Recently, Sen. Tom Harkin was asked to lead a working group given the task of crafting the prevention and public-health components of President-elect Obama's health-care-reform bill. As chairman of the subcommittee on appropriations and health, he's in a position to have a pivotal role in tackling the immense challenges the nation faces in this area. He spoke with me about his vision for health-care reform. Excerpts:
Dean Ornish: Why you are so passionate about preventive health care?
Tom Harkin: I want to lay down a marker right here at the outset of America's great debate about national health-care reform: if we pass a bill that greatly extends health-insurance coverage but does nothing to create a dramatically stronger prevention and public-health infrastructure and agenda, then we will have failed. I have long believed that prevention and wellness are the keys to solving our health-care crisis. We must recreate America as a "wellness society" focused on fitness, good nutrition and disease prevention--ultimately, keeping people out of the hospital in the first place. You paved the way for a lot of people, and this is something I have been laboring on for a long time.
We don't have a health-care system in America; we have a "sick care" system. The problem is that this current system is all about patching things up after the fact. We spend untold hundreds of billions [of dollars] on pills, surgery, hospitalization and disability. But we spend peanuts--about 3 percent of our health-care dollars--for prevention.
When President-elect Obama recently introduced former senator Tom Daschle as the new secretary of health and human services, he said, "Now, some may ask how at this moment of economic challenge, we can afford to invest in reforming our health-care system. But I ask a different question. I ask, 'How can we afford not to?'"
Every year, we keep putting more money into high-tech, very expensive remedial things. And yet, we know there are better, safer, more cost-effective ways of dealing with many of our chronic illnesses.
Heart disease is a good example. More than $30 billion were spent last year on angioplasties, yet randomized trials clearly show that they don't prolong life or even prevent heart attacks for most people. In contrast, studies show that most heart disease is completely preventable today, simply by changing lifestyle. My colleagues and I have shown that heart disease is usually reversible by changing lifestyle. So, why has it been so hard to reform health care?
It's been so hard because the deck is stacked, socially and economically, against the kind of preventive measures that are cost-effective and that evidence has shown work. From the earliest time, our kids are led into eating unhealthy foods.
I'm encouraged that some of the large companies, like PepsiCo, are finding that it's good business to make healthier foods, which makes it sustainable. What can we do to encourage kids to eat more healthfully?
We can start at the earliest times in a child's life, like the Women, Infants and Children's Program, to make sure that mothers get healthier foods. This next year coming up is the reauthorization of the Child Nutrition Act, and that's under my jurisdiction. Making sure that kids in the Head Start Programs get early education and information about what is healthy and what is good and have healthy snacks for them, too. In 2002, I took a few million dollars and I started a free fresh fruit and vegetable snack program in schools. My theory was this: if kids could get a fresh piece of fruit or vegetable for free, they would eat it. And if they would eat it, they wouldn't get the "growlies" and wouldn't be rushing to vending machines or eating cookies. People always say, "Well, we will put a couple of apples or oranges in the vending machines," but kids aren't going to buy that with their money. But if you give it to them free, they will eat it.
Kids get these little packages [in the program]--apples, oranges, broccoli and baby carrots are already sliced for them. In the current farm bill, I fought very hard and I got $1 billion for this program. Within five years, we'll be able to get close to 90 percent of all the elementary-school disadvantaged kids a high level of free and reduced-priced lunches. These kids are now eating fresh fruits and vegetables.
People get their taste preferences when they're young, so if we can get kids enjoying healthful foods like that when they're young, they're much more likely to do so when they're older.
Absolutely. A lot of these kids getting these fresh fruits and vegetables at schools are going home and asking their parents to get them. I was at a fourth-grade class, mostly poor kids, and they were having fresh oranges, and there were kids who had never had a fresh orange in their life.
As you know, many of the subsidies in the farm bill are perverse, making it significantly cheaper to eat fat, salt and sugar than fresh oranges.
Well, we're changing that. For the first time ever, I got fruits and vegetables included in the farm bill. We spend a staggering $2 trillion annually on health care, more than any other nation in the world, yet the World Health Organization ranks U.S. health care only 37th among nations. Thirty-seventh! We are 20th out of 21 industrialized nations in the quality of health care for children. When I look at these statistics, it seems as though we have lost our capacity to be shocked or outraged. Just how much evidence do we need that America's approach to health care--or should I say sick care?--is not working?
The only state that mandates physical education in schools is Illinois. That's another approach that red states and blue states can get behind: getting exercise back in our schools. As you know, exercise and better nutrition improve academic performance as well.
Exactly. I'm looking at tying reimbursements for school meals to schools that have a physical exercise program, and/or giving bonuses to schools that have an exercise program.
The Robert Wood Johnson Foundation [a philanthropic organization dedicated exclusively to health and health care] has shown that when you change public infrastructure, it really does change behavior.
I put an amendment in the last highway bill that said that any state or local government that gets federal money for highways, bridges or streets would have to incorporate in their planning bike paths and walking paths. It lost, but part of my wellness initiative is to use the finance committee to put out tax incentives to workplaces that offer comprehensive wellness programs. Allocate more Medicare dollars for early diagnosis and prevention with no copays--if you have a colonoscopy, there shouldn't be a copay; there shouldn't be a deductible. We waste so much money in Medicare. For example, Medicare will not pay for any kind of diet or nutrition counseling if you are pre-diabetic.
