Why Health Care Reform Won't Reform Health

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

 deepakchopra.com

Follow Deepak Chopra on Twitter: www.twitter.com/Deepak_Chopra

Comments

[Duffed]

Part IV

You know what really grinds my gears? when you said "doctors are not trained to keep people healthy". Doctors know & can tell you exactly what it takes to keep you healthy, but we are not pre-schoolers and we can choose to listen or not. Since when did adults give up on being responsible for their own actions? Also, one of a doctors chief decision criteria is "QOL" (quality of life). You are right that those surgeries do not extend life, but they do improve the quality of an individuals life. If a person is in a position to pay for that it is their right to have it. Your statement is dangerously close to rationed care.

Next yes we have a sick-care system, because insurance is meant to take care of you, in case things go bad, the individual, should by and large be responsible for their own quality of life. If you want to be a couch potato, be prepared to deal with obesity related issues! If you want to smoke, be prepared for lung, throat & mouth cancer! Massive public education was not the only reason smoking went down, there were also financial considerations (the ever increasing cost of a pack) as well as a shift in the societal norm. In fact, public education campaigns was probably the least important of the 3 reasons (but that is a chicken & egg argument).

[Duffed]

People, this is America, if an individual chooses to live an unhealthy lifestyle that is their right no matter how much you disagree with it. The question the becomes how do we balance that right with the greater societal good? restricting choice should not be an option...

[Duffed]

Part V.

While I am all for "turning sickness into wellness" let's be real here. The public run health institutions we already have are on the fast track to bankruptcy and the truth is there is probably very little the gov't can do about that. The main reason being that this country is just so large. We are not france (which by the way has a culture ingrained with smokers) or canada or britain and while we can learn valuable lessons from their systems; we could not successfully duplicate them. It's a question of scale, and the bigger something gets the less efficient and more unwieldy it becomes. It is up to "We the People" to stand up and take responsibility for our own fat as*ses and get out off the couch & into something physical! It is up to our gov't to make sure that when something does happen our insurance companies don't have a legal ability to drop us. I don't care for the status quo, but I don't care for the public option either (to much potential to bankrupt us). Our current system could work, with better regulation, no profit motive for our servicers, less liability for docs and more PERSONAL RESPONSIBILITY.

[Duffed]

Part III

A public option isn't they key to our insurance issues, rather we would be better served by removing the profit motive from the insurance industry altogether. Without the need to drive share prices, alot of the worse practices in the insurance industry would lose their appeal. Gov't should step in with financial incentives for the most expensive patients, extensive regulation (although I do not know how much faith we can have in our regulators) and removal of state to state only insurance. I am even on board for gov't subsidized co-ops, medical savings accounts, etc. But why would we want a public option when the public options we have now are A. fraught with issues & B. on their way to bankruptcy? Then take into account that the gov't, the largest buyer of pills, has given up the right to negotiate prices and to me it paints a disheartening picture.

[Duffed]

Part II

Yes, patients don't demand tests, because they are by and large ignorant of the medical field. Doctors have been trained to demand these tests due to a broken malpractice system that demands they practice defensive medicine, which not surprisingly is expensive and burdensome to the system. When you have to run everything under the sun so you could demonstrate to a judge you did everything a reasonable individual could think of, it does get a little out of hand. We as a culture have to realize doctors are not perfect, we are meant to suffer and die (sad I know, but who doesn't go through it) and a medical mistake is not a golden ticket to the bank! yes there are some doctor's that make mistakes that should be punished (like having their medical license revoked, jail time, paying for any followup medical costs) but compensation for pain & suffering only really benefits the lawyers.

[Duffed]

Part I.

Deepak, this article is very paritsan, and for my money you don't seem to get into the nuances...

I feel like you gloss over the individuals responsibility in this and villify doctors without good reason. PERSONAL RESPONSIBILITY is the key to healthcare in america. The increasing rates of obesity, heart disease, etc. can all be attributed to the fact that individuals care less and less about their own health that is until it becomes a problem for them. The human animal has gone so far from its roots, i.e. physical work to live, that it now takes an extra effort to preserve the body's natural state, something the vast majority of us seem unwilling to do. This includes exercise and diet, how many people do you think stop and read the ingredients before they buy? or just go on what they like? Providing guidelines is useless, because honestly, I believe most people already know the basics of what they need to do, they just don't care to put in the effort and my life experiences have led me to believe you can't regulate human behavior in that way.

[knosiswar]

There is an issue with our food supply that is the responsibility of our protection agencies that they need to handle.

http://www.youtube.com/watch?v=dBnniua6-oM

Sugar: The Bitter Truth

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. ...

[P3]

There is indeed a health care need, but you focus on the the physical.
The physical body, or life, is short term, what is the average now,
some 70 years.

Dealing with peoples long term health care, means you will have
to focus on the spiritual side.

Because, "from ashes to ashes, and dust to dust" is the short term
results.

How about spiritual health care, clean-up the inner nature. None of
the medical "tests" can tell if you, mock or slander, anger or hate,
pride or arrogance, uncharitable or unforgiving.

