Real Health Care Reform: What's Next?

Health care reform is not just about who pays. It must also address what we are paying for. And we have to start paying for health rather than treating sickness.
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On a recent episode of my show, I met a woman named Sandi. Her eyes streamed with tears as she told me about how she binged on food every night after her children were asleep. She was at her wit's end. She was suffering with complications from obesity -- borderline diabetes, hypertension, fatigue and most importantly, depression and anxiety. To modern medicine, she was a simple math equation -- her BMI needed to be under 30, her blood sugar around 100 and blood pressure around 120/70. There are any number of useful drugs that could help. But they would by no means deal with the cause of her problems or bring her to wellness.

Sandi isn't just a math equation that I can fix with drugs or surgery. She is a person, plain and simple. To treat her properly I need to understand every aspect of her life -- her food cravings that she likens to getting a crack hit, her feelings of defeat as she gives in night after night, her feelings of powerlessness and isolation. I need to look at her family; her life circumstances; her mental and spiritual health; her relationships; her daily routine; where she lives and how she gets to work each day. I need to provide to her with a comprehensive list of additional resources -- therapists, counselors, nutritionists, exercise trainers, spiritual counselors, her personal "go to" team to buttress every corner of her personhood.

Sandi will go to a long-term rehabilitative facility that treats patients with chronic eating disorders by addressing the physical and emotional components that make up the distress I witnessed at her intervention. The list of factors is lengthy, but each of them is deeply embedded in every tear that rolls down her cheek as she shares her story. And Sandi's tears are a call to action.

As I write this, the news is that the House passed the health care reform bill which will now move to the Senate. As government does its part to grapple with the economics of coverage, we the care providers and we the people have an enormous part to play. All of us must work together to create the change we need so that all Americans can experience a culture of health and well-being. Health care reform is not just about who pays. It must also address what we are paying for. And we have to start paying for health rather than treating sickness.

Recently at an event held by the Bravewell Collaborative, this community of philanthropists and thought leaders delivered a report on integrated medicine to the Insitute of Medicine. This event and the report signified the perspective on health we need to adopt going forward. We need to create a culture of health and wellness that fosters a nationwide understanding that personal behaviors are a major factor in health and well-being. And at the same time, we need to make the necessary societal changes so that all individuals are supported in making the correct choices. We need to make it easier to do the right thing.

We need to create a culture of health and well-being in our country that teaches a new vision -- that true health involves being well in body, mind, and spirit in the context of one's community. We need to change the idea that health is simply the absence of disease. It isn't. It is much more than that. Health provides for a vital state of engagement with life.

Americans pay far more for health care than the citizens of any other nation, and these costs are escalating every year. In fact, spending on health care related expenses now consumes more than one out of every six dollars we earn. Yet we experience greater incidence of disease and the World Health Organization's analysis of healthy nation indicators puts our life expectancy near the very bottom of the top 40 nations.

How can this be?

The problem sits at the very core of how we approach health care.

American health care does not help people become or stay healthy and does not make it easy for people who are seeking prevention. We have a disease management system based on the episodic care of illness or trauma, which means we treat symptoms instead of causes. In essence, we can operate on Sandi, but we can't give her a comprehensive pathway to wellness after her surgery. True healing can only begin when we correctly diagnose the problem and treat the root cause.

When we treat body parts without caring for the whole patient, it means that we are leaving out one of the strongest healing forces available -- YOU, the person with the ailment.

We know from research that the digestive system is controlled by the mind and anxiety, depression, and fear affect its functioning. Social and psychological stress can aggravate a wide variety of diseases, such as diabetes mellitus, high blood pressure, and migraine headaches. Emotions affect heart rate, blood pressure, sleep patterns, stomach acid secretion, and elimination processes. Treating Sandi isn't about the biology of what caused her weight problem -- it's about understanding and addressing those dark hours at night where she finds herself in that vortex of anxiety, defeat and feelings of helplessness. That's a complex understanding that has taken me a lifetime to learn. We can't afford to ignore these connections when we treat people. We can't leave the person out of the equation.

Currently, the majority of our health care dollars are spent after a person is in crisis -- like when I have to bring in an interventionist and watch them go through an emotional catharsis. It costs the most to intervene when the possibilities for full recovery are the slimmest. Think about it. Last year, $2.1 trillion dollars were spent in this country on medical care, or roughly $12,000 per family, and 95 cents of every dollar were spent to treat diseases after they had already occurred.