But they'll pay to amputate your foot ...
... After you get diabetes. It's just nuts. So these are the things we've got to change. A robust emphasis on wellness is about saving lives, saving trips to the hospital and saving money, and it's the only way we are going to get a grip on skyrocketing health-care costs. To date, prevention and public health have been the missing pieces in the national conversation about health-care reform.
It's time to make them the centerpiece of that conversation. Not an asterisk. Not a footnote. But the centerpiece of health-care reform.
Originall published at newsweek.com
I have been on a very low fat diet for MS since I was diagnosed 14 years ago. I have never used any of the expensive disease-modifying drugs. I had 3 or more relapses over 2 years before starting this diet; I have had no relapses or progression since then. This cannot be a placebo effect.
Others who use dietary control of MS include Montel Williams and Ann Romney. I greatly doubt that Michelle Obama's father (who died of MS complications) was told to limit his fat intake, even though the benefits of a low fat diet for MS have been reported for almost 60 years.
Energy and Transportation: Do I drive when I could walk or ride a bicycle? Using our own energy leads to cleaner air and healthier living standards.
Food Production: Do we really want the people and mindset that has created the current financial fiasco to have control over our food supply? Genetically modified crops and grains are a irreversible step in this direction.
Add to the latter the issue of quality employment and "free" trade: Read the history of the banana as a lesson.
The problem is that many people just want to have a "happy" pill. We all feel down at some point in our lives (I have) and this is normal and when I feel down I exercise and try to keep active, and it works. One of the things that have to happen is that we all have to take care of our own health our. I, for once I do not trust the current medical system that only prescribes drugs, I do not trust the physicians either .... I go to a chiropractor and try to eat healthy, exercise regularly, etc.
I know we are going to be fighting drugs and insurance companies but I am ready.
Medicines ought not to be "fought", but used properly, if they are really needed. Find a physician that is worthy of your trust, and shun the ones that aren't. Your doctor ought to be on YOUR side & no one else's.
But when or if we get it, then a new debate has to begin about the whole "one size fits all" approach that is used now. In other words it can't just come down to all the high-tech tests and prescription medicine - and unnecessary surgery - that we have now.
In fact the climate will be ripe to develop much more effective medical approaches than the haphazard system we have now.
The question of how much good all these Pills do is really not even on the table now - it is not even part of the debate.
When the Profit Motive is removed from the medical system such questions will finally come to the fore.
In 1995 I put forth an 8 point plan that emphasized prevention. Hillary Clinton liked it . Now it is an economic imperative!
Here it is for your and Huff Post readers consideration-
-Stop prolonging death. It’s both expensive and dehumanizing at best, greedy and cruel at worst.
-Empower US citizens to assume increased individual responsibility for health and convince medical consumers that it is in their best interests not to assume the role of helpless, dependent victims/patients.
-Yet also recognize that we have medicalized America’s social problems. So we must provide healthy and safe jobs for all able citizens thereby reducing poverty and all its subsequent health impacts (possibly 1/3rd of Health Care Costs)
-Provide healthy environments including healthy air, water, soil and food.
-Rebuild America’s public health infrastructure to ensure we provide appropriate macro and individual interventions to especially low income citizens such as childhood and adult immunizations and response to man-made and natural catastrophes.
-Face the reality that a very large percentage of illnesses, injuries and hospitalizations are entirely preventable. Subsequently, the elimination of tobacco, alcohol, drug, medication and dietary abuse alone could immediately reduce medical costs by a factor of at least fifty percent.
-Incent and train physicians to maintain the health of patients and populations. Radical changes in provider re-imbursement and medical education strategies are necessary
-Recognize that early childhood preventive medical education can profoundly affect lifelong health behaviors.
Dr. Rick Lippin
Southampton,Pa
Regards,
CS, medical doctor
Of course, the resistance will come from big money players in our current "sickcare" system. They think they're doing just fine, thank you very much, and feel no incentive to change course. They are wealthy enough from the current system to throw big money into lobbying and advertising to prevent a course change towards prevention (Perhaps that's their form of the "Prevention!" mantra.)
There will be a continuing need for major-care trauma services - broken bones, injuries, onset of major diseases, etc., but it's way past time to transform our healthcare and health insurance models to include preventitave healthcare modalities - such as chiropractic, naturopathy, theurapeutic massage, ortho-molecular & nutrition treatment and counseling, certain body energy therapies, therapeutic touch, homeopathy, etc. All of these have beneficial health effects. I can personally attest to the efficacy, in my own life experience, of most of those I just listed.
Our current "system" isn't simply broken and, thus, fixable. You can't solve a problem with the same consciousness and thinking that created it. It once was an innovative idea which served well for a time. That time has passed; let the patient pass "into the light" of transformation into a system of wellness care that works here and now for the 21st century (not for the past and then of the 20th century).
Think about this...if someone from a very early age taught you to eat right, exercise, and go for regular checkups (preventative care) then you would decrease your risks and never get say diabetes or congestive heart failure. Well this is where the big bucks are for pharm companies and hospitals. These two diseases alone are huge money makers. Hospitals are not full of people with colds and stomac pains. No they are there because of complications of some disease.
http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/