Healthcare, with emphasis on caring for actual health

Full disclaimer: I am neither Democrat nor Republican and I do not intend to promote or disparage either. This is a nonpartisan look at the highly politicized health care crisis facing the US and its proposed reform. It is, also, ultimately about food and other health choices and acting as a Food Renegade (thank you www.foodrenegade.com for Fight Back Fridays).

(And I promise a recipe for kohlrabi in my next post later today!)

An op/ed from Senator Tom Harkin (D-Iowa) (http://news.yahoo.com/s/ynews/20090625/ts_ynews/ynews_ts408) points to the key feature of the Obama administration's health care reform effort - reducing medical expenses by keeping people healthy. All politics aside, whether you see Obama as the answer to, or the author of, everything stupid - this approach to controlling health care costs is so common-sense it is genius. And is likely doomed to failure.

Legislation fails when it threatens the livelihoods of any group with enough power to make it fail. Here is a perfect example from Michael Pollan's Unhappy Meals (http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?pagewanted=2&ei=5088&en=7c85a1c254546157&ex=1327640400):

...a little-noticed political dust-up in Washington in 1977 seems to have helped propel American food culture down this dimly lighted path. Responding to an alarming increase in chronic diseases linked to diet — including heart disease, cancer and
diabetes — a Senate Select Committee on Nutrition, headed by George McGovern, held hearings on the problem and prepared what by all rights should have been an uncontroversial document called “Dietary Goals for the United States.” The committee learned that while rates of coronary heart disease had soared in America since World War II, other cultures that consumed traditional diets based largely on plants had strikingly low rates of chronic disease. Epidemiologists also had observed that in America during the war years, when meat and dairy products were strictly rationed, the rate of heart disease temporarily plummeted.

Na├»vely putting two and two together, the committee drafted a straightforward set of dietary guidelines calling on Americans to cut down on red meat and dairy products. Within weeks a firestorm, emanating from the red-meat and dairy industries, engulfed the committee, and Senator McGovern (who had a great many cattle ranchers among his South Dakota constituents) was forced to beat a retreat. The committee’s recommendations were hastily rewritten. Plain talk about food — the committee had advised Americans to actually “reduce consumption of meat” — was replaced by artful compromise: “Choose meats, poultry and fish that will reduce saturated-fat intake.” (Emphasis mine. Though the choice of italics here is not. I just can't seem to un-italicize it.)

So the question is, who's gonna hate this idea? Or more specifically, which group has something to lose and has the extraordinary means to kill the proposal?

On the one hand, private health care insurance companies are gonna love it because the healthier their insureds are, the less they will have to pay out in claims.

On the other...

Medical care in this country is primarily specialty care, which emerged very specifically from the 'sickness care' approach to health care. You want to fix what's broken? For whatever your issue, there is a specialist. New specialties pop up wherever advances in medicine occur - look at the evolution of interventional cardiology since the advent of angioplasty. And I'll tell you what, if I have a brain aneurysm - its a sure bet that I want the very highest-rated vascular neurosurgeon ready exactly when I need her. I selected the hospital to deliver my baby- even before I was pregnant - because it has the finest neonatal department in the area. Thankfully, I had a healthy baby, but should she have needed any critical care, it would have been instantaneously available.

This reform effort (right now, anyway) seems to lean toward placing greater emphasis on primary care, while moving away from emphasis on (far more expensive) specialty care.

My own personal demands for unfettered access to specialty care offers a peek at the problem, now that I'm looking at the issue. I learned earlier this week at my primary care doctor's office that she regularly performs PAP smears and skin cancer checks during routine physicals. I needed neither of these when I saw her because I continue to see my OB/GYN annually for an exam (even though I am done having children) and because just last week I had a dermatologist (actually some para-professional in the dermatology practice) map my moles (though I am extremely fair-skinned and I have burned like crazy over the years, I have yet to have any areas of concern). A little over a year ago, I had an echo-cardiogram at the primary care physicians' office to determine if my Mitral Valve Prolapse had advanced at all in the 20 years since I was diagnosed (glad we checked as it turns out I do not actually have Mitral Valve Prolapse at all). All of this points to the fact that at least some of my demand for specialists is utterly unnecessary. And that my health insurer paid out far more than was likely necessary for me to have these routine exams as specialty care costs are far greater (though only an additional $5 over my regular co-pay for me).

