Don't Tread on Me: Transcending the Left Wing/Right Wing Health Care Debate

Recently, I found myself in the middle of a contentious debate on Larry King Live sandwiched between President Obama's longtime personal physician, Dr. David Scheiner, and Dr. Ron Paul, the libertarian Republican member of Congress from Texas.

Dr. Scheiner described his disappointment with President Obama for not supporting single payer health insurance as part of health reform, saying "Continuing private health insurance is crazy." On the other end of the spectrum, Congressman Paul wants to drastically limit the size and scope of the Federal government (a few days ago, he was the featured speaker at a John Birch Society luncheon in Houston).

These are false choices, a microcosm of the health reform debate between the traditional left wing policies of big government as the big teat taking care of everyone and the right wing policies of small government and survival of the fittest. We can transcend our divisions if we think more multidimensionally.

I want to focus here on an example of how my colleagues and I were able to bring together some of the most conservative Republicans and liberal Democrats across the political spectrum at the highest levels to work together to change Medicare coverage, how we're doing it again, and the lessons we learned that can enable health reform to be truly bipartisan.

For the past 32 years, I have directed a series of research studies showing that changes in diet and lifestyle can make such a powerful difference in our health & well-being, how quickly these changes may occur, and how dynamic these mechanisms can be.

We used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. We showed that comprehensive lifestyle changes may stop or even reverse the progression of coronary heart disease, prostate cancer, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions that account for at least 75% of the $2.1 trillion in health care costs.

I thought that when we published our findings in the leading medical journals that this would change medical practice. In retrospect, that was a little naïve; good science is important but not sufficient to change medical practice. Despite the talk about evidence-based medicine, we really live in an era of what I call "reimbursement-based medicine"--it's all about the Benjamins.

I realized that it wasn't enough to have good science; we also needed to change reimbursement. We doctors do what we get paid to do and we get trained to do what we get paid to do. Therefore, if we could change reimbursement, then we would improve both medical practice and medical education.

Thus began my 14-year epic journey to persuade Medicare to cover intensive lifestyle changes for reversing heart disease. This culminated in achieving some coverage last year in the "Medicare Improvements for Patients and Providers Act of 2008" (Public Law 110-275).

Beginning in 1994, I was able to enlist the strong personal support of both Bill Clinton when he was President of the United States and Newt Gingrich when he was Speaker of the House for the idea that Medicare should cover programs of intensive lifestyle changes for reversing heart disease, not just preventing it. This was at a time when relations between Clinton and Gingrich were highly acrimonious during the midterm elections.

We also had the strong personal support of both liberal Democrat Rep. Charles Rangel (D-NY) and arch-conservative Dan Burton (R-IN), who joked at a press conference at the Capitol ten years ago that this was the only issue that they both agreed on. They even co-hosted a bipartisan Congressional retreat in 1999 in which all members of Congress were invited to learn how to improve their diet and lifestyle. We also had the support of many other members of the Senate and House on both sides of the aisle, along with the president of the AARP, the Chief of Medicine and the Chief of Preventive Medicine at Harvard Medical School, the head of the American Board of Internal Medicine, and many others.

And it still took us 14 years. As Secretary of State Hillary Rodham Clinton said in a recent interview with Fareed Zakaria on CNN:

ZAKARIA: Speaking of -- final question -- speaking of hard negotiations, what message would you have to the Senate Democrats who seem to be holding up the passage of a comprehensive health care bill? Or are they amending it in ways that are useful and productive?

CLINTON: Well, actually, I think that it's a very healthy process that's going on. They are having to hammer out all of their differences, and there are serious differences in viewpoints, for example. But what the president has said and what I believe is the right approach is that this can't be put off any longer. I mean, it's a little bit like what I was saying about climate change....

You know, in '93, for example, Fareed, I had a man who became a friend of mine, but I didn't know him at the time - Dean Ornish. He came to see me, and he said, look, I have proof...

ZAKARIA: This is the doctor...

CLINTON: Who did a lot of work on cardiovascular health. And he said, "We have proof that changes in diet, stress reduction, exercise are as effective, if not more effective than medical interventions in lowering people's overall threat of heart disease." He said, "But I can't get Medicare to pay for somebody going to an exercise class or to pay for a nutritionist to come to their house and talk to them."

