentration on grains and vegetables. Acupuncture, massage and herbal formulas are available in the institute's clinic. It is harder to get into a "live in" Qigong program in China than a program at a day use center. The Wu Lin program is a kind of a perk or work benefit, available to certain people who have earned the benefit or who have severe medical need.
Most hospitals in China have departments of Qigong, and in some hospitals Qigong is actually the primary modality. In one hospital in northern China, the only curative modality is a form of Qigong where one specific meditation technique is practiced. At another hospital in central China, a very specific practice of Qigong that emphasizes simple bodily movement is practiced in large groups. The director, Pang He Ming, states that group practice produces a "field" effect (as in magnetic or electrical field) that has a beneficial physical effect on each individual. This particular Qigong institute is famous for its work with victims of paralysis. When the paralyzed patients first attend the institute they just sit in the "Qi field," eventually they can move about and help to generate the "field" for others.
How many participate & How many kinds?
It is difficult to estimate how many people in China regularly practice Qigong. Estimates from government health administrators, physicians, Qigong masters, and the directors of the Qigong institutes range from 80 million to 150 million people. In Beijing, Shanghai, Guangzhou, Hangzhou, Hong Kong, and other, smaller communities throughout China, the parks are filled every morning with people doing a nearly infinite variety of different self-care practices-some sitting in meditation, some standing in meditation among trees, some in small groups doing self-massage and breathing practices, some in large groups doing taijiquan (t'ai chi ch'uan), some in pairs, some doing taijiquan with swords, some doing taijiquan with large red fans, some doing more vigorous forms of wu shu, some doing a kind of Qigong aerobics with music, and some doing a sort of ballroom dancing Qigong with partners and a voice, over music, saying, "inhale," "exhale."
Hangzhou is a tourist and silk center in China. A popular saying proclaims that "above there is heaven, below there is Hangzhou." In the 8th century AD, a lagoon off the Qiantang River was transformed into a huge lake called Xi Hu, and later the Song dynasty used Hangzhou as the Capital of China. Around the lake are beautiful parks and plazas, which are filled with people practicing the traditional Chinese methods of health enhancement and self-care in the early mornings. At 6:30 am, an estimated six to seven thousand people practice around the lake. It's an incredible sight, an inspiration. It is a kind of health wonder of the world.
In one group, all wearing the same outfit and moving in unison to music, over 300 people practice together. The taijiquan fan group has between 100 to 200 participants. The largest taiji sword group numbers over 100. Perhaps the numbers are lower on a Tuesday or Wednesday? Not really! Every day, huge numbers of people perform health maintenance practices that are easy to learn and apply and profound in their clinical effects.
Across China, one can find thousands of various forms of Qigong self-care in current practice. There are medical forms named for particular organs or body functions like "the liver exercise" or "activating the spleen and stomach." There are poetic forms named after animals, seasons, or forces of nature, such as "dancing dragon flying," "fire fusing with water," and "five animal frolics." There are martial forms like "supreme, ultimate boxing" and "iron shirt." There are forms named after individuals and families like "Yang's Taiji," "Chen's Taiji," "Zhang's Channel Conductance Qigong," or "Hai Deng's secret method." Some are named for temples or spiritual figures like "Shaolin qigong," "Kuan Yin practice," "Taoist alchemy," or "Buddhist Lohan form." Clearly, the self-care heritage of China is rich and long.
Qigong and Cancer
In Beijing, Shanghai, and numerous small cities, an organization called the Cancer Recovery Association meets to practice a more recently developed system of Qigong named after its originator, Guo Lin. This form is a mild variety of Qigong, a walking form, that is very easy for even the most unwell cancer patients to practice. The Cancer Recovery Association has over 60,000 members throughout China, 4,000 to 5,000 alone in Shanghai. On any one day at each of ten meeting sites throughout Shanghai, typically in parks, 30 to 50 members of the Association gather to practice Qigong and then meet to have tea, share testimonials, and seek the state of light-heartedness.
Mister Yuan, the director of the Shanghai branch and a recovering cancer patient himself, says, "We operate a social model of healing. Each individual may have a different regimen of therapy, including one or all of acupuncture, massage, herbs, chemotherapy, x-ray therapy, etc. However, we all have the social model and Qigong in common. We support each other, tell our stories, shift our attitudes from stress and worry to light-heartedness and we practice Guo Lin's Qigong."
