What's Missing From The Health Care Debate

The nationwide debate over health care reform touches on many issues, from affordability to access. But one crucial element has been largely missing from the discussion: prevention. That is, how to help Americans stay or become healthy.

Dr. Dean Ornish and Dr. Andrew Weil both provide their perspectives on the need to take an in-depth look at the type of health care system that we really want in this country and at how our individual lifestyle choices impact our health.

Dr. Ornish, who was just named the medical editor of the Huffington Post, argues in "Resuscitating Health Care Reform" that health reform is in danger of failing because the focus is too much on who is covered rather than what is covered:

If we just cover bypass surgery, angioplasty, stents, and other interventions that are dangerous, invasive, expensive, and largely ineffective on 48 million more people, then costs are likely to increase significantly at a time when resources are limited. As a result, painful choices are being discussed -- rationing, raising taxes, and/or increasing the deficit -- and these are threatening the public acceptance and thus the viability of health reform.

Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions. If lifestyle interventions proven to reverse as well as prevent many chronic diseases are reimbursed along with other strategies for improving cost-effectiveness across the U.S. health care system, then it may be possible to provide universal coverage at significantly lower cost without making painful choices, and the only side-effects are good ones.

In his blog post, "The Wrong Diagnosis," Dr. Weil explains that the type of reform being considered is not going to make health care any more affordable or efficient:

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly...

Most cases of disease should be managed in other, more affordable ways. Functional, cost-effective health care must be based on a new kind of medicine that relies on the human organism's innate capacity for self-regulation and healing. It would use inexpensive, low-tech interventions for the management of the commonest forms of disease. It would be a system that puts the health back into health care. And it would also happen to be far less expensive than what we have now.