As the cost of health care skyrockets, American governments, policy makers, and individuals increasingly wrestle with how to come up with the money to pay for it. Possible solutions, including Obamacare and draconian Trumpcare, focus mainly on responding to disease once it has struck rather than on preventing disease in the first place. Zooming out will help us see the big picture, identify the root causes of rising health care costs, and find solutions that can work over the long term.
How Are We Doing?
Globally, the World Health Organization concludes that chronic disease is now the chief cause of death, that 1 in 4 deaths is caused by living or working in an unhealthy environment, and that depression is the leading cause of disability.
Nearly half of US adults have at least one chronic disease. The National Cancer Institute predicts that 40 percent of Americans will get cancer, and the Centers for Disease Control and Prevention predicts that 1 in 3 could have diabetes by 2050 if current trends continue. Clearly, our health care system is not successfully addressing these diseases.
Health care expenditures account for more than one-sixth of the American economy (gross domestic product) and are projected to increase to one-fifth of the economy by 2025. Americans pay far more for health care but have the worst health, compared with other rich Western nations. Medical errors are the third leading cause of death in the US, and medical debt is the leading cause of personal bankruptcy filings.
Better Care for Our Cars Than Ourselves
Many of us take better care of our cars than our bodies. We give our cars proper fuel. We periodically change the oil, check fluids and tire pressure, replace filters, and do other maintenance to minimize the potential for dangerous, disruptive, and expensive problems.
But many of us show much less care for our own health. We may sit too much, move too little, sleep too briefly, stress ourselves out, or expose ourselves to contaminated air, water, and products. We may consume sugar, white flour, toxic pesticides, and junk the human body was never designed to eat, while missing out on essential nutrients. When problems come up, we go to the doctor, say “fix me,” and get prescriptions for “magic bullets,” aka pharmaceuticals. Yet all drugs have potential side effects, which can lead to taking even more drugs to address them, creating a downward health spiral.
Our collective institutions and policies put profits before health. Industry is allowed to pollute air and water and put new synthetic and often health-damaging chemicals into our world without adequate testing for safety. Taxpayer-funded food subsidies primarily promote junk food rather than organically grown food or fruits and vegetables. Revolving doors between industry and government allow industry to steer policy at regulatory agencies such as the US Department of Agriculture and Food and Drug Administration.
Government agencies end up protecting industry from citizens rather than protecting citizens from industry. The food industry is allowed to conceal what’s in our food and deceive people about unhealthy food. The drug industry can keep unfavorable clinical trial studies locked up in file cabinets and publish just the favorable ones. The drug industry can market drugs directly to consumers and influence medical school curriculums. And even though poor nutrition has been implicated as a key factor in many chronic diseases, most doctors receive scant training about it.
Damage Control Costs Too Much and Often Fails
Our health care system waits for trouble and then delivers expensive and painful damage control. It’s the equivalent of parking an ambulance at the bottom of a cliff instead of building a fence at the top. For example, health insurers often won’t pay $150 for a diabetic to see a podiatrist, who could help prevent foot ailments associated with the disease. But most will pay $30,000 or more for an amputation. Both costs could be avoided. Best-selling author Joel Fuhrman, MD, a self-described “nutritarian,” estimates that about 90 percent of what US doctors do wouldn’t be necessary if people took better care of themselves. Chronic diseases are among the most preventable, and costly, of all health problems.
Alternatives to Conventional Medicine
Many doctors and patients are disillusioned with the current system, which operates predominantly on a fee-for-service basis, rewarding doctors for doing as much as possible rather than for providing the best care possible. Questioning whether they are providing good care in conventional medical practices, doctors increasingly turn to “alternative” forms of medicine. More than one-third of US adults use some form of complementary or alternative medicine, a long list that includes naturopathy, homeopathy, chiropractic manipulation, and acupuncture. It’s hard to argue with success, and alternative approaches are making their way into mainstream medicine, as evidenced by the Cleveland Clinic Center for Functional Medicine, located in one of America’s leading hospitals.
Make Health Our Top Priority
Health should be the first priority of individuals and society alike because it is foundational to happiness. The desire for happiness ultimately motivates everything we do. While preoccupied with illness, we feel worse and enjoy life less, work and earn less, help others less and burden them more, spend time and money trying to get well, have lower energy, and think less clearly and optimistically.
If health were our top priority, we would take actions that would improve our lives and our world on many fronts, such as these:
- Plant gardens at schools and teach students about food, nutrition, cooking, and health.
- Grow and eat whole, organic food, mainly plants.
- Verify chemicals are safe before putting them into commercial use.
- Stop burning fossil fuels, biofuels, and wastes, thereby preventing air pollution and helping the climate.
- Prevent water pollution.
- Promote adequate exercise, rest, relaxation, and stress management.
- Train doctors about nutrition, toxins, consequences of lifestyle choices, and alternative forms of medicinal care.
- Disclose food ingredients and clinical trial results.
- Reduce industry influence on food and medicine, and staff regulatory agencies and governments with people who don’t have conflicts of interest.
- Practice and promote preventative medicine, and pay doctors to keep us healthy. One option is “capitation,” in which a doctor, medical group, hospital, or health system receives a flat fee every month for taking care of an individual enrolled in a managed health care plan.
If we implemented these actions, improvements would compound. We would spend a lot less on health care. We could use the saved money for productive pursuits such as education, research, the arts, and environmental restoration and conservation. We’d get more done and have more fun. And we’d have a stronger democracy that works for citizens, as the Founding Fathers intended.
It’s hard to imagine any good way to pay for the irresponsibility and senseless waste in our current health care system. Some health care repair schemes are, of course, better than others. The Republicans’ current plan to slash health care coverage, further enriching the wealthy, would take us backwards. But regardless of the plan, fixing health care for real will require putting health promotion at the top of our priority list.
Ellen Moyer is a registered professional engineer with a BA in anthropology, an MS in environmental engineering, a PhD in civil engineering, and 30 years of environmental engineering experience. She is also US Green Building Council LEED accredited professional. Her third book, Our Earth, Our Species, Our Selves: How to Thrive While Creating a Sustainable World, quickly became Amazon’s #1 “Hot New Release” in the categories of Green Business, Nature Conservation, and Environmentalism.