Well, we worked and worked on that all through the time my husband was president. And then finally sometime during the Bush administration, the Centers for Medicare and Medicaid, CMS, said, "OK, fine, we'll begin to pay for this."

Well, it shouldn't be that hard. You know, we're more than happy to pay for a pill or pay for a procedure. How do we change behaviors? How do we convince, you know, the medical establishment to do that?

For example, in 1995 I met with Bruce Vladeck, Ph.D., who was the Administrator (director) of Medicare at the time. In that meeting, Dr. Vladeck said, "Dean, before I'll consider doing a Medicare demonstration project, you first need to get a letter from the director of the National Heart, Lung, and Blood Institute of the National Institutes of Health stating that it's safe for older Americans to walk, meditate, quit smoking, and eat fruits and vegetables." I was incredulous, but we did.

I understand those who think that single-payer health care is the way to go. However, after needing 14 years to get Medicare to do something as obvious as paying for intensive lifestyle changes scientifically proven to reverse heart disease despite the strong personal support of those at the highest levels of government and the leading experts in the scientific community, I share the Republican concern about greatly expanding the power of the Centers for Medicare and Medicaid Services. I'm as deeply suspicious of big government as anyone. I'm strongly in favor of universal coverage but not single payer.

But I also understand the anger at large insurance companies that drop coverage on people who get sick or lose their jobs, or who don't provide coverage for 48 million Americans who are uninsured. Again, too much power concentrated in too few institutions often leads to abuses of power to the detriment of the American people.

There is a third alternative. The idea that changing our lifestyle can prevent and even reverse the most common, the most deadly, and most expensive diseases transcends the old left wing/right wing, red state/blue state divisions. These are profoundly human issues that we can all support, bringing together liberals and conservatives, labor and management.

For Democrats, it's a way to make true health care (not just sick care) available to the 48 million uninsured while reducing costs rather than dramatically increasing them, as I outlined in an earlier column.

For Republicans, this approach emphasizes freedom of choice and personal responsibility, not to blame people but to empower them. These are things you can do to heal yourself, to keep you and your family healthy that also, by the way, substantially reduce health care costs while improving the quality of care.

As a more recent example of the power of this approach to bring both sides together, Senator Ron Wyden (D-Ore) recently introduced new legislation, the "Take Back Your Health Act" (S. 1640) that will pay for intensive lifestyle changes as treatments, not just prevention, for these conditions as a complement to regular medical care. This legislation was co-sponsored by Senator John Cornyn (R-Tex) and Senator Tom Harkin (D-Iowa), and recently joined by Senator Sherrod Brown (D-OH). Dr. Mark Hyman, Dr. Mike Roizen, and I consulted on this legislative language.

"This is a groundbreaking bill, based on the proven idea that lifestyle changes can improve the health of those with chronic disease if people stick with a program that has that goal in mind," said Senator Wyden. "The Take Back Your Health Act gets doctors and patients invested in the success of treatment, since doctors won't be paid unless their patients actually get better."

"This legislation will provide seniors who have chronic diseases with the care coordination, training, and support necessary to make and sustain intensive lifestyle changes that have been clinically proven to beneficially affect or even reverse the progression of many chronic diseases," said Senator Cornyn. "I'm pleased to join with my colleagues in a bipartisan fashion and will continue pushing for common-sense solutions to our health care system."

"The health reform debate is not about continuing the status quo, but about changing our health care system and the medicine we do," Senator Harkin said. "This legislation will change the medicine Medicare does by reimbursing health care professionals for proven programs to address disease, including coronary heart disease, diabetes, and some forms of cancer, through intensive lifestyle change. Health reform is about giving individuals more choices and individuals should be given the option to engage in a lifestyle treatment program instead of surgery and pills."

One of the reasons why the old liberal/conservative dichotomies no longer apply is that these have been eclipsed by a larger issue: the consolidation of power. I strongly believe that the Founding Fathers of our country got it right: power corrupts, and any time you have too much power concentrated in one place it tends to get abused, so checks and balances are always needed.

And almost every day we learn of new abuses of power that occurred under the Bush administration which actively tried to disrupt the balance of power in favor of the Executive Branch of government.

Bureaucracies tend to perpetuate themselves, whether they are multinational corporations or large government institutions such as Medicare, often at the expense of those that they are supposed to serve. Too much power in any institution tends to stifle innovation.

