By Donald
B. Ardell – August 09, 2009
This week's essay deals with reforming the ways we Americans
organize, pay for and benefit from our medical system. A thing or two has been largely
overlooked by policy wonks shaping legislative proposals for Congress to haggle
over. I suggest that these are consequential
matters that deserve priority attention and creative resolution. Let me begin with
a quote:
"Did
I ever tell you how I shot a wild elephant in my pajamas? How he got into my
pajamas I'll never know." Groucho Marx
In this country, health care system reform is getting more
attention than Michael Jackson, Walter Cronkite, Lance Armstrong and that
unhinged professor who protested too much, just because the police, in his
living room, demanded he identify himself and be polite about it. What a nerve. All the fuss about health system legislation is a good
thing, but it would be a much better thing if proposals took notice of the
proverbial elephant in the room (but not anyone's pajamas), which the experts
and politicians alike seem determined to ignore.
Except
me. I'll describe the elephant in
just a moment. First, a few
observations about the maddeningly myopic health reform debate.
A major assessment of the situation appeared in a recent New
York Times analysis of reform attempts. The author took the view that all ideas put forward by Democrats and
Republicans share a basic flaw. I
agree with that statement, but I don't think the writer identified the correct
flaw. According to David Leonhardt
("Health Care Reform and the Unpopular T-Word," Economic Scene, New
York Times, July 29, 2009), the flaw in all plan proposals is that none would
raise revenue as quickly as costs will surely rise. (During the last ten years, the economy grew 20 percent; medical
costs rose 50 percent.)
Well, that
sounds like a flaw to me, too, but it's not as devastating as the flaw (or
unacknowledged elephant) that will trample any and all reform attempts, even IF
revenues somehow rise in concert with but not much greater than medical costs.
The debate
to shape legislation one way or the other addresses all manner of topics, but
focuses on controlling costs via efficiencies, as well as boosting access to
care and improving the quality of services. Hello? What
about boosting the sorry health status of the people? Why is this upstream situation given so little attention?
Yes, everyone needs access to quality medical care at affordable rates in a
system the economy (and taxpayers) can sustain. However, we must at the same time create conditions wherein
Americans are prodded, motivated and helped to live so as to remain healthier
longer and thus needful of less medical attention.
There are, in fact, two elephants in the room, both of which
are equally ignored. I know - how
the hell can politicians ignore something so impressive, so big and so loud
(not to mention so dangerous) as two bloody elephants? To me, it seems inconceivable that this
is happening, but to me a lot of things seem inconceivable. (I still find it inconceivable that
George W. Bush was president of this country for eight years and that Sarah
Palin was a major party candidate for vice-president.) But, I digress. Back to the elephants.
No, I
don't think it is what Senator Lindsay Graham identified when he said,
"Well, the big elephant in the whole system is the baby boomer generation
that marches through like a herd of elephants. And we begin to retire in
2008."
Wrong
elephant, Senator.
The largest elephant is the fact that Americans have sorry
lifestyles. Two-thirds of us are
undernourished, overfed, underfit and overfat. Or, put in a more positive light, most Americans have not
realized their potentials for well-being. There is less reason, exuberance and
liberty than there would be if more citizens pursued REAL wellness
lifestyles. In addition to the
four under and over factors I just mentioned, most of us are overstressed and
undercalm, overmorose and underhappy, overbored and underexuberant and
underskeptical and overly superstitious. (The under and over dichotomies could go on at length but enough,
already. I'm sure you get the
point.) We are a society that does
not make choices favoring health and optimal functioning. That is the larger elephant in the
room.
Let me
tell you a bit about the smaller elephant, also a substantial problem. It is nearly unbelievable that this
huge creature is not being specifically addressed in reform discussions at the
highest levels. Even if the
larger elephant (sorry lifestyles) were not around, this smaller beast can only
be ignored at great peril at reform prospects. Ignore this creature and no reform element will make much
difference. In fact, overlook this
monster and any reforms could render a very bad situation much worse.
