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Few people disagree that the U.S. healthcare system is broken. What's a lot less clear is how to fix it. Last week we began our series on healthcare reform by exploring the disparities between healthcare costs and outcomes. This week we're taking another stab at the huge issue by asking: what role does keeping people healthy have in the future of healthcare?
Smoking cessation, weight loss, diabetes education and nutrition programs: do these things actually have a place in the reform lawmakers are working on? Health Promotion Advocates say yes. And they're working hard to lobby Congress to say the same.
Meanwhile in Oregon, lawmakers just passed a bill to create a new state agency to coordinate healthcare reform efforts here. What role will health promotion and disease prevention have in their planning? What exactly does health promotion mean? And what programs actually work?
Are you involved in a public health effort to promote healthy living? Have you participated in such a program? What role do you think health promotion has in the future of healthcare reform?
Guests:
- Dr. Bruce Goldberg: Director, Department of Human Services and the Oregon Health Authority
- Michael O’Donnell: Chairman, Health Promotion Advocates
- David Rebanal: Program Manager, NW Health Foundation
- John McConnell: Health Economist, Oregon Health and Science University
Photo credit: Pink Sherbet/ Flickr /Creative Commons
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The market can be a beautiful and cruel mistress. I can't afford to get sick, so I really have watch what I eat and drink. I also keep very physically active and do my best to stay in shape. I'm 57, female, and self employed. My premiums are 300 dollars a month higher than my house payment, and my deductable is three thousand dollars. That's just for 50% coverage. I have to hit eight thousand dollars to get full coverage. I feel that I should get a discount on my insurance because I take good care of myself.
I wish that we had a system like the French in that there is a drugstore on every corner. When you get sick with something simple like oh say, a sprain or minor infection, you go to the pharmacy first for basic care. I find it stupid and wasteful that I have to spend 150 bucks just to see my doc to have her call in a simple antibiotic to the pharmacy. We really need a whole bunch of Nurse practitioners or highly trained pharmacists to free up the doctors to do the major stuff.
So much of the discussion about health care discussion assumes that most of us have employer provided insurance. One of the faster growing sectors of the economy is the self employed and small businesses. We really have to pay through the nose compared to the employed who have group rates. The cost of health care is killing me and all I can do is pray that I can continue to meet my constantly rising premiums until I'm 65. I live in fear that I'll lose my insurance for any reason because at my age no one will insure me at any price.
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Prevention is the future. Dean Ornish, MD is working with Pres. Obama to get preventative medicine covered by insurance companies in hope that MD's will start to prescribe interventions such as lifestyle change programs the same way they prescribe drugs or surgery. In Oregon www.wsheart.com has applied Dr. Ornish's research and created a revoluntionary program that is ahead of its time.
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Americans spend vast sums on health care for the simple reason that as a population, we are terribly unhealthy. Independent science shows the principle cause of the chronic diseases that afflict us, is the food on our fork. We know this. But what people believe about eating healthy is simply to eat a little less of those foods that are killing us with artery disease and obesity. It is time for the public message to be changed from telling people to eat a little less bad food to one of educating us to the best health promoting diet and lifestyle that science has found. Of course, most people would not make the necessary changes, just as few quit smoking when the danger was first revealed. But over time, when given honest scientific based dietary advice, uncorrupted by the food industry or the medical business, people will begin to choose a healthier path. It is not simply adding more fruits and vegetables, and whole grains to an unhealthy diet. A health promoting diet is based on whole, unprocessed plant foods (starches) like whole grains, beans, potatoes and others with the addition of fruits and vegetables and with no added oils. It is that simple. References may be found at www.drmcdougall.com. We are being killed by our addiction to a diet based on animal sourced foods, laden with fat, oil, and sugar, and it is stealing away our health. Eating a health promoting diet and getting a little exercise will do wonders to lower our need for the health care business.
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(My first attempt at posting went awry)
Albert Einstein said: "We can't solve problems by using the same kind of thinking we used when we created them."
Folks: The 'elephant in the living room' is this: We have incorrectly defined the term/word "health". Currently we, in the USA, default to the WHO's definition for health which basically says that health is two things:
1- when you are not sick...and
2- when you feel, more or less, well
This is a poor definition for numerous reasons that I will not go into. Our whole health care paradigm (even so-called health promotion) is based on this erroneous definition. And remember, you can NOT fix a broken paradigm.
Each day in my office as a wellness-based chiropractor in a quiet suburb we engage in true health promotion using the following concise and holistic definition:
'Health is one's level of function from the cellular level to the social level.' Once you get the definition correct, then you have a precise and clear target to aim at. Also, many of the conventionally-popular health care interventions begin to look non-sensical.