Do not people consider an unclean spirit the "root cause" of
many physical problems.

If so, then it should be delt with too.

[knosiswar]

The FDA should IMMEDIATELY BAN HIGH FRUCTOSE CORN SYRUP for human consumption. HFCS doesn't metabolize the same as natural sugar-sucrose, and is responsible for this country's weight gain. HFCS wreaks havoc on the bodies endocrine system, affecting hormone and insulin production and regulation.

Could we solve the Health Problem with a single bullet? BAN HIGH FRUCTOSE CORN SYRUP!!!!!

Sugar: The Bitter Truth, video here: http://www.youtube.com/watch?v=dBnniua6-oM
Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods.


http://en.wikipedia.org/wiki/Fruit_sugar

Unlike glucose, fructose is almost entirely metabolized in the liver. "When fructose reaches the liver," says Dr. William J. Whelan, a biochemist at the University of Miami School of Medicine, "the liver goes bananas and stops everything else to metabolize the fructose." Eating fructose as compared to glucose results in lower circulating insulin (pancreatic beta cell insulin release is controlled only by blood glucose levels) and leptin levels, and attenuation in the suppression of ghrelin postprandially.[53] These hormones are implicated in the control of appetite and satiety, and it is suspected that eating large amounts of fructose increases the likelihood of weight gain.[54] Excessive fructose consumption is also believed to contribute to the development of non-alcoholic fatty liver disease.


Meira Field, Ph.D., 'The livers of the rats on the high fructose diet looked like the livers of alcoholics, plugged with fat and cirrhotic."[50]

[iblogleft]

Well done.

Now if we can just explain the basic principal of sick care vs. health care to the majority of Americans that still think free-market Capitalism is the best model for health care, something may get done... in 100 years.

[Nyland8]

Once again, we find ourselves in Bizarro World.

It's so funny how the paradigm has slowly shifted in this country to one where most Americans think it is their doctor who is responsible for their health.

While so many remain totally distrustful of their government - the one that, in a democracy, they get to participate in - they seem all too willing to pray to a priesthood of smocks and stethoscopes, in near-total abdication of their own contributions to their health.

"Give me a pill or a procedure that will fix me !! " America demands of it's "health care" providers. And pay no attention to the underlying causes of disease, because addressing those would require that I both learn something about my body AND make the lifestyle changes that are known to reduce my susceptibility to pathologies.

How ironic in a country with a government "of the people, by the people and for the people", that those very people should mistrust their government, preferring to roll the dice of Social Darwinism - and yet, when it comes to their most personal care, and the wellbeing of their families, they're the first ones to relinquish autonomy of their health to an industry rife with perverse incentives and conflicts of interest.

Are Americans ineducable?

[Alison Rose Levy - Huffpost Blogger]

Brilliant and perceptive comment, Nyland8. You cover all of the bases there. I'll bet that it's that NYC air, it makes one think and articulate clearly.Or it could be the prevalence of good Chinese (and Indian) food.

And of course, Deepak, you are 100% right about what needs to change-- and many thanks for stepping into the shadow to help us all think this through clearly.

Blog readers and commenters interested in these topics might enjoy my blog today: http://www.huffingtonpost.com/alison-rose-levy/health-care-by-sound-byte_b_283313.html

As well as another great blog at: http://www.huffingtonpost.com/2009/09/12/toxic-waters-clean-water-_n_284628.html
If we're talking about prevention, we also need to take a look at the contaminants that (thanks to the Bush era rollback of the Clean Water Act) are now in our water.

Interested in these topics? For blogs, radio shows (with Deepak Chopra, Andrew Weil, and others) sign up for the free Health Outlook ezine at: www.health-journalist.com

[independentByNature]

Nyland8,

You are right, we are the ones responsible for our health, I totally agree... But as the Deepak points out above, the "public" option is merely the other side of the same pill that will solve all our problems (and most for or against it fail to think past this point).

Once we go with the public plan, how is our government benefactor going to force us to be more healthy? Tax sugary food? Mandate a government certified diet plan? Perhaps while we're at it we should ban alcohol (think of the costs that could saved in emergency room visits) and cigarettes (long term health costs)?

The problem with the public plan is that it's merely the same old, same old under a new roof. How is it going to make our lives healthier and better? That's the reform I'm interested in.

[Nyland8]

Point taken.

While the public option, and health care reform in general, are certain to address some of the elephants in the room, they are by no means the total solution.

One of the things the public option does is bring us a lot closer to universal health care - and without universal health care, there is no real health care, because germs, parasites, viruses and plagues don't discriminate if you have good coverage or not. We spread and catch diseases from people who are too poor to see a doctor when they, or their children, become symptomatic. Unless you live in a bubble, only universal health care begins to approach comprehensive health care.

Another thing it does is offer the benefit of scale - because the buying power of large programs is better than the buying power of small ones.

Yet another is that it offers a counterbalance to a current system which is driven by disincentives, mis-incentives and perverse incentives.

But you're right ... it doesn't address all the problems with our current health care system. That will require other societal actions, changes in the architecture of our beliefs, better education from an early age, de-coupling big pharmaceutical interests from primary care providers, outlawing certain types of advertising, streamlining FDA approvals, creating incentives for cures over treatments, castrating lobbying interests ...