The fact is -- it is much easier to prevent a disease from developing than it is to cure it once the problem has reached a critical stage.

Let's look at chronic disease as an example. More than half of Americans suffer from one or more chronic diseases and we know that conditions such as heart disease, cancer, and diabetes are not only the leading causes of death and disability in the United States, they drive more than half of the health care expenditures of the nation.

But we also know that seven of the most common chronic diseases -- cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental disorders -- have been linked to behavioral and environmental risk factors that can be addressed. They might even be prevented altogether if people were helped and encouraged to make better choices. By this I mean eating nutritionally sound food, adopting healthy habits such as not-smoking, building healthy relationships, living and working in non-toxic environments, being purposefully engaged in life, practicing stress reduction activities, and staying fit through exercise.

People often have a hard time believing that something as simple as the choices we make about our daily lives can be as powerful as drugs and surgery. But they are.

The World Health Organization just released a report revealing that global life expectancy could be increased by nearly five years and millions of lives could be saved annually by addressing 24 factors affecting health. The list includes a mixture of environmental, behavioral and physiological factors, such as air pollution, tobacco use and poor nutrition.

In a recent study published in the Archives of Internal Medicine, CDC researchers found that individuals who adhered to four healthy lifestyle habits had a 78 percent lower risk for chronic disease, including diabetes, stroke, heart disease, and cancer. The four factors were never having smoked, having a body mass index (BMI) less than 30, exercising for at least 3.5 hours per week, and eating healthfully.

The Lifestyle Heart Trial published in the Lancet showed that people with severe coronary heart disease were able to stop or reverse it without drugs or surgery by simply making intensive lifestyle changes.

A trial published in the Journal of Urology by my colleague Dean Ornish showed that lifestyle changes can slow, stop, or even reverse the progression of early-stage prostate cancer.

You get the point. Or do you? This isn't theory. These aren't utopian pipe dreams. This isn't idealism. This is evidence-based peer reviewed science that even the most methodical and empirically minded individual can understand.

Said differently, the science suggests that the reason lifestyle change programs work so well is because the combined interventions affect gene expression, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses.

When you look at the big picture, improving the health of all Americans cannot be achieved by addressing the health care system in isolation from the rest of society. We have to change our entire culture. That's not as daunting as it sounds. It's simply a matter of how we look at things. The steps themselves are simple, but they require a social choreography and a new outlook. On a positive note, in all my years in medicine, I have never felt we were at such a critical mass as we are now for these ideas to take root and grow. Regardless of the outcome of the health care reform debate, the national discussion has created a turning point for the way we see and prioritize health.

We have to make the promotion of health part of what we do in our homes and in our places of work. This could range from reducing the amount of toxic chemicals we use for cleaning -- to planning nutritional meals for our families -- to demanding smoke-free work environments -- to making time in our schedules for exercise -- to adopting corporate wellness programs that reward healthy behaviors.

Being health conscious involves monitoring what food we grow and how we manufacture it, which includes anything from supporting local farmers -- to buying organic foods -- to regulating how our food is genetically altered -- to asking major food processing companies to remove trans fats and reduce sugar content in their products.

Our cultural emphasis on health must involve improving the quality of our air and water. This could mean planting more trees, placing stricter demands on automobile emissions, eliminating contamination sources flowing into our lakes and oceans, and creating riparian buffers along our rivers.

City planning and health departments need shared goals. Having health as a priority in community design would mean creating more bicycle and walking paths, establishing a network of green rooftops, creating community gardens and ensuring that all residents have access to fresh food.

Health promotion has to be part of the educational process of our children. This would include teaching nutrition and stress reduction in elementary and middle schools, ensuring that food served in cafeterias is healthy and nutritious, banning the sale of soda and candy on school premises, and demanding that recess and physical education classes are never cut from the school day.

Our focus on health has to be part of the work processes of our corporations, which means helping employees in their pursuit of better health, eliminating toxins from the manufacturing process, and creating products that leave smaller footprints or -- in the case of medicines -- produce less side effects.

And it has to be part of our everyday culture. This can mean anything from having access to calorie counts for restaurant items -- to encouraging our friends to make better choices -- to ensuring that insurance companies reimburse for prevention.

When we do all this, not only will each individual benefit, so will the whole country. An investment in health and wellness is an investment in our future prosperity and the strength of our nation.

We are so close, and I hold great hope. Lets do it.

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