If by some miracle of rational thinking (at the policy-making level) we were to broadly adopt this definition, we would immediately be half-way to solving our "health crisis" (not health care crisis). A crisis that is truly the greatest threat to our nation's autonomy and very existence.
Cheers.
John J. Collins, DC CCSP
www.springbrookclinic.com
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Health care reform has little to do with insurance and much more to do with individual health behaviors as well as a consistent place where an individual and family can receive care which is preventive, curative of illness and supportive of good health. Health promotion can be very simple, regular excercise, good diet and adequate rest. Combined with avoiding addictive or dangerous substances including alcohol and nicotine, those strategies will signifcantly decrease our reliance on expensive illness focused care and also reduce costs.
Health care providers - nurses, nurse practitioners, physicians,physical therapists and others must focus on assisting individuals to maintain or achieve the highest health status possibl rather than perpetuating the reliance on drugs and procedures.
I believe that each of us must understand that when we contribute to our own poor health status, we affect everyone through higher costs of care, unavailability of time with providers and the lack of resources devoted to prevention and health promotion.
Registered Nurse
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Recognize naturopathic physicians for the primary care physicians they are. Instead of treating symptoms with chemicals, naturopaths treat the whole person with many natural therapies, with prevention at the forefront. They treat the root cause of illness. They have the same and many times more years of education as medical doctors have.
When medical doctors study drugs and surgery, naturopaths are studying nutrition and how to keep the immune system strong to keep illness away. Have naturopathic insurance available and affordable for everyone. This will bring total costs of healthcare down for the whole country. Right now we have a "disease" care system with medical care. We need across the board "healthcare", which naturopaths provide.
Doctors should be able to determine the time they need to see a patient, not the insurance company. Naturopathic appointments are typically 45 min. to 1 hour long. When only the "branch" of our tree is treated with chemicals, the illness continues down underneath, unless the "root" cause is addressed.
The first Hippocratic principle all doctors learn, is "First do no harm." This becomes hard to understand when chemical medications typically block or interfere with some known (or unknown) bodily process . Then you have to take another chemical to counter what the side effects from the first chemical is doing!
The future of medicine lies in understanding the therapeutic use of lifestyle; nutrition, exercise, mind-body therapies and supplementation to restore normal function. The future is not in newer and better chemical pharmaceuticals!
Char - Vancouver, WA
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My biggest issue is that HEALTH care should not be an insurance issue at all. Insurance is (or should be) for the treatment of catastrophic and unexpected issues. This is illness or injury care.
HEALTH care is about day to day and year to year, regular, planned behaviors and treatments. And I don't see a good solution to our problems until health care is decoupled from illness/injury care and considered one of the regular costs of a good life, whether we pay for it personally or through our taxes.
Also, as a nation, we need to start thinking of HEALTH as a personal/life issue, not something job related. As an uninsured person, I have a little secret for you, I can still see my doctor, I just have to pay for the visit, the same way I would pay for my car, furnace, or roof to be checked and maintained. When I can afford it, I will reestablish my high deductable insurance for catastrophic care.
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"Also, as a nation, we need to start thinking of HEALTH as a personal/life issue, not something job related. As an uninsured person, I have a little secret for you, I can still see my doctor, I just have to pay for the visit, the same way I would pay for my car, furnace, or roof to be checked and maintained. When I can afford it, I will reestablish my high deductable insurance for catastrophic care."
We do not need to start thinking that way. We always have. We need to do exactly the opposite.
The best example I can think of is from my profession. A typical sleep study costs somewhere on the order of $2,000. A CPAP machine costs about $500, and CPAP masks can cost about $100 every six months. A lot of people end up on CPAP in their 40's - 50's. If they live another 40 years to their 80's - 90's, the total cost is: $10,500.
Given the vast amount of data indicating that bad sleep health can lead to a number of major health problems (including heart problems, diabetes, etc.) and the fact that bad sleep health is usually combined with obesity, you can see that $10,500 is extremely cheap compared to treating sleep health as a personal problem and paying out when they have major health problems.
Granted this cost would go up if you include the costs to counsel people to lose weight instead of relying solely on CPAP, but the costs will never come anywhere near the costs of major surgery and dialysis.
If you do not buy the logic, just ask an insurance company. They are more than willing to pay out for sleep studies and CPAP equipment because they know it will cost them much much less in the long run.
Unfortunately, they are very narrow-minded and do not apply this logic across the board and promote overall health improvement.
