Americans spent $2.7 trillion on healthcare in 2011. Each year, we spend about $300 billion on pharmaceuticals. Yet 65% of Americans are overweight. Preventable, chronic disease persists. U.S. life expectancy ranks 50th among developed nations. Why?
“We have a very profitable disease care system,” says Shannon Brownlee, medical journalist. “It doesn’t want you to die and it doesn’t want you to get well. It just wants you to keep coming back for your care of your chronic disease.”
Healing the system
“Healthcare reform was a good place to start,” says Dr. Andrew Weil, director of the Arizona Center for Integrative Medicine. “But it will do little to address the root problems. We don’t have a healthcare system in this country. We have a disease management system.”
Doctors focus on “getting rid of the bad,” Weil explains. “We do nothing about supporting the good, that the body can and wants to be healthy. Both of these approaches are necessary. But, it would be great if we had a better balance in Western medicine.”
Nutrition “is almost omitted from medical education,” Weil notes. He created a fellowship program to train doctors in prevention, nutrition and healthy lifestyles.
“When medicine became a business, we lost our moral compass,” says Dr. Steven Nissen, Chairman of Cardiovascular Medicine at the Cleveland Clinic. “We don’t have to spend ourselves into poverty on healthcare. We just have to do it differently.”
“We need to change the nature of medicine,” says Weil. “A great deal of what’s done in conventional medicine is to put band aids on things,” he explains. “It’s much better to try to work at a deeper level.”
Costly, high-tech medical interventions, including pharmaceuticals, increase the cost of care. Weil wants doctors to transform the mindset that “drugs are the only legitimate way to treat disease.”
Only New Zealand and the U.S. allow pharmaceutical advertising. “It drives demand,” says Nissen.
Healthy lifestyles empower patients
“Our bodies have a remarkable capacity to begin healing themselves, and these chronic diseases can not only be prevented but even be reversed, and much more quickly than we once realized,” says Dr. Dean Ornish, founder and president of the Preventive Medicine Research Institute and creator of The Ornish Spectrum.
“Lifestyle changes can not only work as well as drugs and surgery, but often even better at a fraction of the costs and the only side effects are good ones,” Ornish continues. He found that heart disease is reversible. In other research, men with early-stage prostate cancer experienced lower PSA levels and were less likely to require treatment.
When patients adopt healthy habits, “over 500 genes were changed and in fact, turning on the genes that prevent disease and turning off the genes that promote breast cancer, prostate cancer and colon cancer,” Ornish says.
Change what makes sense
“If we can change reimbursement, it’s a game changer,” Ornish says. “We change medical practice and we change medical education.” In 2010, Medicare announced it will reimburse Ornish’s heart disease lifestyle program. Insurance companies will follow Medicare’s lead, he believes. “If everyone covers it, it becomes the standard of care.”
“Fee-for-service rewards physicians for doing more. It doesn’t reward them for keeping their patients healthy,” Brownlee observes. Other developed nations spend $3,000 per person on healthcare. America spends $8,000.
If doctors were reimbursed for health outcomes, we’d be healthier as individuals and as a nation, says Dr. Don Berwick, head of Medicare and Medicaid from 2010 to 2011. “I don’t blame anybody. They’re just doing what makes sense. We need to change what makes sense.”
Finding success stories
Cleveland Clinic physicians pay themselves a salary, says Dr. Toby Cosgrove, CEO. Remaining profits are invested into growing the organization. “The decision on what we do for a patient is dependent upon what the patient needs, not on our financial incentives.”
The result? “The actual cost for care here is among the lowest in the country and yet the outcomes, the survival rates are at the highest levels,” says Nissen.
All about the Benjamins
The insurance industry won when Healthcare Reform passed in 2010, says Wendell Potter, former director of communications for CIGNA. First, there is a mandate that we buy their coverage. Second, there is no public option because “they didn’t want to have a new competitor.”
Several consumer protections passed. “The insurance industry’s objective is to try to weaken those consumer protections over time and to try to influence how the law is being implemented,” Potter notes.
“We have to make it easier and more affordable for people to make better lifestyle choices,” Weil notes. “We have made all of this unhealthy food the cheapest and most available food.”
“The Department of Agriculture subsidizes all the wrong foods,” Brownlee explains. “We subsidize corn, sugar, wheat. We don’t subsidize carrots, celery, apples.” Food lobbyists prevail in Washington. “The money is funneled towards Congress and Congress doesn’t want to fix it,” she asserts.
Ornish’s next goal? Conquer diabetes. “Half of all Americans will be diabetic or pre-diabetic in the next 10 years,” he says. “If we can prevent that and even reverse it, that’s how we’re going to make true health care, not just sick care.”
Dr. Erin Martin, a Fellow in Dr. Weil’s program, wants to “act more as a guide for patients, taking the time to educate them and having them understand that there are choices that they have the power to make for themselves. Patients really respond to that.”
Seeking “escape fires”
Berwick tells the story of Wag Dodge, a smoke jumper who fought a 1949 forest fire in Mann Gulch, Montana. Flames began to overtake his team.
With a lit match, Dodge started a fire around his feet. It spread to create a safety zone where he could take shelter. He urged the others to join him. Instead they tried to outrun the fire. Thirteen men died that day as 3,200 acres burned. Wag Dodge escaped virtually unharmed.
“That’s how embedded people get in the status quo,” notes Berwick. “They can’t recognize an invention when it’s among them, and they can’t give up their old habits.”
Grassroots drives healthy change
Escape Fire looks at institutional change (in the military and corporations) but misses the grassroots. Millions are eating vegetable-based diets, exercising, practicing meditation and yoga, and receiving mind-body therapies. Outside a broken system, health and wellness are on the rise. That too drives demand.
To promote wellness and improve your own health, visit the Escape Fire First Aid Kit.