Primary care physicians (largely represented by the somewhat powerful American Medical Association) will likely support of the focus on wellness rather than sickness care. It just makes sense to have your health care hubbed in one office and to see your same doctor once a year for a complete physical. If and when the need for additional expertise arises, you then see a specialist with the advanced education, training and experience to most effectively address your condition.

Specialists (who are not nearly as cohesively represented in the halls of Congress as primary care physicians for complicated reasons that combine the AMA's generalist focus and punishing anti-trust laws) will say that specialty care IS quality care and any shift away from our current system is a danger to patients. Specialists will point to patient frustration and outrage over managed care efforts in the past. And, it's true, patients commonly had to dance to get a referral from a primary care doc, in many cases delaying necessary specialty care because the patient had to schedule a visit to the primary care physician first and only after that appointment occurred could the patient schedule the appointment with the specialist. "Managed care" as we know it did not enhance patient care. It did enhance health insurers' profit margins because it financially rewarded primary care docs for two things: 1) seeing more patients in less time and 2) restricting access to specialists and tests. Both points worked directly against patients and against quality, timely health care. People are unlikely to embrace any suggestion of a return to this failed system.

Add to that Senator Harkin's comment:

"As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health." (Emphasis mine.)

Sure, Americans spend a staggering $40 billion a year on weight-loss products. But we spend twice that on cigarettes.

Is education the answer? I know my kid learns about healthy eating in school every year. And then lunches in the school cafeteria that boasts selling 125 pounds of french fries each week. There is always a gaping chasm between what people know and what people do with that knowledge. (My favorite example is this: while studying in 1994 to be a Red Cross Certified HIV/AIDS educator, the group of students in this class - all there with the shared goal of reaching out to the community to help people protect themselves from a deadly disease - would step out at each break time to inhale deadly-disease-causing carcinogens.)

Most of us have had the power all along to protect ourselves from many preventable debilitating and deadly illnesses. Will new legislation aimed at ultimately reducing our national debt inspire us to act for our own personal selves and our families in ways that we never have before?

Not likely. What is likely is that we - the health care consumers - will be responsible for killing this health care reform proposal. We are trained to respond to high cholesterol with a 'pass me a magic statin pill and another double cheeseburger, please'. In September 2001, the New England Journal of Medicine reported that as many as 90% of the cases of Type II Diabetes in women was preventable and reversible with healthy eating and other lifestyle changes. Yet, between 1990 and 2005, the prevalence rate doubled causing the CDC to chacterize Type II Diabetes as an epidemic. In November 2007, The National Institutes of Health noted that while it was traditionally seen as an adult-onset condition "type 2 diabetes is increasingly diagnosed in children in parallel to rising obesity rates." Type 2 diabetes is just one example, but it might be tough to find a more dramatic one. Have you seen the 'living with diabetes' magazines - yes, more than one - in the checkout lanes at the grocery store? 90% preventable type 2 diabetes has become its own industry.

What is it going to take to get us to change? What needs to happen to get us to act in our own self-interest health wise?

Check the ACLU's completely un-subtle message about what lengths our government could possibly go to if we move to a universal health care program http://aclu.org/pizza/images/screen.swf
It is frightening to think that it just might take this Orwellian level of intrusion into our personal lives to make us seek our own wellness. I hope there is an answer before 1984 arrives.

___
(I know the ACLU is considered a crazy left-wing organization. But the link below was sent to me by a strident right-winger -defined for these purposes as believing all Democrats are evil morons- friend of mine with the subject line: Ordering Pizza in an Obama World. So that makes this whole post 'fair and balanced' for sure!)




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