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A lot of people end up on CPAP in their 40's - 50's. If they live another 40 years to their 80's - 90's, the total cost is: $10,500
So, I'm not sure what you are saying here. That people want/need something that they cannot afford so someone else should pay? That is socialized medicine, which would be fine with me
To me, this is wellness care and should not be a part of the insurance industry
Besides, based on the current rate people are listing for insurance, if you are paying $300 a month, you have paid that much to the insurance company in about 3 years. If you live from 45 to, say 85 and pay $300 a month for health insurance (assuming it doesn't go up) you will have given the insurance company $144,000. It only SEEMS to work if your company pays your premium so you don't see how much money is being spent. How will you feel when this cost drops directly onto you because your company cannot afford it any more? Or they let YOU go because the insurance company wants to streamline the policy and you are an outstanding expense for them?
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It will be extremely difficult for our healthcare system to be truly preventative in its current form. There is a huge misalignment of incentives that keeps it from directing money towards prevention. Hospitals and practitioners do not make money when people are well, except in a capitated system such as Kaiser. They only make money when people are sick, so they direct their resources towards diagnosing and treating disease, rather than promoting health.
Although I recognize that the government is not always the most efficient, we need a single payer system that focuses on evidence-based prevention strategies and includes alternative care. Only in a single payer system will the incentive be to prevent disease and promote health. If all the money goes into one pot, and practitioners are salaried employees, there won't be the incentive to focus on disease and procedures.
Jack
RN
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The government, FDA, needs to get out of the recommendation business. If you actually eat like the newest food pyramid suggests you’ll end up looking like a pyramid! There are too many carbohydrates at the top.
If you were cynical you’d think the recommendation were designed by those who treat obesity associated diseases - to create those diseases! OR, perhaps it’s the Feds way of dealing with multi-trillion non-funded promises of Social Security, Medicare and Medicaid. People are going to die early and it’s going to look like natural causes. It’s their own fault for being obese not the governments that recommend people eat like cows being fatten for slaughter. The FDA has no accountability for it’s bad recommendations and mistakes.
The FDA is controlled by the food and drug business interest not by what’s in the public interest.
Who in government has the credibility and incentive to really give sound preventive advice? Spare me. -
As a naturopathic doctor and primary care physician, I focus every day on the foundations of health. As many comments have noted, we need more of a focus on these foundations or lifestyle factors such as diet, exercise and nutrition. My training as naturopathic doctor gives me such a wonderful background and set of therapeutic tools to address prevention and health. Prevention isn't just about checking blood sugar levels every year to see if you are on their way to becoming diabetic. Prevention is about learning how to structure your life around stabilizing blood sugar in the first place with exercise, a balanced diet, adequate/quality sleep, and when needed some herbs or medications to help your body find homeostasis. Naturopathic doctors have the time and the training to focus on prevention in this way. We also know when it is time to use good quality herbs as well as when we move on to using medications.
When I do have the opportunity to work with other MDs, NDs, RNs etc, our patients thrive. Patients are able to find natural ways to treat many of their health issues with a naturopath, yet still go see their surgeon or dermatologist when needed. Why not capitalize on this type of relationship?
Healthcare should encompass as many avenues as possible toward wellness including massage therapy, acupuncture, chiropractic care and naturopathic medicine. Don't just make these options an afterthought for when medications and surgery aren't working. It is more cost-effective to utilize these professions before jumping into surgery or lifelong medications, which often will not be needed. If you have an issue or doubt about these types of care, ask me about my patients. Look into my education. Attend one of my anatomy classes. Ask your friends who have seen other healthcare professionals. Become a patient yourself. It is time for us to be open-minded and holistic-minded if we want health care in this country to help people and be cost-effective.
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"Open-minded"---there are many open-minded people who don't see the empirical evidence that "massage therapy, acupuncture, chiropractic care and naturopathic medicine" do much to help anyone. As a matter of fact they may do harm. Such as the time my mother fell at work and went to a chiropractor who kept adjusting her with out taking an X-ray until she was in so much pain and couldn't walk---she had actually fractured her hip, which was then fully broken by the chiropractor and she ended up at Good Sam for a hip replacement.
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Unfortunately all professions in healthcare (and otherwise) have individuals who veer dangerously off the path of good judgement. I am truly sorry that your mother was a victim of this. I could list many examples of other healthcare providers who have made even fatal errors, but would not limit these mistakes to any one profession (ie the surgeon who removed the wrong cancer-ridden lung). On the other hand, I can recount twice as many happy patients who couldn't imagine life without their chiropractor (insert any profession here). One of my patients who had chronic low back pain without the option of pain medication or surgery would not be able to walk or interact with her family without her adjustments.
As far as those who "do not see the empirical evidence" in the professions listed, I can only speak for my own. There are too many references to list in terms of research into naturopathic therapies ranging from herbal medicine to specific nutrients, physical medicine, dietary options and even adjunctive cancer treament.
My point in the original post, was that people need options. If we already have an exhausted, overburdened and shrinking allopathic medical community (especially primary care physicians), it is time to consider opening the playing field to others who are qualified. I see a very clear way that naturopathic physicians can offset this problem.
