Twenty years ago, in order to keep presidential candidate Bill Clinton's campaign on message, James Carville hung a sign in their "war room" that read:
- Change vs. more of the same
- The economy, stupid
- Don't forget health care
While point number two swiftly entered the national vernacular, the other two slogans have equally influenced the U.S. political landscape, especially since 2008. Four years ago, the country was on the precipice of transformation. Meaningful change was promised, and opportunities for significant, long-lasting reforms were abundant. Americans, particularly the millennial generation, turned out in record numbers to vote, and hope for the future was palpable. America, like a patient suffering from a debilitating chronic disease, seemed finally ready to put in the time and do the hard work to get healthy before that fatal heart attack occurred. After decades of procrastination, we heeded Carville and health care system overhaul became a top priority.
Pause: The State of America's Health
Obesity prevalence increased 137 percent over 20 years, from 11.6 percent to 27.5 percent of the population. In 2008, more than one-third of children and adolescents were overweight or obese. The medical care costs of obesity in the U.S. totaled about $147 billion in 2008 dollars.
Diabetes has almost doubled in prevalence since 1996, rising from 4.4 percent to 8.7 percent of the adult population. For children, the prevalence of Type 2 diabetes increased 21 percent from 2001-2009, while Type 1 diabetes rose 23 percent. Estimated total diabetes costs in the U.S. were $174 billion in 2007.
Asthma diagnoses grew by 4.3 million from 2001 to 2009, and 9.4 percent of children currently have asthma. Asthma costs in the U.S. grew from about $53 billion in 2002 to about $56 billion in 2007.
Developmental Disabilities prevalence increased 17.1 percent over the last 12 years. The prevalence of autism increased 289.5 percent, and the prevalence of ADHD increased 33 percent. Autism alone is estimated to cost the U.S. $137 billion per year.
Early in 2009, shortly after the inauguration, the Institute of Medicine convened the first-ever Summit on Integrative Medicine and the Health of the Public in Washington, D.C. I remember this time so clearly. As a vocal advocate of Integrative Medicine (IM) as the solution to our country's health care woes, I shared legendary IM journalist John Weeks' enthusiasm. "The week of Feb. 23, 2009 is promising to be the most significant policy week in the history of complementary, alternative and particularly integrative medicine," Weeks declared. More than 600 scientists, academic leaders, policy experts, health practitioners, and advocates gathered to debate IM's potential to improve the health of our nation. A core belief among contributors to the IOM gathering was that IM "could shift the focus of the health care system toward efficient, evidence-based practice, prevention, wellness, and patient-centered care, creating a more personalized, predictive, and participatory health care experience." Finally, here was a way to simultaneously create a more cost-effective healthcare system and a healthier America.
Scrrreeeech. Not so fast. What happened in three short years since this peak of optimism? Sadly, though not surprisingly, typical American political process happened. Despite the bipartisan understanding that this type of vast overhaul would take time and effort, partisan (read: special interest) bickering set in faster than vultures to a feast. Americans became disillusioned, tired of the politicization of what should and could have been a defining moment for our nation. What has barely survived this period of retreat is the somehow both bloated and watered-down Affordable Care Act (ACA). It's like the morbidly obese patient who is in reality, on the inside, malnourished. Once a beacon of hope that would lead to long-term, sustainable transformation, the ACA has become, through cynicism and well-paid lobbying efforts, a bit of a mish-mash of promising concepts (financial incentives for outcomes-oriented coordinated care like the patient-centered medical home) and more of the same (continued reliance for the most part on inefficient fee-for-service/more-care-is-better-care payment systems). We need an ACA that, yes, improves access to quality care, but the system must rely on incentives that encourage true preventive care and nurture a national wellness ethic. It is evident that a prevention-first approach that emphasizes nutrition, fitness, and mind-body-spirit health is not only scientifically valid but also makes strong economic sense.
"We are currently experiencing a perfect storm where economic, scientific, and moral imperatives are all colliding and increasingly they are aligning around one very powerful, integrated solution. This provides an opportunity for us as a nation to do well by doing good -- through fundamentally changing the way we think about health, money, and politics illuminating the often invisible forces that are putting our health and our nation at risk." -- Dr. Mark Hyman, Chairman of the Institute for Functional Medicine
The real problem is that the big dollar incentives don't line up. The folks with the most skin in the game (insurance and pharmaceutical companies, hospitals and large medical associations) profit dearly from the status quo. More care equals more money. Providing incentives to create an actual health system, one that values staying well and limiting chronic illness, would mean taking money and control away from the major players. But for it to materialize, we as a society will need to push hard for serious changes. And, frankly, I am not sure most Americans really want this kind of change.
Wait, you say. Why wouldn't everyone want a renewed focus on health and wellness instead of a high-priced disease-treatment system in which people are actually sicker than ever before? Because America is the land of what-have-you-done-for-me-lately. Fix it now and deal with the consequences later. That is the way our political and economic systems have functioned for a very long time. Unfortunately, our health care system has evolved in parallel process.
Question: how many people would rather take pills for high cholesterol, sugar, and blood pressure rather than deal with the hard work of addressing their nutritional and fitness needs?
Answer: Just look at the increased U.S. drug expenditures over time. In 2008, spending for prescription drugs was $234 billion, more than double what was spent 10 years prior. A side effect of this incredible rise in prescriptions? Each year, adverse drug reactions lead to approximately 700,000 ER visits, 120,000 hospitalizations and $3.5 billion spent on extra, related medical costs. High-tech diagnostic tests and the most expensive latest-greatest medications are sometimes the right answer for acute, urgent problems. The problem is that the major health issues our country now faces are chronic, complex issues resistant to simple, one-ill/one-pill solutions.
Are we, America, ready to make the hard choices? Are we ready, willing and able to challenge the long-entrenched power brokers that absolutely will fight to the bitter end against this change? Because change -- real change -- does not come quickly or easily. We're going to have to drop our "Veruca Salt" attitudes and dig in for the long haul. We are dealing with really complex issues that have taken a very long time to develop and will take a very long time to solve. It's no different than the 60-year-old obese diabetic with high blood pressure and asthma who needs help now but you know he's not going to get well overnight. He needs time -- time to develop good eating habits, time to move from couch to 5K, time to get his mind right by starting that yoga practice. We're talking about complex challenges that require innovative, interdisciplinary complex solutions -- and there is no quick fix.
As we approach a new presidential election, I remain cautiously hopeful. I see signs in my medical practice that more and more families are wholly committed to raising healthier children and building healthier communities. I want to believe, Fox Mulder, so I'm willing to listen to Matthew Heineman, a fellow optimist and Director/Producer of ESCAPE FIRE: The Fight to Rescue American Healthcare:
"The cards are currently stacked in favor of the status quo, fix-it-now approach, with powerful business interests pushing for more high-tech, costly tests and treatments rather than promoting lifestyle changes that could prevent many chronic diseases in the first place. We have a disease-care system not a true healthcare system. But I'm optimistic that there are solutions that will favor prevention and patient-centered care. There are leaders in medicine, business, government and the military who are supporting change within the system in ways that empower individuals to lead healthier lives. We are all in this together, and it will take commitment by all of us to create a sustainable healthcare system for the 21st century."
So I ask you, again, America: Are we really ready to see this process through? Because that is how we're going to actually make a change that I can believe in.
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