... the list goes on and on. It's a complex subject.

But nothing less than a public option is the beginning of real reform.

[huffpostreader10000]

And what incentives does the govt have to take care of you? Is canadian healthcare better, then? The private system has a profit to make, and so it has an incentive. If it gets 'perverse', then you sue it. You just have to be at least somewhat informed which means even you yourself now have an incentive to look after not only your health but also your health costs. Sure, people get greedy and corrupt, but you fix those instead of eliminating the system and replacing it with big govt.

[Nyland8]

Well ... no. The point is, the government has no disincentive to serve your needs - but the so-called health care insurers do. That's what makes health care insurance unlike most types of insurance, which truly can be driven successfully by the marketplace alone.

You have to step away from the false choice of big government vs. small government ... because that is not the problem. The issue - the choice - should be good government vs. bad government, and in a country where the government is "of the people, by the people and for the people", that means that WE are the government. So as well or as badly as it serves us is really our own fault and our own responsibility.

Private health care insurance, by its very nature, cannot be made to NOT have perverse incentives. Even if you "reformed" it by requiring things like not dropping coverage for chronic illness and refusing coverage for pre-existing conditions, then all the insurers will do is raise everyone else's premium. They'd have to. It's their fiduciary obligation to themselves and their shareholders.

There is NO perverse incentive in offering the public option. And a government bureaucrat beats a corporate bureaucrat every time.

[dogdiva]

I'm a bit curious as to why we never question the good intentions of doctors. Why do we not assume that they represent a cross section of America just as Congress does. It would be great if doctors were to 'engage' enough to HELP people be healthier. If you can't stand your patients then it's kind of unlikely that you'd be very helpful guiding them to health unless more people respond to threats than I thought.

Everyone in the health care debate takes up their own 'real estate' as being THE MOST IMPORTANT. I completely agree that 'wellness' is going to have to be factored in if we are to survive as a nation, but I keep getting a sense that the doctors posting here believe THEIR 'real estate' should be at the top of the list. I say if the father of 3 develops a brain tumor but they have no money for insurance and no money for health care period, I doubt they will be comforted by a good diet and exercise. I'm just saying...there might be somethings more critical RIGHT NOW.

[stereolabb]

Everyone should see Food, Inc.

[DrP]

As long as the medical establishment continues to recommend the wrong diet for "Type II Diabetics," they will not improve their health outcomes. Low-fat, high carb diets will not work. If "diabetics" don't follow them, it is because they will feel weak and hungry and gain weight on them, so they just "give up." Angel food cake is not a "diabetic dessert." The ADA is the worst offender. Dean Ornish is not a good reference for this issue.

[jayraye]

Regarding # 3: The market is also not free when Big Insurance is being handed millions of customers mandated to purchase their valueless product (ie customers bound to Big Insurance.) And by valueless, I mean that Big I does not provide healthcare, Doctors and Nurses provide healthcare.

[Merlin7]

Yes! Corporations make billions of dollars annually selling unhealthy foods and drinks. To really improve the nation's health it would be necessary to:

-- Ban junk food and fast food. Strip the store shelves. Close down the hamburger joints that infest every neighborhod. Empty supermarkets of most foods that are not natural or fresh. Ban most frozen and processed foods. Require meat to be chemical-free and sharply restrict the amount sold to each household.

-- Ban all tobacco products and sharply restrict per-household sales of alcoholic beverages. Limit bar and lounge hours to two or three hours per night.

-- Require PE in every grade of school with emphasis on cardio. Require employers to have workplace exercise classes, with incentive plans for employees to participate.

That would be a start. Without such tough measures, our health care "reforms" -- which actually are just ploys to get the government to pay for overpriced insurance policies -- will not significantly improve our health statistics.

[CroatianCritter]

Your recommendations sound a little fascist to me. There is another way. Our OBSESSION with lower costs has been our biggest downfall. Taking away these products will do nothing other than create a black market for them (SEE DRUG WAR!). We need more transparency from our food companies and more public pressure to get the proper nutritional information into the public eye. And with proper demand, healthy food can become more prominent in our daily lives. As far as people eating bad food. Many of them know that this food is bad and if the information can be provided and they still make the same bad choice (SEE SMOKERS), then who cares what happens to them?

[arktig]

Good work! I can add a few things. First, medical education in this country is quite inaccessible. AMA has assumed legislative functions and controls the amount of medical students and residencies. Of course they keep the numbers low in order to keep the prices high. Only doctors (and may be lawyers) enjoy such privileges.

Second, pharmaceutical companies are bribing doctors and directing them towards using costly medications (regardless of side effects) while ignoring prevention and other remedies.

And third, the elephant in the room - the riskiest group, the elderly, are separated from the insurance pool and handed to the government to care for. If Republicans and Democrats think that a full public option is not viable, then they have to stop Medicare and let the elderly merge in the private pool. Of course, in the next elections, they all will be booted out of office, which by the way, is the only hope for some real change.