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As a health care professional, I know that whatever type of health care reform is legislated, we will never lower costs if we don't place emphasis on PREVENTION. Why? so many illness are caused by our collective bad habits from overeating to staying out in the sun too long.
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I think President Obama's choice for Surgeon General is an excellent step in the right direction. Choosing a physician that is "in the trenches" so to speak, is an excellent idea. Dr. Regina Benjamin has first hand knowledge of the strain that the safety net clinics are under and how the front line of health care should be prevention and primary care.
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My employer promotes healthy living by providing exercise equipment, locker rooms, and healthy lunch choices. They see this as an investment in their employees. A healthy employee will be more alert, have lower stress, and miss fewer days. This is a medium size business but what are the large companies and the government doing for their employees to try and keep them healthier?
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Is Oregon moving toward a single payer public healthcare system, if so why and what does that look like?
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I really hope in health care the competition will be eliminated for good because providing health care to people should not be about making a profit. Everybody should be taxed for health care and health care should be provided to anyone who goes at the doctor. Everyone should pay for health care with no exceptions and everyone should be treated for any sickness with no exceptions. Medical insurance (as in "car insurance") should still be available and optional, there is where the private industry should be involved.
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Let me begin be stating I eat healthy and responsibly, because that is just who I am. However I have a real aversion to hearing over and over again from so many people about how terrible everyone's eating habits are, how repulsive fat people are, how they are all to blame. This moral superiority that often comes from many seemingly organic liberal friends is terribly tiresome.
Yes, it is fantastic if people run from Food Front to Whole Foods, and munch on Kashi bars while riding their bikes, but it doesn't inherently make them better people. Nor is there any evidence to suggest that the obese are just glutinous losers, like so many would like to believe. Our society is infested with many mental/social issues, being overweight is perhaps just one of them, that is an easier target then most. I would prefer to worry about the emotional, mental and cultural issues, because that is where the real problems lie. This picking on the obese is too easy and utterly unproductive.
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This won't be a popular idea. but a big part of the problem is that we put too much emphasis on individual responsibility. We don't look enough at how culture and social structures encourage, discourage, obstruct, constrain and enable individual choices.
Take fast food advertising. There is a commercial on t.v. for one chain now that literally is food porn -- a svelte young woman brags about how hot she is and how much she has to give up to wear the skimpy bikini, but she's not going to give up the sloppy, dripping, sexualized pound of meat hamburger she then bites into. Or the campaign of another chain to say we need a "Fourth Meal."
Or take work discipline. I know of employers that encourage voluntary "wellness" walking on lunch breaks. I know of no employer who defines it as part of the job that they pay for for employees to get up and walk 20 minutes on the clock, though the health and mental health benefits would make them more productive workers in the long run.
There are many, many examples. It is not just about individual incentives, it is about changing the collective behavior of corporations and governments.
Chris Lowe
Master of Public Health graduate student, OHSU
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Chris - I totally agree with you. You can't make the individual completely responsible and allow big corporations to continue their aggressive advertising.
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Absolutely there should be health incentives. I quit smoking in 1982 (yeah, had to quit again in 1992, but never again), and started running daily. In 1987 I added weight training and cross training (swimming and biking). I'd been diagnosed briefly with pre-hypertension in 1983, but essentially was able to exercise my way out of it - until three years ago, when genetics interceded, but at least it is well controlled. I'm now 58, ran the Portland marathon in 2000, and participate in occasional sprint triathlons. I belong to a health club, and work out two hours every morning, and am extremely fit and healthy with the exception of the HBP.
An annual joke at the club to which I belong is how, every year like clockwork, there is an influx of typically obese and deconditioned people right after the first of the year; again, like clockwork, they mysteriously disappear within a month or month and a half, having accomplished nothing. Health club figures typically show that only about 1/3 of paying members use the facilities with any regularity - they make their profits off the huge numbers of people who pay but never show.... Given the amount of dues they are obviously wasting, the question becomes - what incentives would actually change their behavior?
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This is the problem I am currently facing. I am not quite obese, maybe 30-40 lbs overweight, but that is really what allows me to be lazy about it. I have hovered at 205-210 for years (@ 5'11"). I am not happy about it, but I am still young (30) and there is nothing about my health that says: "You must lose weight now."
In 10-20 years, there probably will be. I know this is fact, but just cannot motivate myself when there are some many more interesting, fun things to do.
I will admit, I was one of those people paying not to show up at a gym. I had excuses, the primary being that I arrived at work at 8:30AM and left at 6:30-7:00PM and had no interest in going to the gym.
