David Butler (Guest Patient Author)

I have a varied experience with health care - including in-patient, out-patient, and alternative care. I have a severe form of arthritis called ankylosing spondylitis. For about eight years prior to diagnosis of the disease, I had been treated with chiropractic . For the past eleven years I have dealt with this through use of traditional medicine - including having total hip replacement of both of my hips. I used out-patient physical therapy after both surgeries with great success. I currently see a specialist twice yearly and daily take NSAID's for joint swelling and pain management.

My wife, a lifetime non-smoker, was diagnosed with stage IV adenocarcinoma of the lung with multiple brain tumors in September 2008. She was treated with chemotherapy and radiation in 2008. She was given only one to three months to live in December 2008. She has done alternative treatment since and has outlived the physician's prognosis. She did have a metastasis in the spinal cord late 2009 and had surgery to remove the tumor in February this year. She spent two weeks in the hospital followed by three weeks in a nursing facility. She is currently at home and visited twice weekly each by a home nurse, a physical therapist, and an occupational therapist.

My oldest daughter was diagnosed with asthma at eleven months of age. Early on she was treated in the emergency room three times. Since then, she has visited a specialist yearly and manages the disease preventatively through medication.

I have been on permanent disability since 2001. I have had all types of insurances over the years. While working I had major medical coverage and health savings accounts. I have been without coverage in the past as well. Currently, I am on Medicare and Medicaid.


When I consider "health care reform", I see it from diverse perspectives. We should approach reform with the consideration of as many situations as possible. I believe there are three main categories of citizens.

• The wealthy should be able to save as much as possible (tax free) and buy the insurance of their choice without penalty. It is only fair that they are able to use what they earned to buy what they want for their own health and the health of their families. We would all want to have that opportunity if we had extra money to do so. In fact, some who are extremely wealthy probably do not even need insurance at all - or they could buy catastrophe health insurance. But, the rest of us (most of us) do need insurance coverage.


• The "middle class" working person needs affordable health insurance and a tax free opportunity to save for premiums, deductibles, and other non-covered costs. Really part of the "upper middle class", the small business owner needs affordable insurance as well. Perhaps they could allow business owners to have their own group insurance.


• And the poor, the elderly, the disabled, the displaced family, the unemployed, the financially irresponsible all need help with coverage and premiums. Obviously most of the people of this category did not choose to be in this category - with the exception of the irresponsible or the one who is wilfully poor. In those cases there should either be forced responsibility and perhaps even penalty. We tend to do just the opposite many times. We penalize the wealthy and the hard worker while allowing for irresponsibility by not scrutinizing the need - whether it is legitimate or "self-inflicted". Of course all children should be covered irregardless of social status. The "needy" group of people need public or donation-based coverage.

When we think of health care reform, we need to consider it as a goal not as a guarantee. We live in an imperfect world and it is impossible to solve every problem. But we can aim at implementing as much good as possible for the welfare of as many as possible. Things I believe are thought to be important to most are:

• accessibility - the goal is for all to be covered
• affordability - how much will this cost and who is the source of funding
• quality - safe and timely care
• specificity - to meet the needs of each individual and problem
• diversity - to cover a multitude of differing illnesses and medical/personal situations
• necessity - not wasteful
• individuality - not forced by law or policy, personal choice (agreed with one's physician)

The following is my personal beliefs about and approach to health care:

• preventative care - proactive vs. reactive
• informed patients - self taught or professionally schooled to make wise decisions and choices of care
• educated decisions by patient - not exclusively by the physician
• decisions by patient and physician concurrence - without government interference
• needs-based care, not protocol - this offers flexibility of care
• non-invasive, non-medical options explored first
• to treat dental and eye care as part of medical care
• independence of choice
• variety of options from which to choose (traditional, alternative, health education)
• less government regulation over the consumer, the physician, and pharmaceutical companies

And for all this to work properly

• greed issues addressed - by patient (not abusing the system), by the physician (not overcharging insurance, not performing unnecessary proceedures), by the pharmaceutical companies (reasonable pricing)
• humility of the physician - they are not omniscient, willing to refer patient to more qualified physician
• integrity of the physician - honest and necessary treatment of patients
• realistic patients - physicians unable to fix everything - they are "practicing" medicine and sometimes make honest mistakes - we do not need to be litigious in all cases.