Medicine as a Band-Aid

Spending more money does not equal better health - this is clearly true in the US. On the supply side of health care there is obviously a long list of unnecessary waste ranging from defensive medicine, administrative costs, malpractice insurance and lawsuits, doctors not washing their hands enough, etc. But this isn't the whole picture.

The demand side of the equation needs just as much reform. I was pretty shocked after reading this article in the NY Times "Big Food vs Big Insurance": http://www.nytimes.com/2009/09/10/opinion/10pollan.html?_r=1&adxnnl=1&emc=eta1&adxnnlx=1253081165-y35BhkGbk5zqTRcphZywfg. I'm just pasting in the text because the author is much more eloquent!

"To listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

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.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care....

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."

The American way of eating has become the elephant in the room in the debate over health care.

Also check out this related article: "Getting Real about the High Price of Cheap Food" http://www.time.com/time/health/article/0,8599,1917458-2,00.html

"But cheap food is not free food, and corn comes with hidden costs. The crop is heavily fertilized — both with chemicals like nitrogen and with subsidies from Washington. Over the past decade, the Federal Government has poured more than $50 billion into the corn industry, keeping prices for the crop — at least until corn ethanol skewed the market — artificially low. That's why McDonald's can sell you a Big Mac, fries and a Coke for around $5 — a bargain, given that the meal contains nearly 1,200 calories, more than half the daily recommended requirement for adults. "Taxpayer subsidies basically underwrite cheap grain, and that's what the factory-farming system for meat is entirely dependent on," says Gurian-Sherman."

Obesity accounts for 10% of all health care spending?!? 30% of the rise in costs over the past 2 decades? But the US government has spent $50 billion in the past 10 years subsidizing corn (and indirectly fast food)? I think we need to re-evaluate our contradictory policies, examine their long-term and indirect impacts, and be consistent in our objectives. Obesity (and health behavior) is clearly the elephant in the room but merely blaming overweight individuals is not the solution. Prevention isn't just about getting a MMR vaccine or about a yearly physical but is about changing our lifestyles, which could and should be encouraged through public policy. For example, requiring restaurants to post nutrition facts visibly on their menus, or company bonuses for maintaining a healthy weight, etc. We could also tax gasoline and improve our public transporation...gas is about $8-9 per gallon and many more people bike/use public transit. Also, we need to give the health care industry financial incentives to prevent chronic diseases. Otherwise, costs will continue to escalate, whether we reform health care or not. Chronic disease is no longer synonymous with old age either - young adults and even teens and children are increasingly being diagnosed with diabetes, hypertension, etc. In my field (Gerontology) there is some speculation that the current cohort of children may be the first generation to have a shorter life expectancy than their parents. Ironically, as technology improves, we are able to keep the sickest alive which lowers population health but simultaneously raises costs. But if we can change the incentives, "suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits." (Michael Pollan)

Lastly, here's a link to an article about T.R. Reid's new book (the guy from the Frontline video) "Healing of America" :
http://www.nytimes.com/2009/09/15/health/15book.html?ref=health
And an interview with him on NPR:
http://www.npr.org/templates/story/story.php?storyId=112172939

Sorry for the ridiculously long post! But I'm in Texas this week so you won't have to hear me blabbering on and on in class:)