Add to that the fact that I derive absolutely no pleasure from gym/home exercise. I love hiking and skiing, but absolutely cannot stand structured, repetitive exercise...let alone when it is in-doors. The problem is, hiking/skiing on the weekend is not enough.
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It is not just a matter of buying healthier foods, it is also a matter of knowing how to prepare them. It doesn't do much good to buy unprocessed foods if you don't know how to cook anything that doesn't come out of a box.
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My wife and many of our friends have been in the wellness and human performance 'industry' for many years, and we've learned a few things.
1) the medical profession is woefully unprepared and/or unwilling to tackle lifestyle issues head on. Lets face it - its tough to be the bad guy when you've been trained to be the good guy.
2) we are never going to turn our lifestyle related health crisis around until we call it what it is a) addiction, and 2) get serious about the 'change model.'
In most cases, the 'change model' requires either a personal crisis or a heavy social stigma to bring about a fundamental disruption to the reward system that reinforces so many of the addictions that plague this society. Until we begin to stigmatize over-consuption with taxes and/or penalties (a surcharge on insurance for anyone with more than 25% body fat, for instance), we know that people, as a group, will NOT alter their habits and addictions. Sad, but true...
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When the discussion comes to preventative care, it’s important to note that right in our own backyards, we have a wealth of resources: fresh gardens, community organizations speaking on behalf of our health concerns (the Archimedes Movement), education for patients founded upon basic preventive health models (the National College of Natural Medicine), and organizations researching the latest integrative forms of therapeutic approaches (the Helfgott Research Institute). All the while, each of these entities, leading the way towards a true definition of health; this definition is not only within our reach, but it’s worth the time to invest in medical models that get to the root of the dis-eases and work towards to an optimum –health- care system.
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What is going to make the religious turn non-religious?
We have bigger fish to fry as a society then whether people are eating whole grains, or slowly following Alice Waters around.
If people are unhealthy why do we care so much? What motivates this? Are we that worried about them? Is it the monetary impact? The aesthetic impact, of not wanting to look at the obese? Do we just think our way is superior and that important? I just don't understand the motivation. Because if people die, then they are simply dead and we don't have to deal with them anymore. Why do we have an obsession with making people allegedly healthy, to the point that we would actually consider legislating allegedly healthy behavior?
I just really don't believe that we actually want to make people healthy because we care about them so much---I don't buy it for a second.
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Because of the way the health system is structured: unhealthy people cost more, and the cost for their care is shifted onto insurance premiums and direct health costs that each of us pay - that's why an aspirin costs as much as $10.00 in a hospital. It is the same essential algorithm as with motorcyclists who refuse to wear helmets - when they suffer traumatic brain injuries, everybody else pays for their care.
Hospitals have to provide care to everyone- even people without insurance coverage, and those charges get passed on to the rest of us, as well.
Logically, if everyone were healthier, and had coverage, we would all pay less.
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WpeOpb, seconded...except about motorcyclists. I moved here from Florida where personal injury protection on auto insurance is required and health insurance premiums on motorcyclists are higher. Even in the case of an uninsured motorcyclist, the costs there are a small percent of the overall cost of the uninsured. Plus, motorcycle wrecks tend to be more deadly.
scottmil, it's not about caring about other individuals. It is about what is best for society as a whole. If health care costs come down and people are more healthy overall, standard of living goes up and there is more money free for things like education...which is better for everyone.
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WpeOpb,
Yes, I get and got that if people are unhealthy it costs us all more. But so what? If people die faster, then less people will be around to treat or pay for. So maybe we should encourage the most unhealthy behavior possible, so we can get rid of everyone---won't that save us the most money?
At any, non-sarcastic rate, health-care in the US is not expensive because people are unhealthy, that is a teensy part of the problem. It doesn't make any sense whatsoever that aspirin is $10 in the hospital because too many people are unhealthy---you could make a case it is because too many people don't have health insurance---which is the real problem. Weren't there some studies that suggest if everyone had health coverage, it would make people healthier because they wouldn't have to worry about not having access to care, and this stress relief itself makes people healthier---because it provides relief knowing they will be taken care of in old-age and now.
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I was interested in the comment by your guest that we should not criticise food companies. How can we ignore the vast amount of money that is spent on advertising to persuade us to buy products that may not be healthy choices? Advertising techniques play to our weaknesses and create demand that would not have been present otherwise.
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I agree that "medical homes" are vital to lowering health care costs and increasing postive outcomes. Med students spend hundreds of thousands of dollars on their education. This causes many of them to choose a specialty instead of going into primary care. Who will staff these medical homes? The general practitioner is already spread thin on time. How will these clinics be able to handle the influx? Will a 15 minute visit turn to 10 or five?
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I was having terrible weakness and a variety of odd symptoms including depression . Finally went to my Chiropractor, he did a kinesiology test for certain foods, when i took wheat out of my diet My life improved immensely. The best $4o i ever spent!
