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"Hop up on the table, Honey." mThat's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't. This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system. We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year-almost $8,000 per person." That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and thos

"Hop up on the table, Honey." mThat's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't. This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system. We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year-almost $8,000 per person." That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and thos

Patient Centered Learning: The solution is to permit alternatives to rigid institutions, utilize free internet programs, and have medical students assist practicing physicians by assisting practicing physicians in taking patient histories. These students would offer valuable, free services to doctors. At the same time, they would have a vivid learning experience by spending several hours each day interacting with actual patients. The Cost Of Medical Education Would Be Negligible. The expense of healthcare is directly proportional to the cost of the doctor's education. With the institutional bottleneck gone, there would be a greater number of doctors, and the cost of healthcare would plummet.

A non-institutional, patient-centered educational plan would produce an abundant supply of compassionate, innovative, prevention-oriented doctors at an extremely low cost. Additionally, the pace of medical research would be sharply accelerated.

doctors aren't helping patients through remote means, instead insisting on seeing patients in the office for all medical issues, even the most routine of issues out of habit, out of fear, out of how to get paid.

I want to commend, and cry over, what WP wrote: "What I am seeing in needy areas are things/conditions I thought only existed in previous distant centuries. The patient populations have been well described by Charles Dickens and depicted graphically by Giordano in his opera set during the French revolution…a stream of ragged peasants limping across the stage, right here in the United States, in 2009." I can vouch for it here in Vermont…right next to Dartmouth's great Dartmouth-Hitchcock Medical Center in Hanover, NH…where - at BEST - most Blue Cross/Blue Shield of Vermont clients CANNOT find a primary care physician (PCP) taking new patients… and where - at WORST - several women I know are choosing to die from their breast cancer because they cannot afford medical care and will not burden their kids or society. One woman has an MA in Counseling, and the other a PhD in Human Nutrition. These are not uneducated people… But they are most definitely poverty-stricken…and were poor before the 2008 global economic collapse.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients.

Discussion of barriers presented by health insurance procedures, protocols, and economics to direct and efficient delivery of medical care.

Medicine has increased the ranks of the elderly. Can it make old age any easier? The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the retention of enough function for active engagement in the world. Most doctors treat disease, and figure that the rest will take care of itself. And if it doesn't-if a patient is becoming infirm and heading toward a nursing home-well, that isn't really a medical problem, is it?

Journal of Participatory Medicine JPM will be a peer reviewed journal published exclusively in an online journal format, using Open Journal Systems, an open source journal management and publishing system developed by the Public Knowledge Project.

Americans conduct their own online medical information research--many as a short-term replacement for visits to providers. Is this a sign of the new peer-to-peer, participatory healthcare?