Last Tuesday in a major address to both houses of Congress, President Obama eloquently invoked images of the healing crisis that wise physicians from antiquity on have commended to patients, urging us Americans, who are suffering a crisis of cash flow and confidence, to discover "promise amid peril". His plans for two of the three areas he diagnosed as "absolutely critical" to our future economic health--energy renewal and savings, and educational progress--were dynamic, expansive, spirit lifting, and as he assured us, marked by "bold action and big ideas."
His prescription for health care reform, the third economic intervention, was, however, more tentative, diminished by limited vision and plans that promised mostly old action. His follow-up in yesterday's health care summit reiterated the importance of extending coverage to all Americans, but neglected again to ensure that that coverage would actually improve the physical or mental health of our population or significantly curb our costs.
It is clear, as Mr. Obama told us, that the cost of our current system--at $2 trillion a year and 16.5% of our Gross Domestic Product, and continually, wildly climbing - is "crushing," that "health care reform cannot wait," and that every American should have "quality, affordable care." What was not at all clear in his speech or at the summit was what he was going to do to slow the increase in costs, or provide that quality care. His curiously flat health care ideas were limited to a universally-agreed on administrative measure - electronic records; a "down payment on the principle" of universal health care - not a commitment to action; and praise of, and promised cash for "prevention," which in administration documents so far floated seems mostly about more early disease detection. In his speech, Mr. Obama's only real health care passion seemed to be for "conquer[ing]" cancer, an image which inevitably evoked the hugely expensive, but largely inconclusive "war" on that disease that President Nixon declared almost forty years ago.
Still, it's early times and Mr. Obama is a quick study and a wise man--quite willing, it seems to me, to change his mind to fit the facts he sees. He can begin by taking a step back from the received wisdom he offered us, to adopt the same holistic perspective on health that he brings to energy and education. He will then see that we have a non-system of disease care, not health care, an approach that works well for emergencies, but is woefully inadequate and often counterproductive for treating and preventing the chronic illnesses that beset our population, and for promoting good health: we spend as much as twice as much as other industrialized countries on per capita health care, but rank 37th in the world in major health indices.
What the President will soon realize, I believe, is that we do not need more of the same kind of care for more people, but rather an approach that focuses on health rather than disease, one which makes respectful use of each person's capacity to help him- or herself - mobilizing the kind of creative, even entrepreneurial, activity he praised in education and energy development. Already, simple, inexpensive self-care measures--including diet, exercise, and mind-body approaches like meditation, guided imagery, and yoga, together with group support, are being demonstrated to reduce stress, improve immunity, decrease blood pressure and blood sugar, to reverse heart disease and diabetes, increase mobility in people with arthritis and lift the mood of those who are depressed--in short, to make major contributions to treating, preventing and lowering the cost of the chronic illnesses that cripple us, threaten to bankrupt our country, and prematurely claim our lives.
I hope President Obama will soon bring this focus to programs the Federal Government already controls, the ones that provide care to the elderly and poor, to active duty military and veterans, and to Congress. I hope too that he will boldly put back "on the table" the "single payer" approach to health care for all the rest of us that has caused such fear in US politicians for so long. Properly designed, government-supervised single payer can not only save the yearly $350 billion that Physicians for a National Health Plan estimates, but actually refocus our system on health and wellness and even enlarge the caregiver and treatment options that the current, apparently free-choice insurance system actually limits.
Two and a half months ago, the Obama administration asked the American people to hold and report on discussion groups on health care issues. We at The Center for Mind-Body Medicine organized one of hundreds of these meetings. To the thirty of us (patients, providers, and policy wonks, left, right, and center) single-payer seemed the "only sane" alternative-a Copernican simplification of health care chaos--and self-care the true primary care. We saw schools that teach our children to care for themselves--to say "yes" to good food, exercise, self-expression and stress management, not just "no" to sex, drugs, and alcohol--as laying the foundation for our nation's future good health. We asked that all health professionals be trained in wellness education and that jobs be created for people who want to devote their lives to this vital work. We called for a broad ecological, "functional" approach to the underlying biological disturbances that give rise to cancer as well as other chronic illnesses--after all, at least 40% of all cancers are precipitated or influenced by diet, and many others are caused by environmental carcinogens--not just an assault on malignant cells. And we recommended unanimously that a White House Office of Health and Wellness be created. This office would ensure that this health-promoting, disease-preventing approach be initiated and maintained in a coordinated way at all government agencies--at the Department of Education as well as the Department of Health and Human Services, that it would shape the services available to our troops and the kind of food that is served to our children in school lunch programs.
No one I know has yet heard what the President and his team think of any of our recommendations. I hope that by the next time he speaks on health care he will use what we have shared to help himself and all of us to find the deep challenging promise that really does exist amid our current health care peril.
Complete text of The Center for Mind-Body Medicine's recommendations to President Obama is available at here.