How to Achieve Real Change in Health Care. Is Anyone Listening?

A physician I knew (he died at a ripe old age) once quipped, “Medicine is America’s fastest growing failing business.” And unless we refocus our entire approach to health care, it’s going to grow and fail even faster.

Most proposals for health-care reform have focused on either expanding the availability of insurance or reducing the costs of prescription drugs. While necessary, these approaches are essentially extensions of a dysfunctional health-care system, and they fail to correct its fundamental flaws.

Health care (of which medicine is part) is an oxymoron. It’s really a disease-care system that continues to exist only because of the rationing of treatment. Millions of people are excluded from health-care coverage, and others must deal with huge out-of-pocket expenses or simply do without.

The solution I envision would transform this disease-care system into a genuine health-care system. The only way to accomplish this, at a price this nation can afford, is to emphasize prevention.

I don’t mean inoculations or well-baby checkups, although they certainly should be part of any health-care system. Nor do I mean near-compulsive cholesterol and blood pressure checks, although they too have a place.

Rather, I recommend that the incoming Obama administration fund a large federal and state campaign that tackles prevention in a way similar to how government discouraged the use of tobacco products. The anti-tobacco campaign has largely worked, and one focusing on prevention can work as well.

Focusing on prevention is imperative. Unless we reduce the demands placed on disease care, the current or extended disease-care system will eventually collapse financially.

Nearly all experts agree that most chronic health problems result from poor eating habits, a lack of physical activity, and other lifestyle issues, such as smoking and alcohol consumption. These are behaviors that can be modified to reduce the risk of disease, and less disease means lower health-care costs.

It’s important that this campaign convey the message that each and every one of us is a partner in our own health. We can’t abuse our bodies and then expect doctors or magic pills to reverse the damage, regardless of who pays. We must acknowledge our personal responsibility for staying healthy and do a much better job of eating more nutritious foods and staying reasonably fit.

I would make nutrition the foundation of any health-care campaign, for a couple of reasons. First, it’s the basis of our biology and biochemistry. Second, two of every three Americans are now overweight or obese. More than 23 million have type 2 diabetes, and somewhere between 40 and 100 million have some form of prediabetes. These are signs that our eating habits and lifestyles are truly warped. Ominously, these health problems increase the risk of heart disease and most other chronic degeneration diseases.

There’s no need to get distracted by arguments over which diet is best. Everything I’ve learned about healthy habits boils down to emphasizing fresh foods over almost anything that comes in a box, can, jar, bottle, or bag. It’s as simple as that. Opt for a piece of fish or chicken and some vegetables instead of a burger and fries in the drive-thru. And yes, eat smaller portions.

Physical fitness is important as well. While we don’t have to build Schwarzenegger-type bodies, we do need to realize that all the time we spend in front of televisions and computers helps make us fat. Just going for a daily walk improves blood sugar and weight, and obviously the more we do, the better off we’ll be.

Food companies could certainly be given incentives to help spread the word about eating better and becoming more physically active. They could also retool some of their food products to wean people off junk foods. After all, the health of their profits will at some point depend on the health of the nation.

A consortium of medical societies, food-industry lobbying groups, and vitamin supplement associations could also help underwrite consumer-education campaigns geared to preventing disease.

Even the Food and Drug Administration could play a role by clearly discouraging the use of hydrogenated oils and caloric sweeteners, maybe by requiring warning labels on some packages. The FDA could also streamline the now complicated processes of making health claims for foods and supplements.

Doctors may dismiss my proposal by saying that patients want a quick fix (code word for prescription drug) and aren’t compliant with dietary changes. But the studies show that one-on-one nutrition coaching and follow-ups do result in compliance and consistency.

Will there be resistance to what I propose? Of course they will be. Every billion dollars saved in disease care will translate to a billion lost in drug company and hospital profits.

But something has got to give. As a nation, we’ve got to get off our duff and make some changes. It’s far easier, better, and less costly in the long run to prevent (or lower the risk of) disease than to struggle to treat it. Furthermore, as people get healthier, they will also have more energy, use fewer sick days, and be more productive. That can only be good for our economy.

We need more than a Band-Aid when it comes to reforming health care and controlling costs. I hate to say it, but for a permanent cure, health care needs major surgery followed, of course, by a lean diet and time to heal. This process will certainly take more than a couple of years to yield clear benefits, but so did the campaign to reduce tobacco use.