Therefore, if we want to bring Republicans and Democrats together, then we need real health care reform by developing new paradigms for government and corporations that focus on how we can address the underlying causes of most diseases--what we eat, how we respond to stress, whether or not we smoke, how much we exercise, and the quality of our relationships. These can empower the individual to make healthier lifestyle changes rather than the false choices of increasing the power of large corporations or growing the power of government institutions, both of which make me want to rebel. Don't tread on me.

Comments

[sfway30]

A public plan is the only fix for what we've got..... but don't worry cousin, your money will get you to the front of the line, just like now...!

[39nurse]

Dr. Ornish- I am a Nurse Practitioner & I have been a supporter of Health Care Reform for more than 35 years. Thank You for all you did to get Medicare to pay for preventative Care in Cardiovascular Health. But changing Medicare is not enough. We must increase Medicaid payments so they cover those who make 150% of the poverty limit and make sure everyone who is eligible for a government program gets on the books. Still that would not cover the millions who are either uninsured or under insured. Health Care should be a basic Human right and we must continue the fight to make it available and affordable that Ted Kennedy started over 40 years ago.

Whatis needed is some sanity in this whole fight. People have the right to live a healthy life and the United States is failing to make sure its citizen live that life. It is not important who runs the programs- in Europe a single payer plan is not run by the government but at the same time insurance companies there can make almost no profit on selling Health Insurance We have to have tort reform-so we can do our job without worry about lawsuits but at the same time the public must have some recorse for bad care Basic Standards of good care need to be upheld .Evidence based Medicine must be used to set these standards as well as basic common sense.

[jeanneyogini]

Dr. Ornish, I agree with your demand for reimbursing healthy lifestyle changes. The missing link to this health consciousness is a means for people to create the inner strength and clarity of mind necessary to make healthy decisions. Day-to-day choices about what to eat, when to go to bed, how much exercise to do, how to handle stress at work—all depend on our mood and state of mind. An effective meditation practice that releases stress and deepens our connection to inner contentment and mental clarity is the best foundation for creating healthy habits that last.

Fortunately, science has taken the mysticism out of meditation and its effect on health. In the market place of self-help and meditation practices, subjective reports are unreliable for the purpose of healthcare reform. But researchers have studied what happens in the brain during meditation, and how meditation effects metabolic rate,
blood lactate, heart rate, blood pressure and aging. A study published in the journal of Psychosomatic Medicine found that a group practicing Transcendental Meditation had 55% less medical-care utilization, both in-patient and out-patient, compared to controls matched for age, gender, and occupation. I hope you will include such authenticated
practices in what you call "reimburse­ment-based medicine."

[Soliel]

Dr. Ornish....I adore you!!!! You and Mackey speak the TRUTH!!!

The information is out there...how we can *dramatically* reduce disease rates with diet and lifestyle (the Western world suffers certain diseases *much more* than other countries who don't have rich diets based on animal products and processed foods).

This is the TRUTH and it is my new passion. If we are to have any kind of public healthcare, you better believe this information and incentives to have a better diet should be in place. Imagine if we dramatically cut these diseases...we'd all pay so much less AND less suffering in the form of cancer, disease, fatigue, pain, etc. The difference would be astounding.

THANK YOU Dr. Ornish for having the COURAGE to speak up. I am with the "third option" all the way. You and Mr. Mackey are lights to a better life.

[Eyeheartfreedumb]

I had no insurance until I was 29. Early in life I had a car payment (cost=$9000) and school loan repayment, while working one (or two) minimum wage jobs ($5.75/hr), plus other emergencies (i.e. car broke, no cash, used credit with no money to pay), not to mention rent, food, etc.
I started doing the right thing when I was 24, and worked to get out of debt. I had two bills that I could choose to pay (rent and car), all the rest were garnished if I had skipped a payment. Meanwhile, ALL of my paycheck was spoken for- - I didn't always eat. If I got sick and couldn't work I'd have had the choice of either skipping rent (homeless) or skipping my car payment (can't work = homeless). If I missed one day of work, I'd be homeless. The stress hurt me, but that was my reality. I once ran a dangerous fever but couldn't go to the emergency room. I had no money, so I stayed home and hallucinated. "Luckily" it was my weekend, so I got to keep my job/apartment.
I was poor and irresponsible as a teen, but this isn't a choice in "the greatest country in the world." But you won't hear stories like this enter the national discourse. The folks on t.v. want to make this about business and grandma- - no one makes money talking about the REAL effects of this broken system.

