Ending the "Sick Care" System: Interview with Senator Harkin

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

 

Comments

[Vajara]

Great post, Dean. Everything you support about health care in this article is on target and should be part of our collective actions. The other side of health is not sick care, rather, health is best defined as an experience of wellbeing, not a sick care intervention. If every citizen could just use their imagination for a moment and see how different life and our relationships could be when we design a model, individualized health care plan for ourselves-­-physicall­y, mentally, emotionally, and spiritually. Let's get moving and exercise our whole being. Thanks for your leadership on what health is all about.

[camper65]

I totally agree with his logic and purpose. But human beings have this incredible talent for doing what they damn well please with no regard for the consequences. And it is NOT the governments job to tell people exactly how to live their lives. Educate, recommend, cajole, convince, suggest - sure. But tell? That's outrageous. Better to deny services to those who abuse themselves and reward those who don't. And ATLA will LOVE the concept. Just think of the lawsuits!

[verhaftik1]

Finally, a Senator who gets it 100% right. We cannot go back to the old 'sick care' system. A shame this article fails 1) to acknowledge that physicians, not patients, are responsible for the 80+ year history of marginalization of public health/disease prevention in the US - in a deliberately profit motivated movement; and 2) reject rhetoric that the US people actually asked for this worthless system.

[camper65]

Take away the profit factor, and you will get fewer and fewer skilled physicians. And who decides what appropriate remuneration is? This opens the door to MASSIVE amounts of corruption as medical organizations try to control the the Congressmen who decide. OUCH!! But, then, I suppose the government could order people to become doctors - or accept a much lower standard of care, and rationed care, which other socialized systems have experienced. (See Canada, e.g.)

[brassminnie]

Health insurance is the only industry that makes a profit by NOT caring for the customer. "Pay us and we'll employ lots of people to assure you don't get the product you thought you were paying for." Then there's the pharmaceutical industry. "Stop that line of research immediately! It could lead to a cure! That would reduce the profit of selling thousands of people medications to keep them alive, at a couple thou a month for decades." The advertising of prescription medication is a real profit-maker too. Tell people that every little pang may be something terrible and exactly what expensive drug they should tell their doctor to prescribe. "None of this generic stuff. Ask for ours by name. We'll even help you pay for it, with your tax dollars." Leeches are still in medical treatment. They're sucking the life-blood out of us. Be prepared. The for-profit industry is preparing every argument, lobby and scare tactic in the book and inventing new ones. It may take a vote by the people to change it. Congress may not be able to do it.

[verhaftik1]

Excellent points. Also, in my opinion, leeches ARE the medical treatment community. It's so obvious by now.

[FormerRushListener]

It is time to investigate the criminal relationship between the pharmaceutical industry and the National Multiple Sclerosis Society. By only considering treatments tested by randomized double blind trials, the NMSS has limited possible therapies to pharmaceuticals, since only drugs can be studied in a double-blind setting. At least 3 studies have shown that a very low fat diet such as Dr. Ornish's will halt the progression of MS - however, since the patients had to know what they were eating, these studies were not double-blind and are therefore ignored. Over 300,000 Americans are losing their ability to work, to see, to walk, and to live a full life because they are not being told to be careful about their diets. They are paying $20,000 a year for drugs that do not work 1/3 as well as the diet, which is free.
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.

[davidly]

Two issues that tie into this directly:

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.

[SilviaMaria]

Let's not forget about alternative care; we can save a lot of money. Take for instance depression: 230 million prescriptions for antidepressants are filled, one of the most-prescribed drugs in the United States and still one in 20 Americans are depressed. Physical activity, exercise, healthy diet and lots of sunshine are the best cures for depression; you can take St. John's Worth too, acupuncture or yoga. These natural cures do not involve prescription medications and they are a lot better because there are not side effects.

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.

[ConfuciusSay-]

Much of what you have said is very true. St. John's Wort is a plant that has been shown to help, along with omega fats. Sunshine is factor in some kinds of depression. So is B12 deficiency, though this isn't common. Physical exercise is about as useful as just taking antidepressants, which is pretty good. But the medicines are useful tools that deserve consideration as part of a comprehensive treatment program, especially at the outset of treatment. If the illness isn't too severe, many people can manage without them, but some cannot.

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.

[krocklin]

Of course we need Universal Health care.
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.