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If the supermodels were doing their job well, then we wouldn't have an obesity epidemic. I guess we don't have enough eating disorders because people want to look like supermodels. Perhaps we need more supermodels? Couldn't that be a component of the solution?
Being unhealthy is good for the environment, the faster people die, the less people around to such up the earth's resources.
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sorry, such=suck
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Raising standard of living also slows population growth without the total disregard for human life. Americans just barely reproduce enough to replace previous generations, and Germany would be shrinking without immigration.
Poorer countries have much higher growth rates despite horrible conditions and poor health care.
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slakr007,
Yes, but America isn't a poor country.
Yes, it would be great to raise the standard of living around the world, which would perhaps decrease population growth (though whether that would work in every culture is not guaranteed). Much of our world history is predicated on inequality, so if everything was equalized who knows what would happen and whether any previous patterns would be applicable. Anyway this doesn't have much to do with my point about letting people die in a rich country. Unless you are suggesting that good health in the USA will slow population growth---or I guess decrease it.
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Yeah, that was exactly my point. America isn't a poor country, but it does have poor elements. Not having kids is a luxury. My girlfriend of 10 years and I do not want kids, we make more than enough money to support ourselves without kids later in life, have access to birth control, and have many things to do with each other besides have sex.
The lower class has almost none of that going for them.
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slakr007,
I am thinking now that it follows from what you said that poor people in America have more kids (then other people), and they are apparently having more kids because they have nothing else to do. It might be hard to know. I suppose I hope you are right, because it would be easier if you are.
But, one has to wonder whether it could be a little chicken and egg. Like maybe they are poor because they have nothing to do (mentally). Then again the poor in America are not that poor. And, again there will always be people who are poor and people who are rich, no matter the standard of living. Religious people in the USA have a lot of kids too. Many poor countries are also very religious.
I guess my point is that maybe we should just focus on the tangible problem of health-care and make sure it is socialized. Then perhaps we could play it as it lays and see what happens---rather then all speaking from some alleged point of moral authority. I think a lot of people are beginning to sound a little too spiritual and moral for my tastes---and a little hokey too.
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No no, I'm not speaking from a position of moral authority. I kind of implied that by saying: "Raising standard of living also slows population growth without the total disregard for human life." That was just me fencing with you over a comment that I didn't really think you whole-heartedly believed.
I also listed a bunch of reasons why poor people generally have more kids. It's not just because they don't have anything else to do. But, if I had nothing else in my life, sex (and drugs, to heap another problem on to the pile) would definitely be a whole lot more attractive.
The question posed was: is health promotion the way to go? I think it is. You say: "let's make sure health-care is socialized." In order to do that, we are going to have to make sure we can afford it. And, as one of my posts below said using sleep studies as an example, health promotion and preventative medicine makes socialized medicine cheaper.
In the long run, it raises the standard of living to provide everyone with good (preventative) health care. It's not morality, it just is. And, the fact that a rise in standard of living can drastically reduce and even reverse population growth is a good thing.
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slakr007, (sorry this is so long)
An attempt to be upfront. I probably do realistically think that the world wouldn't miss much if 99% of the people died. I can't find any empirical evidence of what is so good about having 99% of these people around. So I think maybe I do believe my comment---but then again maybe the 1% will be part of the casualties.
Anyway back to reality: preventative health care is important as you said. It only makes sense to try and decrease risk. But risk is risk, and isn't always accurate or concrete. And, I have a problem with the motivation being monetary---if it is even monetary. Although, I actually think it is more along the lines of I am better then you are, and you should be like me---or you should pick yourself up by the bootstraps like I did. America is a place of victims and now the New Victim is pointing out how unintentionally someone else is victimizing me or all of us by their bad eating habits and obesity. Everyone wants a share of the victim pie.
Then we have to ask the question where do we stop with this prevention? If we can regulate eating can't we regulate sex? Gosh it wouldn't be hard to imagine going further and saying gay sex or sex in general leads to more HIV so lets restrict that too (I realize this is a stretch---but there is something similar conceptually that bothers me).
Anyway (once more) none of these preventative problems are the main problem with US health-care, it is the unregulated free market in a discipline that should not be free, it needs regulation, it needs socialization. We can pay for it, because we are paying for it now, or somebody is. Or are people just dieing willy-nilly without care. It is bound to be cheaper through socialization in the long run. I think this quest for personal responsibility is just a smoke-screen, a way to shift blame. Even if there is some truth in it, it isn't nearly important enough to focus on.
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You know, I think we agree...a lot. I think we are discussing on the edges. Which, I tend to do because I enjoy getting every last opinion out of people. I really enjoy getting to know how people think.
