True Health Care Reform: 10 Missing Pieces
I applaud President Obama for his efforts. I too believe that everyone deserves proper healthcare and that access to healthcare must be a right for all. But I think Washington is barking up the wrong tree. They're busy arguing about what amounts to health insurance reform, while what this country needs is true health care reform.
Interestingly, what is happening in Washington mirrors much of what we do in Western Medicine. We suppress symptoms instead of dealing with the root causes of the problem. All the options on the table now only address how we pay for healthcare, rather than why we are unhealthy and how we change that. But if we don't change why we are unhealthy, we are not only likely to fail in securing better medical outcomes, it will likely bankrupt us too. In terms of getting better health care or becoming a healthier nation we have to make serious changes. We will only flourish if we address the root causes of the problem.
As a nation, we're highly skilled in crisis care and the treatment of life- threatening diseases. But we're rank amateurs when it comes to the equally important issues of preventative care and the management of chronic diseases such as diabetes, heart disease, obesity and many cancers. True healthcare reform needs to provide greater support to these areas as at least 75% of our medical costs are spent on treating these chronic diseases.
Recently on Huffington Post, four physician colleagues of mine Andrew Weil, Dean Ornish, Deepak Chopra, and Mark Hyman all eloquently articulated the problems we face. I won't repeat their arguments, instead I will present some facts about our system and will then offer some recommendations many of which complement their thoughts.
- We have an outrageously expensive medical system. Our costs are more than double that of any other country.
- In spite of the expense, over 45 million of our citizens have no coverage, whereas most other developed countries insure everyone.
- Our system doesn't work well for preventing and treating the chronic diseases that are causing our costs to skyrocket.
- According to the World Health Organization's rankings, the U.S. (health-care system) is 37th in overall performance.
- Our system is not particularly safe. Millions of people are hospitalized annually or suffer from serious side effects of properly prescribed drugs or medical errors.
I don't claim to have all the answers and some of these suggestions may seem unrealistic given our current system, but to fix health care in this country we need radical change.
In addition to my strong belief that any civilized society should guarantee healthcare for all its citizens without exception, here are 10 recommendations that I feel should be an essential part of any health care reform.
1) Invest in educating the public in self care
Ultimately the most effective way to increase the health of the nation and to cut healthcare costs in the long term is if we all take responsibility for our own health and learn prevention. It has been repeatedly shown that what we eat, how we respond to stress, how much exercise we get, our exposure to chemicals and the quality of our relationships and social support systems is powerful medicine. Unfortunately most of us don't know how to do this, so training health coaches to go out and educate the public would help.
2) Motivate people by rewarding lifestyle changes that foster health.
We should encourage and reward people who take responsibility for their own health. Help pay for or give tax deductions for gym memberships, yoga classes, cooking classes, instruction in relaxation techniques, and appropriate doses of certain supplements like Vitamin D, fish oils and probiotics. Visits to Healthcare Professionals for lifestyle counseling and disease prevention should be encouraged and covered.
3) Educate Doctors and other Healthcare Practitioners in nutrition, exercise, stress reduction techniques and natural remedies.
Hundreds of billions of dollars are wasted by doctors when they request unnecessary tests, over prescribe drugs (often with harmful effects), and perform unnecessary surgeries. Many of these services are reimbursed because of lobbyists and clinical practice guidelines established through industry influence or custom, not because the reasons for doing them are scientifically sound. Educating doctors to start with the least expensive, least harmful and least invasive treatments, while having a backup of the "big guns" when needed, would prevent a lot of unnecessary expenses. The Institute of Functional Medicine, has a clinical model that does this and is extremely effective for the prevention, assessment and management of chronic diseases. It has already trained over 10,000 doctors and should become part of every doctor's training.
4) Reimburse doctors for their time in preventing and managing chronic diseases.
In the current model, the reimbursement structure financially rewards crisis care and disease care, but not prevention, early intervention and effective long-term management. But we now understand that chronic diseases develop over many years because of an individual's genetic makeup combined with their lifestyle, environment and social network. The effectiveness of a Functional Medicine approach to chronic disease has been demonstrated, so the tools we need to reduce the burden of chronic disease are available. But it requires more than just a 10 minute consultation. To encourage the supply of doctors practicing preventative care, they need to be paid not only for expensive procedures, but for the time they spend with patients supporting them through these changes. In addition, we need to train health coaches or other health care practitioners to provide this personalized, preventive and participatory medicine.
5) Practice the Precautionary Principle.
In brief, the Precautionary Principle states that: "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." Before chemicals or other engineered substances that may impair body functions and cause diseases are put into our food, water, soil, air, cosmetics and home products, they need to be proven safe. At the moment, our attitude to these chemicals is that they are innocent until proven guilty. They should be assumed guilty until proven innocent.
6) Protect our food supply and encourage healthy eating
The Health and Agriculture departments should work together and apply the Precautionary Principle to our food production. Harmful pesticides, additives and other chemicals should not be used in our food production until proven safe.
Food labeling should be honest, for instance, irradiated and GMO foods should be labeled as such.
Local farmers and farmers markets and the consumption of fresh and seasonal foods should be actively supported and encouraged.
7) Feed our children healthily and educate them responsibly.
Serve fresh unprocessed food for school lunches, food that's nutritious instead of just cheap and convenient. Eliminate junk food and soda vending machines from all schools (and while we are at it, from all public buildings and airports).
Put organic vegetable gardens in schools especially in low-income areas. They not only provide kids with nutritious food to eat, but this also teaches them about the importance of nutrition in general and how to grow their own food.
Ban the advertising and marketing of junk food, sodas and fast food to children...$13 billion is spent annually on it. We should not be convincing children--or adults--to buy products that harm them.
Don't eliminate physical education programs from the schools as is happening now with budget cuts.
8) Subsidize healthy foods like fruits and vegetables.
Most of the billions of dollars in subsidies go to huge agribusinesses that produce feed crops, such as corn and soy. By funding these crops, the government supports the production of factory farmed meats and dairy products. Corn is also made into high fructose corn syrup. All of these contribute to our growing rates of obesity and chronic disease. Fruit and vegetable farmers, on the other hand, receive less than 1 percent of government subsidies. Switch these subsidies around.
9) Remove corporate influence from healthcare.
Corporate influence should not be what drives the system. According to The Washington Post, 1.4 million dollars a day is being spent by healthcare interests to get what they want in the new health bill. There are 4 lobbyists for every Congressman on Capitol Hill. They should be banned. Unfortunately the self interest of these parties often works against outcomes that would better serve our collective and societal good.
Stop direct-to-consumer drug advertising and radically limit the more than $30 billion that is spent by the pharmaceutical industry on marketing drugs to physicians.
10) Give everyone freedom of choice
Lastly, people should have the freedom to choose what method of treatment they want to follow, whether conventional or alternative, western or non western, traditional or non traditional.
By focusing only on how people can get access to costly disease treatment, without the more important discussion about how lifestyle changes can be implemented to prevent these diseases in the first place, is like rearranging the deck chairs on the Titanic. We will simply be perpetuating a flawed and costly healthcare model. For the sake of not only our personal health, but also for the financial health of the nation, we must address the causes that underlie the prevalence of chronic disease that we are experiencing. Unless we address why people are getting sick or the underlying mechanisms of their illnesses, our system will lack a solid foundation. Unless we change our disease care model to a true health care system, we are bound to fail in the long run.
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