[ccairnes]

Foolish academic BS from someone who has never been without access to healthcare. Most people know diet and exercise will improve their health, but millions watch so much TV they buy the junk food and drugs they see advertised because they have no self-control.

What really burns me up is that instead of being able to spend money on the kind of health care we choose, one of the things all the talking heads are assuring us is going to be in the legislation is a requirement that we each buy insurance to pay for allopathic medicine whether we like it or not.

[Tony Sacco]

does any one know how many doctors percapta we have in the U.S.? May be need more.

[nosey10]

Tony Sacco: Obama says we need at least 150,000 general practioners. Now the kicker in this house bill is that we are going to do "affirmative action" crap with doctors. In other words, medical schools will be forced to take students that aren't up to par and train them to be doctors since the shortage needs to be filled and also the affirmative action stuff that is really prevalent in this administration. So, the more we learn, the scarier this reform sounds since I for one, don't want a doctor who isn't the best operating or treating me or my family. If you don't beleive me, look up the health bill from the house, not the senate, and you will find these provisions. We even have the "green czar" involved in health care-why????

[Strepsi]

Dear Dr. Ornish, that was a very interesting article and your conclusions about what should be done to care for people are sound. But I would suggest the premise is false.

In the U.S. there is NO left vs. right. Only Democrat vs. Republican. By the standards of any other developed nation the Democrats are centre-right. The Republicans are far right. There is no left wing representation. Here in Canada we have 5 parties, and our Conservative party is about equal with your Democrats (they want some private services but will not give up a public option - no Canadian party would roll back universal health care).

Your country has a democracy defecit. It is simply not possible to "bring Republicans and Democrats together" - each represents about 1/2 the population, and each is wildly partisan irrespective of platform -- rendering real change impossible. Isn't the real root of the political issue that there are only 2 parties?

[Rhiana]

8/19/2009
Congressmen John D. Dingell (D-MI15) and Sander Levin (D-MI12) have questions for Blue Cross Blue Shield of Michigan President and CEO Daniel J. Loepp about a series of rate hikes the company announced late last week. Blue Cross Blue Shield of Michigan plans to hike monthly premiums for 163,000 Michigan citizens who buy the insurer's nongroup or group conversion plans on average by 22 percent. Blue Cross will also increase supplemental Medicare policies, known as Medigap, held by about 210,000 Michigan seniors by an average of 4.7 percent. Blue Cross had requested an average 56 percent hike for its nongroup plans and 41 percent for its group conversion policies.

Public option please...

[nosey10]

Rhinia: This article makes a lot of sense and we do not want a public option or single payer plan which will eventually give the government complete control over all our health care-it will be a lot like Canada and other countries where there will be a few insurance companies that cover the rich and congress and the union-the rest of us will be up the creek without a paddle. If insurance companies were able to compete across state lines, just like car insurance and homeowner policies, that would help tremendously and congress needs to mandate that these insurance companies can not drop you or refuse anyone with an existing condition or who has lost their jobs, etc. Something that hasn't been discussed is the fact that house insurance is in worse shape than health and I read in AARP a year ago where a man was paying $4500 a year for his homeowners which is required since he has a mortgage so he dropped his health insurance because he couldn't afford both... We definitely need reform-but not a government controlled health
care plan-25 new AGENCIES TO CARRY OUT this mess and Britain says their greatest cost is the ADMINISTRATION end of their plan...We simply cannot afford this-see Mass., Tenn., Hawaii, and Oregon.

[dragonfur]

Been listening too much to the right-wing drivel! Rather the government have control of our healthcare than the for-profit corporations that now control it! You wouldn't be turned down for needed medical care, or a pre-existing condition, or whatever the insurance company deems too expensive for their bottom line.

Better to have government- run healthcare, than profit over people "care" we have now.

Health care insurance and home insurance are NOT the same issue. Don't try to confuse one with the other.

BTW: My Canadian friends swear by their government-run insurance. It's not perfect (it's run by humans, after all: imperfect beings), but it's better than profit-run insurance like the US is burdened with.

Oh, and if crossing state lines is helpful for homeowner insurance, how come the man you speak of couldn't afford his? Doesn't really sound like that's a real help.

[lauraj40026]

Hey Doctor,I was born with cerebral palsey.There is no way to undo that.

