The Next, Even BIGGER, Bubble!

The Next, Even Bigger, Bubble!

The monumental problems facing our health care system have many ominous similarities to the problems that precipitated the collapse of the housing bubble, and ultimately our banking system. This is another obvious bubble about to burst. (A bubble by definition is an artificial inflation based on spending money we don’t have.) 

Frighteningly, no appropriate steps are being taken to avert disaster. In fact, the only step alluded to, creating a unified payer, may only ensure our demise by sacrificing our long-term interests (our health) for potential short-term financial gains.

We need to recognize that this is not a health CARE crisis. It is NOT a crisis of access to, or costs of, care. It is a true HEALTH crisis; a sad indictment of the state of America’s health. 

Each year more and more Americans are getting sick and dying from the chronic degenerative diseases of obesity, stroke, cancer and heart disease. These diseases result from decades of bad lifestyle choices and toxic environmental exposures. 

What drugs, diagnostic tests or surgeries can fix that? 

What amount of money, no matter how large or who pays, can fix that? 

Moreover, does anyone really believe that if we all had unlimited access to free, after-the-fact disease care we would be any healthier? 

While the symptoms of these diseases are widely treated with drugs and surgery, the diseases themselves are not curable and most of what is done, most of the time, does nothing to alter either the progressive nature of the illness, or the course of the disease towards death. That is why patients have lifetime prescriptions for blood pressure, cholesterol, diabetes, etc, medications, and why they have more and more invasive procedures (angioplasty, stents, bypass, etc), over time, until they die; a protracted death at costs that we can no longer afford. 

As I recently told Massachusetts State Senator Ben Downing, it frightens me to think that our State, which has instituted ‘health care reform’ by mandating health insurance and drug coverage for all residents, may actually believe they have solved the health crisis. Even more frightening is that this is being looked at, and considered, as a model solution for the nation. 

The reform mandate only deals with the symptoms of access and costs.

As more and more people access the system, due to increased rates of disease and increased unemployment, the costs will only skyrocket, and the reform, as such, is doomed to fail. 

Indeed, it already is. It is being called ‘The New Big Dig.’ 

“While pledging universal coverage is easy, the harder problem is paying for it. This year's appropriation for Commonwealth Care was $472 million, but officials have asked for an add-on that will bring it to $625 million. For 2009, Governor Deval Patrick requested $869 million but has already conceded that even that huge figure is too low. Over the coming decade, the expected overruns float in as much as $4 billion over budget.” 

No amount of money can fix this problem!!         

While largely incurable with drugs and surgery, the chronic degenerative diseases are, for the most part, preventable and reversable through lifetime, lifestyle changes. This is where we, as a society, need to focus our efforts. 

To get there we first have to let go of the false notion that medicine can save us from ourselves and from the enormous and powerful corporate influences on our eating and pill-popping habits.

 

This is a huge societal issue that demands bold legislated public policy initiatives to avert disaster; policies that assist and guide us towards better lifestyle choices and demand more corporate responsibility and accountability.  

We need nothing less than the creation of a cultural paradigm shift towards prevention through improved health and wellness and away from policies and medical care models that only diagnose and treat disease.

Health:The Crititcal Piece of Reform

Health: The Critical Piece of Reform

Couldn't agree more that prevention needs to be a vital part of health systems. If you have a suggestion for which health system has succeeded best with it, would love to see it. But the VA and Kaiser systems have done a far better job on promoting health of its members than others. Haven't seen any that do it spectacularly well...   Atul Gawande, MD

 Dr. Gawande:

Thank you for your considered response to my blog article: No, You Can’t Get There From Here.

However, disease prevention and the promotion of health will never come from care-based delivery systems whose financial viability depends on diagnosing and treating disease.

In fact, even if they did, their primary tactic of patient education just does not work. Almost all, if not all, people know that smoking is bad for their health, that unprotected sex may result in AIDS, that diet and lack of exercise cause obesity, diabetes and heart disease and death. Yet, sadly, it does not change the behavior of most.

We live in a contradictory world, where the scientific evidence is convincing but the corporate influence (advertising, product placement, lobbying, etc.) is overwhelming.

Historically, most of the major advances in population health came from public health policy initiatives such as improved sanitation, plumbing, smoking bans, seatbelt laws, etc., and not from medical disease ‘cures.’  To believe otherwise now, to discuss national health plans and unified payers or, what should most accurately be called Health Care Finance Reform, as the fix to this pandemic health crisis is both misguided and dangerous. It is treating the symptom and not the cause.

I agree that we need to address the symptoms of costs and access, and I look forward to the inception of national health insurance that includes wellness care and incentives to promote subscribers’ health.

However, the reason I write is to urge you, and other people of influence, to change the dialogue from health care finance reform to public policy discussions to dramatically alter the course of this deadly health crisis.

Much like the pressures brought to bear on the auto industry to make cars safer, we need to exert similar pressures, enact legislation and add taxes (among other measures) to limit access to, and availability of, cigarettes, alcohol, junk food and fast food restaurants; pushing people towards healthier choices.

There are many simple steps that can be taken. As Michael Pollan and others have suggested, the government can subsidize and redefine real and healthy foods. Non-foods would be taxed; at one and the same time creating a subtle awareness of food choices,  financial incentives to buy healthier foods, and tax revenue to support other health initiatives.

We need to limit, or outright ban, political lobbying by pharmaceutical companies. We need to immediately ban direct to consumer advertising of drugs and the associated disease mongering.

There is so much we can do if we stay focused on the right goals.

Thank you again for your time.

Peter D. May, DC CCWP