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Monday, September 7, 2009

Healthcare, Curing the Disease not the Symptoms; Pt. 3: Prevention is Key

From the previous post, it would seem that the U.S. healthcare system is more than capable enough to cure and treat the health needs of the country. So why is it then that we get such bad results and in turn spend so much more money than any other country for those results? The answer I think is
pretty well known and often talked about which are the problems associated with lifestyle choices and preventative care. John Mackey, the CEO of Whole Foods, pointed out in his August 11th Wall Street Journal Op-Ed: "many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable." This indicates that as both an effective way to lower costs as well as improve results we need to focus on encouraging healthy lifestyle changes.

Dr. Frank Lipman in the Huffington Post puts forward his own suggestions of how to improve healthcare in the U.S., most revolving around this strategy including, rewarding healthy lifestyle changes, investing in educating the public in self-care, rewarding doctors for preventing and managing chronic diseases, among other similar proposals. Something that I would add is to encourage and reward businesses, in particular those whose employees primarily engaged in sedintary work, who themselves encourage their employees to stay active and get exercise. For example, encouraging employees to ride a bike or walk to work rather than drive, providing exercise facilities, or organizing gym membership group discounts. These would in fact be beneficial to those companies that provide insurance for their employees as it would bring down their own costs. Strategies such as these would be effective in bringing down overall costs, improve results, and leave our system fundamentally unchanged.

Many of the opinion pieces and commentaries on healthcare reform that I have read, particularly those by doctors, have indicated that the real problem with the proposed reforms are that they are trying to target costs and ways of cost shifting while ignoring what it is that makes our system flawed. It seems that it is a general mindset of how we treat disease that has gotten us to this point, where not only do we fail to avoid preventable disease but we tend to throw money and expensive procedures with no measureable benefits at problems that are ultimately avoidable. There is a great article by Mark Hyman in the Huffington Post that points to such situations. He observes that, "services with NO measurable health benefit consume 30% of Medicare dollars. Better access to the same care will not solve our heath care crisis." For example, we spend $20 billion dollars a year on statin presicriptions (a drug that lowers cholesteral levels) for unproven prevention, 75% of total spending on the drug. In an even more extreme example, in trials testing insulin therapy aimed at lowering blood sugar to help prevent heart attacks, not only were the number of heart attacks unchanged but there were more deaths. And yet, as Hyman points out, we continue to pay $174 billion annually for this type of care for diabetes, despite evidence that lifestyle works better than medications."

All of this evidence makes it pretty clear that reform is needed as the healthcare system is clearly flawed. However it also seems as if the efforts of Congress and the President are misguided. If rather than try and control insurance companies, bargain with hospitals and drug companies, and other such strategies aimed at bringing down cost, we should instead focus on how and why we deliver care. Because in the end, what is the point of reform if, as Hyman says, "the foundation on which we deliver care [remains] flawed"?

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