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Why Health Care Reform Won't Reform Health

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Like most people, I was encouraged and energized by President Obama's stirring speech to Congress last week. With rare candor, he told the truth about the three C's of reform: costs, coverage, and character. The last C was the most emotionally charged. Staring lawmakers and citizens in the eye, the president essentially asked, "Is America a society that squanders $900 billion on a dishonest war but refuses to spend the same amount to give its citizens affordable health care?" Because of the massive counterefforts by lobbyists and the resistance of the right wing, we're holding our breaths on the answer to that question.

But let's say the light prevails and the Democrats deliver a bill that gives insurance access to millions of previously uninsured Americans. As great as that victory would be, health care won't be reformed. Isolated voices like Andrew Weil (writing at the Huffington Post and in his book, Why Our Health Matters), and Dean Ornish (writing as the medical editor at Huffington Post and in his book, The Spectrum), and former Health, Education, and Welfare Secretary Joseph Califano are telling us why.

Here are the basic points that aren't being addressed:

1. Prevention, the key to future health, isn't being followed enough. That's why Americans are getting more obese and sedentary every year. That's why sugary drinks are now the single largest source of calories in the average diet. Alcohol and tobacco still account for 35% of all medical expenditures. Leading causes of bad health — obesity, heart disease, and Type 2 diabetes — could be rolled back by sensible prevention guidelines that people simply aren't following.

2. Supply and demand for doctor care is upside down. Patients aren't demanding the bulk of the $700 billion in unnecessary tests and procedures performed every year in this country. Doctors are creating the demand to cover their backs and increase their income. Even conscientious doctors who put the patient first are caught in lockstep habits, calling for unnecessary tests because that's what doctors do in this country.

3. Without a public option, there's no real incentive for insurance companies to lower their costs. The free market isn't free when the consumer is presented with noncompetitive insurance plans that basically aim at corporate profit and when Wall Street dictates how corporations must be run in order to survive.

4. To borrow a phrase from Secretary Califano, we've become a "sick-care system" that puts all its efforts in developing newer drugs and offering more surgery once a person is ill. Doctors are not trained to keep people healthy. They are also strongly tempted to perform needless procedures that do not extend life span, such as hysterectomies, lower back surgery, heart bypass, and balloon angioplasty.

5. We are addicted to the sick-care system, and no money is being allocated in any of the reform bills in Congress to breaking this addiction. Massive public education was successful, over a long period of time, in getting people to quit smoking. Now we need the same massive public education to get them to adopt prevention. Will doctors, insurance companies, and big pharma do the job for us? Well, did big tobacco do the job of ending smoking? Without government action, the private sector will push drugs and surgery because prevention doesn't show up as profit on their bottom line.

I regret having to walk in the shadow this way. President Obama brought a good deal of light to the whole muddled issue of health-care reform. He spoke truth and balanced it with political realism. He chastised the political reactionaries who want to kill reform by using lies, fear, and misinformation. We're better off for having heard the speech. But costs won't go down and Americans won't be healthier until the five points listed above are dealt with. Right now, health-care reform has been couched in terms of economics first and morality second, with little thought to what should really come first: turning sickness into wellness.

Published in the San Francisco Chronicle
Deepak Chopra on Intent.com

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