I actually agree that the world would probably be better off without 99% of us. But we are here, so what do we do? Personally, I want to live in the world of Arthur C. Clarke and move to the Moon or Mars...but yeah.
"It is bound to be cheaper through socialization in the long run."
I'm not sure about that. I am pretty sure even socialized nations are running into cost problems. It is hard to find objective evidence, but the most even-handed reports I can find show that Canada is running into cost and resource problems and Great Britain is considering private supplements to help with their cost problems.
"Then we have to ask the question where do we stop with this prevention?"
This is a straw man I see applied to government programs in general. The truth is, private health insurance companies (or private companies in general) attempt to regulate your life...and probably more so than the government ever would. When I had to get my own health insurance, the agent asked what hobbies I had. Stupidly, I answered honestly and said I am a private pilot. Thankfully, the agent said: "Oooooo, OK, we will leave that one off." The funny thing is, she never asked if I drove a car to meet her...far more dangerous activity.
The government does not have to meet quarterly profit expectations and has a much larger premium pool. I am pretty sure they will have little interest in strict regulation of our lives.
In fact, if you look at the current system, Medicare does not regulate your life and there is a great deal of law telling private insurance companies what they cannot regulate.
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"If we can regulate eating can't we regulate sex? Gosh it wouldn't be hard to imagine going further and saying gay sex or sex in general leads to more HIV so lets restrict that too (I realize this is a stretch---but there is something similar conceptually that bothers me)."
I'm glad you realize that is a stretch, but I understand your concern. I think if we made it through the last 8 years without banning gay sex, though, you are OK for a while.
I personally think there is a pretty well-defined line between structuring health care to help (rather than force) people live, what is pretty much universally agreed on through good research, better lives by focusing on weight control, better eating, active living, and preventative medicine vs. strictly controlling sex based on disease transmission. I think most people see that line, and I think we have enough historical precedent not to cross it.
Will we ever cross that line again? Maybe. But, I think, if we ever do, we will do it no matter what health care system we have.
"We can pay for it, because we are paying for it now, or somebody is."
That's kind of the point of the whole discussion. We are barely paying for it now. We will not be able to pay for it much longer.
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slakr007,
Rights! We have or should have a right to eat what we choose, perhaps not ethically but legally. Just as we should have a right to smoke or (as far as I am concerned) do drugs (which I do neither). Alcohol has health risks, will we restrict that consumption? Sun has health risks---will we ban people from tanning? (I hate sunny weather by-the-way---I like being pale). We can't give away rights just because the alternative is cheaper, which is essentially the result of what some people are asking we do. I don't support capital punishment, but should I because killing people could theoretically be cheaper. Cost-savings can't always be a motivator. We are on one-hand asking people to spend more to buy organic or buy local, but on the other telling them they need to do this and that because it will save us collectively on health-care. Who has a right to make these distinctions---particularly as a matter of law.
The distinction between gay sex and eating what you want is: being gay is not a choice and eating what you want is a choice. However sex itself is also a choice and perhaps more of a choice then eating what you want. So it would make sense to regulate sex and say unprotected sex is illegal, because statistically the health costs are too great (and not just for gay people).
I don't particularly think people are obese, because of some arbitrary choice to be glutinous---it is complex matter for which you can't place blame. If we have made alcoholism a disease, then certainly any weight issues are also a disease---but we probably don't see it that way because we think over-weight people have made some lame free-willy choice to be so, but yet with alcoholism they allegedly can't control themselves because of disease---this type of thought is on very shaky grounds. They are either both a disease or neither of them are a disease. I think unless we are willing to declare obesity (or any weight issues) a disease then we can't really treat or regulate it as a part of health-care.
We need to find ways to make health-care cheaper, I am certain it can be done, there is no conceptual reason why it should be so expensive. It only got this expensive because it is a necessity and the market has no regulation, and health-care inherently lacks a sense of market competition. Market competition is necessary for a free market to function somewhat effectively.
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So...we both agree social engineering is bad.
I am looking at this from the direction of funding primary care doctors to spend more time with you, get to know you, develop a relationship with you, provide consistency, give you options you might not know about, help you lose weight if you want to, put you in contact with nutritionists to help you eat better if you want, suggesting that you get a sleep study done to see if your chronic fatigue and depression is because of apnea, and providing family planning and sexual hygiene advice.
I guess I am not seeing where turning the system around to reward people for seeing primary physicians more often and rewarding physicians for taking primary positions instead of shooting for $300k/yr. surgery positions is trampling rights.
This is independent of whether it is single-payer or not, and that is an integral point. A single-payer or government system can be just as awful if it continues the trend of rewarding people for staying away from doctors and hospitals.
In the end, it is better for everyone, even for the people that choose to do whatever they want whenever they want.
