Much to Like. More to Come?

I am encouraged.

There was much to like in President Obama's Wednesday night health care reform speech to a joint session of Congress.

First, he promised to freeze out of the debate those who spew nonsense about death panels and similar claptrap. He thus exiled the bad-faith obstructionists to the outer darkness, where they belong.

Then, some necessary shaming: "Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy....We are the only advanced democracy on Earth - the only wealthy nation - that allows such hardships for millions of its people." Exactly right.

This was followed by the financial stakes. "Our health care problem is our deficit problem...nothing else even comes close." Spot on.

Finally, he laid out a system that would "build on what works, fix what does not, rather than build an entirely new system from scratch." Many are now focused on the president's ringing endorsement of a public medical insurance option: "If Americans can't find affordable coverage, we will provide you with a choice."

But as I have stated in my book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future, medical insurance reform of any kind is doomed without medical content reform. It doesn't matter if the insurance is provided by a private corporation, the federal government or any other entity. A health care system that costs $64,000 annually for a family of four in seven to nine years - as ours will, without radical change in medical practice - will quickly bankrupt taxpayers, policyholders, or whoever pays the premiums.

That's why a quick reference in the hour-long speech gets my most enthusiastic accolades. "We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average," the president said. He added that a special commission "can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system - everything from reducing hospital infection rates to encouraging better coordination between teams of doctors."


These weren't the most-well turned phrases and they garnered no applause, but to me, they were the vital heart of the speech. Everything the president proposed will fail, utterly, unless we transplant the "best practices" in the current system into medical facilities around the nation, too many of which are dysfunctional due to fear and greed.

To the two exemplary, physician-led medical systems cited by the president, I would add another valuable model: the clinical practices of integrative medicine, such as those we teach at the Arizona Center for Integrative Medicine at the University of Arizona in Tucson. The low-cost, high-return medicine we have developed there can form the backbone of a new, less costly, much more effective American medical system.

Now, would I have liked to hear more from President Obama? Absolutely. As I expected, when he mentioned specific medical content at all, he emphasized disease prevention via passive measures such as colonoscopies and mammograms rather than through lifestyle change and health promotion. I wish he had pledged to foster healthy living throughout our culture. For example, we must:
  • Reverse the perverse farm subsidies that make the worst calories in the supermarket the cheapest.
  • Reinstate the slashed school fitness programs that have contributed to the child obesity epidemic.
  • Create incentives and disincentives to encourage more Americans to make healthy lifestyle choices.

Health care reform that doesn't address these issues will produce limited benefits. That's why such reforms are the basis of my health care call to action. I hope these are next on the president's agenda.

In the meantime, we cannot afford to wait on Washington. We must take responsibility ourselves to eat right, exercise, practice stress reduction and take the other necessary steps to maximize our own health and happiness.

While it frustrates me, I understand the president's measured approach. Given that every chief executive since Theodore Roosevelt has tried to reform the medical system and none, so far, has succeeded, President Obama's first major speech on the subject may not have been the time to overreach. If we can just move incrementally toward creating a system that spreads the efficiency, compassion and high-quality outcomes of our current clinical exemplars, we'll have done something quite profound.

And we'll have laid the groundwork for future measures that create a truly healthy citizenry.

Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of His new book, "Why Our Health Matters: A Vision of Medicine That Can Transform Our Future" is now available. Become a fan on Facebook.