[Artemrs]

We absolutely must incorporate a one payer health care system in this country. All other Western Industrialized Nations have health care for their citizens, and I might add, many have free or nominal higher education grants for college-bound students. If a country wishes to compete in this global world with a healthy populace and well-educated and trained people to assume roles that a society needs to thrive, health care is a number one priority. I have been fortunate to have traveled to many of these countries and talked to the locals about their health care and education system. Of course, they pay higher taxes than we do. Do they gripe about it, yes, but would they trade their system for ours? Absolutely not! You get what you pay for. We have many people in our society who would never want to pay for others who they feel "don't pull their weight." However, the reality is one never knows when they might be in "that" position; just look around you at what is happening now. People have lost jobs who never thought they would 2-3 years ago. Many have lost their health insurance, or are about to. A society that must concentrate on being productive, innovative, and competetive can't be bogged down with something as basic as being able to go to the doctor for preventive medicine and treatment if they are sick. For the good of our society this is a must.

[drricklippin]

Thanks Dr. Ornish and Sen. Harkins-

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

[ChiProgressive]

Great insights, but wouldn't you want to have an extra 3 to 7 weeks of life in a nice comfortable ICU?

[ConfuciusSay-]

Honestly, I wouldn't. But different strokes, etc.

Regards,
CS, medical doctor

[SpiritHorse]

Of course the topic of healthcare reform is much larger, but I would agree that the key mantra for healthcare reform is "Prevention! Prevention! Prevention!"

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).

[dapperd72]

This was a healthy exchange between Sen. Harkin & Dr. Ornish, however I'm surprised Dr. Ornish didn't use the "v" word once in this entire exchange, namely *vegetarian* or better yet, vegan. As the author of progressive diet books such as "Reversing Heart Disease" and "Eat More, Weigh Less," I expected someone of Ornish's stature to address the dietary issue head-on, not limited to persuading schoolchildren to simply eat more fruits & veggies instead of candy, soda & other blatant junk food. Animal products in general, whether they come from a factory farm, slaughterhouse or high-tech processing facility, such as the massive supply of genetically engineered products so ubiquitous nowadays, are inherently junk food and I'm sure Ornish is fully aware of these ugly realities. The transition of the mass populace to a vegan majority will save our economy millions of dollars in sickness care costs for unnecessary & avoidable degenerative diseases, most of which are the most common among Americans, heart disease, stroke, cancer & diabetes, all of which stem directly from consuming animal products. The regular practice of eating as low as possible on the food chain will ultimately save our planet as well as our health & I seriously hope Daschle will get our economy off the agribusiness gravy train that robs our finances from our backpockets in favor of a plant-based diet for everyone's benefit.

[iseeYouOrange]

I read all the comments and everyone seems to agree that preventive healthcare is the key.

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.

[tenzenz]

Secretary Daschle is right on. It's amazing how everything ties together & he recognizes it. He can push to implement the programs through almost every branch budget within the government & without. Those kickbacks that the Insurance Companies receive from the federal government could still be given to them with strict oversight on their need to invest this money in preventative health measures including Health Club Memberships. A family pays more than a Thousand dollars a month based on an average 50% copay from their employer for Health insurance, & gets nothing out of it unless someone is sick. Imagine how far this money would go if these Insurance Companies offered Free Health Club Memberships for these Families in order to make sure that family is provided with a proper Healthy Life Style? Imagine how much further this helps the economy, by creating a need for these Health Clubs & the employment opportunities it creates. Then if you consider employers that provide these facilities along with the proper Training Staff, they could reduce their CoPay. On the other hand, if Families are not taking advantage of this benefit, then they should have their CoPays increased due to their likeliness to develop chronic health problems. It is just a WIN-WIN Situation in every corner of Society as well as the Health Care System. There is no doubt that Preventative Health Care is much less expensive. Could it save 100s of Billions of $$$ per year once it is an established Life

[WmC]

Sounds like maybe Sen. Tom Harkin should be considered for Commerce Sec--it also looks like he would have made a better Sec. of Ag.

[Scoppertop]

Take some good old-fashioned Vitamin C to prevent most illnesses...

http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/

[brassminnie]

Stop living on starch, sugar, salt and chemically processed foods to prevent most chronic illnesses. And get off the couch and do something. It doesn't even have to be 'exercise' to be beneficial and help you lose weight. Most 'snacking' is actually due to boredom. What need are you actually trying to fill? Toss some frozen veggies and a hunk of meat in the crockpot. Get a ten-minute-meal cookbook. And above all, learn what that stuff on the chart on the package means, like how many grams equals a teaspoon of sugar, so you know how many CUPS of sugar you're feeding your kids every day. Obesity is killing children. They made kids' sizes bigger because the majority are overweight. Basically, if your ten-year-old wears a size ten, she or he is a probable profit-producer for the pharma corps' chronic disease maintenance drug business in a few years. They made women's sizes bigger too. It's called 'vanity sizing.'