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I think health promotion must be reflected by practical means such as universal health care, fed/state funding only organic agriculture and livestock, prohibiting air, water, industrial and energy pollution.
Only flavorful nutritional foods and drinks should provided in schools, along with ample time to eat, or schedules broken into multiple eating opportunities throughout the day. Culinary classes (teaching nutrition) can be taught as early as grade school. I liked the idea one caller mentioned regarding government programs such as food stamps incentivizing healthy foods.
I believe universal healthcare relieves detrimental stressors by allowing individuals and families to address problems early with the guidance of health professionals.
Pharmaceuticals and their side effects should be used in a highly discriminatory manner and regulated for lowest or non negative impact. Regulation for recreational drugs would ban such products as methamphetamine.
I think society/gov't can promote good health at the most basic levels while educating about lifestyle choices such as smoking and drinking.
Urban development should incorporate walking, running, and human energy-based travel.
This could all be great fun!
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Why do we as humans and systems change?
Until we explore answers to that question, massive programs, expenditures and policy on health care are premature.
I believe that what we're talking about at a core level is two kinds of change:
- Individual change in health promotion behaviors
- System change in accountability, reimbursement, incentives, disincentives, political decision making, equity etc
Research in weight loss and smoking cessation indicates an underwhelming success rate.
- Research in system wide change suggests it is daunting at best.
What's needed, from my perspective, is a disciplined, well funded, ethical inquiry and documentation of which change models work.
"What works over time?" and How do we define 'works'?
One predominant change theory is that "Until the cost/pain of not changing is perceived as greater than the perceived cost/pain of changing. . . we are unlikely to change." That model is interesting but inadequate.
Three of the most thoughtful, well considered and respected thought-action leaders on change are:
- Alfie Kohn, Punished by Rewards - The Trouble with Gold Stars, Incentive Plans, A's, Praised, and other Bribes"
- Robert Cialdini, "Influence the New Psychology of Modern Persuasion"
- Buy-Ology by Martin Lindstrom
Why not convene an "Oregon Why Change Thought Action Team" to noodle on these questions and create humane, practical and doable models for "sticky change".
Charles Maclean
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Big Brother thy name is "Health Care".
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I want to bring up and make clear the issue central to our health care problem, and that is money. Over the last 30 years or so, the focus in US health care has shifted from patient care to making money. There is little interest in preventative care because there is no money in healthy people. It is sick people who provide profits, particularly those afflicted with cancer, heart disease, and diabetes. These illnesses are huge money makers for hospital and drug industry. Why is the health care industry spending millions per day lobbying to send meaningful reform down to defeat?
Unless we get a strong national, affordable government plan, or a private not-for-profit plan, as an option to the commercial plans, forcing them to compete, we will make no progress. The Obama initiative will simply join the Clinton effort and business as usual will continue.
To address the ethics of the matter we should first ask ourselves these question, and answer them honestly:
Is it moral to profit hugely from the illnesses and medical care needs of our fellow citizens?
Why do Americans spend twice or more on medical care than any other industrialized nation, yet have poorer health, higher infant mortality, and shorter life spans?
Is the free market, or the profit motive, in fact always the best option? Or are there undertakings in the life of our communities and our nations that serve us better when done in common, that is, socially? We undertake fire protection, policing, and education in common, or socially. Why not health care? Is it not of equal importance to the common good?
And finally, though not directly related, yet absolutely pertinent, we should ask, and answer: For whose benefit is our Washington government working? The people at large or the big money special interests?
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Hello, Kristen Porterfield, WIC (Women Infants and Children) Certifier in Bend Oregon.
Getting back to basics. Encourage all new mothers to breastfeed their newborn babies. This alone will prevent a number of health care issues, nipping all of these concerns in the bud. Thanx for listening.
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Comments are now closed.
Keeping people healthy will be critical in the future of health care. Duh.
However, having never seen an x-ray of anyone that showed nothing wrong, I would suggest this:
We have a tremendous opportunity to mandate the use of our advanced diagnostic and investigative methods, equipment and protocols to establish a baseline profile for each of us while healthy. This would feed the statistical engines that must apparently be kept running for the endless publication of studies and their announcements of correlations between this behaviour and that malady. It would also give us an idea of what we look like when we’re healthy and provide a great reservoir of data to be studied and evaluated by health care professionals of all kinds. Then, when we are sick or injured and need to return to our traditional model of "study what’s gone wrong and fix it when it’s broke," we would have more to work with.
A full and comprehensive nothing-wrong diagnostic would also provide a glut of data for the proposed universal electronic medical records that we will soon have - want them or not. If we can have no assurance that these records will be handled appropriately, the least we can do is load them down with as much valid data as possible - even if we can't be sure it will ever be validated.