[LoudmouthLime]

On page 279 of Dr. Weil's book "Spontaneous Healing", Weil writes, " Do not seek help from a conventional doctor for a condition that conventional medicine cannot treat, and do not rely on an alternative provider for a condition that conventional medicine can manage well".
This makes sense.

Claiming that the answer to our health care crisis lies in simply changing our diet, not so much.

While it's true that what we eat can affect our health, it doesn't begin to offer a solution that will upend the greed and politics in the current health care system affecting all our lives.

Ironically, it's hard to reconcile the fear of a government option and not fear regulation of what we put in our mouths.
If eating well is the answer, what agency will enforce this. What agency will oversee dollars for no donuts, paying families for eating broccoli instead of burger.

It's magical thinking, naive at best and yet another opportunity for abuse.

Simplify. All industries involved in our health care require a total overhaul. This will not happen through insurance industry and corporate philanthropy.


Public Option.

[tweedledeedumb]

When repubs took over the senate, house and had the presidency under Bush, 2nd term, they didn't try to be partisan, they said what they were going to do and did it...Democrats be damned. If only the Democrats had some balls!

[Lasthorseman]

Missing the real point.
Who is going to own decisions about my health care me or the state.
And why the militarization of health care via international "swine flu" conferences focused around martial law, mandatory injections of untested vaccines.
Is the flu shot a bio-weapon for population reduction.

[GRAycon]

It's possible that this may be the case. The main cause of global warming is said to be human pollution, which is unsustainable because of the 6 billion+ people on the planet. Therefore, it seems logical that the way to solve the problem is a massive population reduction. What better way than a world-wide biological threat like H1N1? That way, specific populations can be targeted for elimination under the guise of "helping" them; and the massive deaths can be blamed on ineffective vaccines, increasing virulence of the virus, etc. It would really be a brilliant plan!

[blueken]

You miss the point, your choice is a government by the people for the people who will make decisions on your health care, or a for profit insurance company. You can vote on the government, the insurance companies, not so much. I have had about 8 insurance companies in the last 40 years. All of them were chosen by my employer. All of them had a nice thick book of rules. Everyone came with higher co-pays and less coverage. Everyone cost more than the last. This can't go on forever, or it will eat our economy whole.

[Rhiana]

This is the new one? "Death panels" weren't crazy enough for you? Now its the CDC conspiring to kill people?

There are plenty of REAL things to be scared of, why not try one of those... like losing your job, and then your health insurance, and then your house.

[dadw5boys]

Ask this question : As long as the Central Bankers are forced on us and the INTEREST alone on the National Debt is now $500 Billion Dollars a year. The fact is that we will never be able to repay even the Interest now.

Americans need to make a DEFENSIVE move to help all Americans so maybe one day Americans can survive to kick the Central Bankers out of the USA and reclaim our country so it is prudent even Vital that we pass a Government Option on Health Care isn't it ?

The Central Bankers give us little choice but to protect ourselves by passing laws that protect all Americans so our dream for a Free and Sovergien America can some day live again. As long as the Central Bankers control our money they control our Government .

[humaneismyth]

single payer eventually will be the only way to go.There is no argument for private health insurance .Their very existance creates a wedge of inequality and a breeding ground for profiteering and corruption.

[GRAycon]

As opposed to the profiteering and corruption that would benefit politicians and both parties under the government-run health care system.....

[indy100]

Yes, that's why the citizens of every other nation with national healthcare/health insurance are marching in the streets to end their current sytems and adopt a system like the US has. Except they aren't....­..........­..........­..........­...

[balancedsolution]

Dr. Ornish... just by your word transcendence shows you are a higher thinker.

There need to be more doctors like you and Dr. Weil that take heart in knowing that true medicine lies in prevention, and such compensation should be rewarded for lifestyle changes and positive outcomes such as weight loss and diabetes reversal.

Unfortunately as you know the pharmaceutical companies have their boots on the throat of true progress as profits are revered more than disease eradication. Disease Management is how they make their money, and trying to convince the populus they really do need their drugs, when in fact they need healthier foods.

I asked an alternative practitioner once what they would do if diagnosed with cancer, and the answer i got was to accept that i have it and to die peacefully without chemo/drug intervention.

If we can somehow teach the masses about alkaline/acid states in the body, and make healthy foods more available and more cost effective we will create a marvelous change; a paradigm shift.

Thank you