By John Ballard (Inside joke: Deron, this one's for you!)
Dr. Weil was a guest of Larry King last night. Asked his opinion of the health care reform discussion he had no problem framing the whole matter in a truly non-partisan manner, moving the Overton Window a few degrees in the direction of reality by quietly using the phrase "disease management" instead of "health care."
This video captures the nub of his message. Those who can see the future, well past the current debate, know that the real remedies, both medical and financial, will be found in lifestyle modifications as well as a realignment of medical charges and payments from volume to value.
Lest anyone dismiss Dr. Weil as someone from la-la land dreaming of a vegan ideal, Big Food vs. Big Insurance by Michael Pollan neatly weaves together the health care debate and America's food addiction. Actually, that should read "America's government policies ensuring food addictions, obesity and corporate profit from unhealthy eating habits." And yes, Dr. Weil made reference last night to those policies as well.
No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.
That�s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry....
...The American way of eating has become the elephant in the room in the debate over health care. ...
But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America�s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side � like the large segment of the Fortune 500 that has concluded the current system is unsustainable.
That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There�s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.
The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There�s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it�s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.
But these rules may well be about to change � and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like �pre-existing conditions� and �underwriting� would vanish from the health insurance rulebook � and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.
It's a hard-hitting piece if you have the nerve to read it. Most people will skip it because it hits too close to home. I'm currently fifteen pounds into a truly punishing diet the doctor gave me when I went for my first ever Medicare benefits physical. I hate it. There's no other way to say it. I once had a fondness for grapefruit juice but I'm learning to gag at the idea of yet another day of the stuff at breakfast, lunch and supper. Yeech!
But I digress. I figure as long as I'm doing my part to keep down your health care bill, the least you can do is pay attention to the preachers.
Clearly Dr. Weil and I agree on many things. While the healthcare system is far from efficient, with billions and billions in waste needing weeded out, it is difficult to argue that our fast food ways are a major factor in driving up costs. I like to frame it in such a way that simply considers patients a stakeholder group equally responsible for our problems, joining the list of physicians, hospitals, insurance companies, Big Pharma and the government. Each must be at the table and each much be prepared to give up something in the name of reform.
ReplyDeleteIt would be interesting to see the health insurance and food industries engage in some sort of battle over this. I can promise you that, in some way, I will be joining the fight against the food industry in the near future.
Your personal diet sounds pretty radical, and I wonder if it has something to do with the fact that it was prescribed by a doctor. Like Dr. Weil mentioned, there is a gaping hole in medical school curriculum in terms of nutrition. I have found that registered dietitians (at least the good ones) are a far better resource for nutritional counseling. The changes they propose are often far more sustainable and based more on common sense lifestyle changes. Unfortunately, in our healthcare system, their role has been greatly minimized for reasons not yet known. That will change.
It's just the old fad "grapefruit diet" that's been around for decades, erroneously also called the "Mayo Clinic" diet. I really don't hate grapefruit all that much but the post sounded too bland without a little complaining.
ReplyDeleteThanks for visiting.
My favorite line in the piece was: "There�s more money in amputating the limbs of diabetics than in counseling them on diet and exercise."