Among the many various forms of Qigong self-care, there is one unique ancient approach that is currently gaining popularity in China, called "spontaneous movement Qigong." Each person moves about (dynamic) or is stationary (quiescent), according to their own internal process and needs. Each person stands, sits, or lies down according to the status and need of their own Qi. The unique benefit of spontaneous movement Qigong is that each individual's practice is completely appropriate to their own condition. Spontaneous movement Qigong is a classic, ancient approach to self-care that is highly personal, although it is often done in a group.
In Guangzhou, Master Zhang is a gracious teacher of many students who meet to practice in the park near the Pearl River every day. Master Zhang's Qigong consists of a period of active Qigong followed by a period of meditation Qigong. Then participants do "spontaneous movement Qigong." When asked why she works with spontaneous Qigong, Master Zhang responds, "Every person has a different need, goal, and nature. Spontaneous Qigong has no limits, and each participant moves about or is still according to their own process at the moment. Some of my students are very ill, some are Buddhists, some are Taoists, and some are scientists. Spontaneous movement allows each of them to get the greatest benefit from within their own perspective."
In the light of all this, is the self-care tradition of China a possible resource for resolving the medical crisis in the U.S. The answer is an unqualified "Yes."
Potential Medical Cost Reductions of an Integrated System
Certainly, one of the most pressing current challenges of modern American society is the extreme cost of conventional medicine. In the U.S. an insurance company, American Western Life, has discovered that "natural protocols," including herbal medicine, homeopathy, acupuncture, nutrition, and lifestyle alterations can save from 31% to 82% in the cost of medical treatment. Mutual of Omaha, Prudential, Travelers, Blue Cross, and numerous HMOs have begun to pay for alternative medicine. Numerous corporations have found that $2.50 to $5.00 may be saved per $1.00 spent on wellness and health promotion programs.
In America the integration of alternative methods, including Chinese medicine, will probably not look like the integration of Western medicine into the Chinese medical care delivery system. Historically in the U.S., we have vigorously avoided embracing and integrating the "alternatives" to the comprehensive extent that the Chinese have. But it is clear that medicine in the U.S. is in a transformational period, and there is treasure in China that could have substantial benefit if integrated into the emerging system. It will be interesting to see how enduringly conventional Western medicine will resist this resource. The existence of the Office of Alternative Medicine at the National Institutes of Health in Washington, D.C., and the remarkable use of acupuncture in detox and treatment of addictions both suggest a trend toward integration.
The most obvious economic benefits to an integrated or comprehensive model in the U.S. can be summarized as follows:
- Many disorders respond immediately to acupuncture, massage, and herbal formulas. A series of visits with an acupucturist and a course of one or two herbal formulas often will clear the case. This is why the Chinese use the four-step model outlined above. Natural methods that cause no side effects will, in a large percentage of cases, resolve the problem.
- The expense of treatment with acupuncture, massage, and herbs is less than with Western medicine. Often the cost of treatment with natural methods is less expensive than preliminary diagnostic procedures in the West. Massage involves no technology and minimal supplies. Acupuncture requires only minimal technology, if electrical stimulation is used, and minimal supplies. Herbal formulas (and homeopathic remedies) have not historically required FDA approval and are therefore much less expensive than pharmaceutical drugs.These examples suggest that integration will have dramatic economic benefit.
- Treatment, in a sense, is diagnostic. When gastrointestinal pain responds quickly to alternative methods, the need for expensive technical diagnostic methods is averted. If such pain does not respond to acupuncture, for example, then more extensive diagnosis may be appropriate.
- The Chinese have found that this system can be used to rule out certain diseases and frequently resolve the case.
- Acupuncture can be applied in a group setting. Rather than one doctor seeing one patient at a time at an exorbitant cost, one doctor can see a dozen or more patients at a time. In an era when the cost of medicine is at tragic proportions, the strategy of applying a high volume of effective treatment for a low cost is very desirable.
- The methods and modalities of traditional Chinese medicine tend to suggest the value of self-care. Invasive diagnoses as well as procedures and medications that cause side effects, tend to deter the individual from pursuing self-care. It is usual in traditional Chinese medicine for diet, self-care, and herbal tonics to be used parallel with treatment.
