By Paolo von Schirach
March 27, 2012
WASHINGTON – Let’s say the US Supreme Court strikes down the “individual mandate” provision within the land mark health care law passed two years ago. Or suppose the Justices will declare the entire law unconstitutional. Such a decision, so close to the elections, will have huge political ramifications. By the same token, if the Supreme Court will uphold the law there will be rejoicing in the Democratic camp and consternation among Republicansw ho labeled th law an attcak against liberty. Either way, these would be significant political consequences that would however have zero impact on improving the health care outlook for America.
Health care law is about covering the uninsured
Whatever its fate, this law does little to address the real issues affecting the absurdly high cost of health care in the United States. The 2010 health care reform legislation tried to solve the problem of millions of Americans with no health insurance. And this is important, of course. However, the new law takes the cost of health care as a given and it tries to spread it around.
Sick Americans and eager doctors
But the only solution is in reducing costs, thus changing the debate. And, while difficult, it is entirely possible to reduce cost, not by rationing health care; but by teaching people how to stay healthy. Indeed, the real problems affecting US health care are lack of any serious education effort about prevention, millions of sick people who could be healthy and thus in no need of care, and a ”fee for services” system that rewards doctors only when they perform some procedure.
Add the two and you have created the perfect combination for cost explosion: lots of sick people, (many with chronic diseases that require constant treatment), and doctors who make money only when they treat. We have an increasingly unhealthy population and doctors who are extremely happy to treat and over treat people, prescribing any possible procedure and drug under the sun, knowing that in most cases the insurance will pick up the cost and so the patients will have little or no objection to over treatment, since they will not pay out of pocket.
A prevention focused system
In contrast, picture this totally opposite scenario. Through a complete and comprehensive national education effort, all Americans are taught that regular nutrition rich in vegetables, legumes and fruits combined with regular exercise, adopted not as a temporary regime but as life style, are the keys to stay healthy. Doctors and all others involved in health care are moved away from the old “fee for service” system and are instead rewarded financially for keeping people healthy. And so doctors, instead of being the equivalent of auto mechanics or body shops that will fix your car after it had a breakdown or an accident, will be in large part teachers and educators, helping and enabling the general population to adopt and follow a “wellness” regime.
What would be the result of such a radical transformation? Very dramatic. You would see the rapid decline of the obesity epidemic and all its consequences. There would be a drastic decline of most cardiovascular diseases and all the various heart complications and premature deaths due to heart attacks. You would see the end of diet related type 2 diabetes. You would see a much healthier and more productive population. You would see seniors in their 70s and 80s in good health, capable of carrying on on their own, instead of having to pay the cost of nursing homes or other assisted living solutions.
Prevention will not eliminate disease; but it will reduce it
Of course, there will still be diseases, and cancer and trauma victims due to car or industrial accidents and what not. Good diet and exercise alone will not immunize everybody from everything. Of course, America would continue to need highly trained doctors and surgeons. But the demand for medical services would be drastically diminished, because overall people would be much healthier, due to life time choices regarding nutrition, prevention and exercise.
Give people a choice, and most likely they will opt for a healthy life style
And this is not about forcing people into any regime that they would rather not follow, citing individual freedom of choice. This is about teaching, in most cases for the first time ever, that good diet and exercise are among the best possible medications people can get. While there will be exceptions, most people, if given a choice, would prefer a healthy diet rather than the high probability of needing coronary bypass surgery or worse down the line. What is more appealing, a good diet, or dealing with the consequences of type two diabetes? Is it better to drink 4 or 5 sugary sodas a day along with junk food and become obese, or drink green tea and have a better shot at a healthy and long life?
War against tobacco was a success
Years ago, the US Government went out of its way to do battle against the tobacco companies and their disingenuous claims that tobacco is really neither harmful nor addictive. The heroic effort undertaken by policy makers was aimed at reducing the health impact of cigarette smoking. And it worked.
So, let’s follow that example. Given a new national consensus on the basic notion that it is better to learn how to stay healthy than to spend time and resources to treat preventable disease after it has occurred, we should be able to redefine the function of health care. We would move away from a heavy emphasis on treatment to focus instead on prevention and wellness education.
I am sure that most people, once they have the appropriate information in their hands, will make the right choices. This would make Americans healthy, happier and much better off, because, if we take all savings together, we would spare at least 7 or 8% of GDP. This is roughly what we pay now for treatments that will become unnecessary.
Let’s change the focus: from treatment to prevention
The current US health care debate is still tackling the issue from the wrong end: “Given sky high costs, let’s make sure that everybody is covered and that we agree on who pays what”.
Instead, let’s turn this around. “On account of good prevention, our demand for health care services is drastically reduced, our aggregate costs are down, insurance costs less and therefore insurance affordability and coverage expansion are non issues”. As you can see, good health has also significant economic benefits, for each person and for society.