The
smaller elephant is obesity. OK,
maybe most people can't sustain REAL wellness lifestyles even if they knew of
such an option and were motivated to pursue such lifestyles (big
"ifs"). However, the
lesser elephant (but still HUGE) could be addressed in the context of health
system reforms. The cost savings would be immense.
According to the lead article in a USA Today article by
Nanci Hellmich entitled, "Obesity Is A Key Link To Soaring Health
Tab," (July 28, 2009, page one), those 30 or more pounds over healthy
weight cost the country $147 billion in weight-related medical bills last year.
Consider some of the consequences of obesity, as noted in a government-funded
report by RTI International entitled, "Weight of the Nation" highlighted
in the USA Today story.
* About
34% of adults - more than 72 million - in the USA were obese in 2006, up from
23% in 1994, according to government data. Two-thirds of people in this country
are overweight or obese.
* Obesity
accounts for 9.1% of all medical spending, up from 6.5% in 1998.
* An obese
patient has annual medical bills of $4,871 compared with $3,442 for a patient
at a healthy weight.
* Obese
patients on Medicare spent about $600 a year more in prescription medications
than patients at a healthy weight.
* The
average American is 23 pounds overweight and collectively, we are 4.6 billion
pounds overweight. (Statement attributed to CDC Director Thomas Frieden.)
*
Taxpayers picked up about half the $147 billion tab in 2008 through Medicare
and Medicaid.
* Obesity
increases the risk of heart disease, diabetes, several types of cancer and
other diseases.
* As
important, obesity and simple overweight costs in other ways, such as lower
prospects for a dynamic life wherein one can experience more joy and happiness,
success in life and other psychological advantages. Obesity is, according to the report cited, the single
biggest reason for the increase in health care costs. The lead author put it
this way: If you really want to rein in health care dollars, you have to get
people dieting, exercising and living a healthier lifestyle.
As William
Dietz, director of the CDC's Division of Nutrition, Physical Activity and
Obesity observed, "Obesity is not a problem that is going to respond to a
silver bullet or single solution. Comprehensive policy and environmental changes are needed."
The
president could regain support for his own health plan reform concepts by
including incentives for healthy lifestyles. This could entail benefit elements that promote wise
lifestyle choices generally and specific features that would combat obesity
specifically, particularly exercise, nutrition and related benefit subsidies
conducive to appropriate body weight.
The president would, with this single addition, regain the
high ground by putting something positive into play, namely, a message that
Americans can do much better in looking after their own best interests. Initially, given the widespread nature
of the obesity problem, he would be offering the overweight a little help from
their government, given the stake all taxpayers have in citizen health
status. This seems good for the
president at this time, as support for his reforms (focused on access and cost)
has fallen dramatically in recent weeks. (See Laura Meckler, "Support Slips for Health Plan - Obama Push
Faces Growing Doubts in Poll; Overhaul Advances in House/Senate," Wall
Street Journal, July 30, 2009.) Mr.
Obama's new emphasis is consumer protection. He should add to that consumer enhancement of life quality.
In putting
forward a legislative program that addresses the need for healthy lifestyles,
provides support for healthy lifestyles and creates conditions conducive to
healthy lifestyles, Mr. Obama would be calling attention to the elephants in
the health system reform room. More important, a reform plan that assists all citizens to make better
choices will lower costs and thus fund expanded access to care for everyone.
The great
wit Steven Wright once remarked, "My roommate got a pet elephant. Then it
got lost. It's in the apartment somewhere."
It's not
hard to find either of the elephants in the health system reform debate
dominating the air and other media waves at this time. Just look around. 
Be well.
Don Ardell is the Well Infidel. He favors evidence over faith, reason over revelation and
meaning and purpose over spirituality. His enthusiasm for reason, exuberance and liberty are reflected in his
books (14), newsletter (500 editions of a weekly report) and lectures across
North America and a dozen other countries. On July 26, he won his division in the National Sprint
Triathlon Championship in Newport Beach, CA.