Cost Reduction & the Implementation of a Sustainable Self Care System
It cannot be emphasized too often that self-care is free health care. The challenge of "retooling" in the U.S. to create a self-care system that is spontaneously sustainable over time will have some cost. However, in managed care it is not an expense against profit; it is an investment against demand. "An ounce of prevention is worth more than a pound of cure" is not a pop new phrase. Our own culture has a tradition of the value of the timely and foresightful purchase of an ounce of prevention rather than the belated purchase of a pound of cure.
The most obvious economic benefits to a strong self-care component to the health care system in the U.S. consists of:
- Self-care is free health care. If prevention is learned and then self-applied, it then becomes a resource that the individual owns and can use for the rest of their life. Medical treatment, conversely, is procured only from highly trained and expensive experts. When follow-up on medical treatment is necessary, the purchase of the second pound of care is always expensive; the second ounce of prevention is frequently free.
- People can learn self-care in large groups. Treatment, unless it is group acupuncture treatment, is generally provided one person at a time and is more expensive. Group practice self-care is extremely cost effective.
- Sick people and elders tend to become isolated in the U.S. Group learning and group practice of self-care methods tends to cut costs that are associated with such isolation. Group applied self-care is not only physiologically beneficial but sociologically beneficial as well.
Unfortunately, there are certain limits to the application of self-care. However, the limits are not inherent to self-care itself but are actually reflections on some negative aspects of American society. First, self-care is too simple. People are addicted to complexity. For example, taking a deep breath and thinking a relaxing thought takes less than 10 seconds. It triggers numerous physiological mechanisms that are associated with healing. One can take a deep breath anywhere, at anytime, with no need for a prescription and no special equipment. But very few people do it. It's too easy and it's difficult to believe that something so easy could be so profound.
Second, people want to break the rules of health and then have the system pay a highly trained professional to fix them for no additional cost. Tragically, it is very unlikely that Americans, whether rich or poor, will be moved to take preventative action and practice self-care. Our population has the bad habit of expecting society and the system to fix them.
The self-care system in China is pervasive and enthusiastically supported by the medical system, the government, the business community, the media, and 1,000 years of tradition. In the U.S., with the mobilization of broad support, particularly from the government, medicine, education, and the business community, self-care may blossom and bear powerful social and economic fruit.
Toward a World Medicine: a Health Care Millennium
A new era in health care and medicine is critically needed. A strategy for a rebirth of self-reliance is needed. A way to reduce overwhelming medical expenses and reduce the national debt is needed. A more humane and natural medicine is needed. The integrated system that the Chinese have developed is an excellent model to draw upon in the Western world to meet these needs. Were some of the Chinese model to be used in the West, it would go a long way toward creating a common, integrated medicine for the whole world.
An integrated, comprehensive, and multidisciplinary system of medicine, as well as a culture-wide sustainable tradition of self-care is crucial in America. Necessity demands innovation. The features of an emerging new structure for health care and medicine will not replace and are not really an alternative to conventional Western medicine. The emerging system must be collaborative. Integrative medicine and self-care need not be invented in America. Excellent resources for the development of these new features of American medicine are in place and highly refined in China and other cultures.
We are in a special time in the U.S. concerning the medical cost crisis. A new political era is at hand, a new scientific paradigm (the quantum) is affecting all levels of society, and our 3rd millennia is directly before us. Remember that by the Chinese calendar it is the actually the 5th millennia.
With the inspiration of new possibilities and with China as a mentor in health care and medical matters, enthusiastic support from business, education, and the media, along with the commitment of our citizens to reach out and grasp wellness through self-care, the U.S. can transform the medical cost nightmare. The economics of such a system in concert with military and other reductions can radically reduce the our budget deficit. By the millennia, with the united cooperation of all citizens, including the medical community and people from every social and economic level, the U.S. has the opportunity to create a completely new health care system and dramatically reduce the national debt.
Here, at the brink of the millennia, there is an opportunity for the human community to breakthrough to integrated ideas from the current "either/or" context, to embrace collaboration over competition, and to grasp the benefits of self-reliance in all aspects of life, including health. The best of science in collaboration with ancient wisdom, through a link between conventional Western medicine and traditional Chinese medicine, is a powerful strategy for achieving an "integrated world medicine."
By Roger Jahnke, OMD, Director of "Health Action", Santa Barbara, CA