The Missing Link in Healthcare Reform

The Missing Link in Healthcare Reform
Why Healthy Living & Prevention Aren’t Part of the Plan…But Need To Be

By Marc Isaacson, President/CEO
Village Green Apothecary
Bethesda, MD

At this moment in history, we have a real opportunity to re-invent and revolutionize our entire healthcare system. However, current proposals are nothing more than a band-aid, missing the chance for true healthcare system reform. The proposed “fix” does very little to keep healthcare sustainable 10, 20 or 30 years from now. It also does not address one of the root causes of the healthcare crisis – chronic disease. Chronic diseases, which are the most prevalent, costly and preventable of all health problems, account for 75% of healthcare spending.(1) A recent study shows that if individuals adhere to some simple healthy lifestyle practices, chronic disease could be reduced by as much as 80%.(2) Healthy life choices such as maintaining a healthy weight, eating well and getting regular exercise, coupled with addressing nutrient deficiencies, could drastically reduce healthcare spending.

Unfortunately, a major challenge we have as a country in establishing the right long-term healthcare approach is having our voice heard by our legislators and practitioners, and even our fellow citizens. The pharmaceutical industry and insurance companies, with the cooperation of other healthcare and political “old guard,” are going to great lengths to keep the focus of reform away from changes that threaten the status quo. These groups are much more intent on protecting the hefty profit margins that they currently enjoy than on supporting reform that would truly benefit most people. Despite this strong opposition, we must pull together and voice the need for change. We must ask well-respected integrative doctors, (including MD’s and DO’s, who are trained not only in traditional medicine, but also in nutrition and lifestyle therapies,) to join the panel of experts advising healthcare reform policy-makers. Leading integrative pharmacies should also be part of the process. It is time for a paradigm shift where our focus moves from a disease- care system to a health-care system.

How We Got Where We Are Today

The United States spends more on healthcare than any other country in the world, yet ranks a lot lower in life expectancy than other countries that spend far less.(3) According to recent statistics, average U.S. life expectancy ranks 50th in the world, falling behind many other industrialized nations.(4) In addition, healthcare costs are skyrocketing and the numbers are indicative of our current crisis. In 2007, total spending was $2.4 trillion, or $7,900 per person. U.S. healthcare spending represented 17% of the gross domestic product (GDP). U.S. healthcare spending is expected to increase at similar levels for the next decade, reaching $4.3 trillion in 2017, or 20% of GDP.(5)

Total Medicare expenditures were $468 billion in 2008 and are expected to increase in future years at a faster pace than either workers’ earnings or the economy overall. At the beginning of 2009, the assets of the Hospital Insurance Trust Fund were $321 billion and are projected to be exhausted during 2017, 2 years earlier than projected in their last report.(6)

Medicaid benefit expenditures are projected to reach $673.7 billion by 2017, approximately 113% higher than in 2007. Medicaid is expected to grow about 7.9 percent per year on average – much faster than the projected average annual gross domestic product growth (GDP) of 4.8 percent. If these Medicaid trends continue as projected, a steadily increasing burden will be placed on both federal and state budgets.(7)

Chronic diseases such as cancer, diabetes, heart disease, and hypertension are just some examples of the most common and costly health problems in the nation. The total impact of these diseases on the economy is more than $2 trillion annually and growing.(8) With nearly half of the adult population suffering from at least one chronic illness, healthcare costs are rising at an alarming rate.(9) Diabetes diagnosis tripled between 1980 and 2006, triggering a significant increase in healthcare spending.(10) In addition, the doubling of obesity since 1987 accounts for nearly a third of the rise in healthcare spending.(11)

Healthcare Reform: Missing the Long-Term View

The essence of the pending plan is built around competition and cost management. The thinking is to have a lower-priced public plan option or co-op that would provide competition to private insurance plans. There would also be subsidies and tax credits to make healthcare more affordable across the board, with additional incentives for small businesses and those in low-income brackets.

With the proposed plan, there appears to be the potential for initial cost savings of up to 15-20% in some segments, such as for small businesses. More uninsured individuals would also be covered, which is needed. The bigger issue over the longer-term is how to maximize outcome in relation to cost. If the plan focuses on managing cost, increasing efficiency, and subsidization to make healthcare more affordable, that only addresses part of the situation. Of critical importance, the proposed plan must also consider the long- term view (20-30 years) and the necessity of building a component around individualization, preventative medicine and healthy living.

Why Prevention and Lifestyle Are Being Left Out of the Plan (Hint: It’s All About Money)

The pharmaceutical industry and other “old guard” institutions invest heavily to sway decisions about healthcare in Washington, DC, in an attempt to control the thoughts and awareness levels of consumers. In the 2008 election cycle, the healthcare sector (pharmaceutical industry, American Medical Association, hospital groups and the insurance lobby) gave $167 million in campaign contributions to congressional candidates and poured $484 million into lobbying efforts.(12)

Pharmaceutical manufacturers spend approximately $30 billion annually promoting and marketing prescription drugs.(13) In 2005, over $7 billion was spent on marketing to physicians by sending teams of sales representatives to go into doctors’ offices to “educate,” train and sell the need for pharmaceuticals.(14) Also in 2005, about $16 billion was spent on giving free samples to physicians.(15) And last year, $4.3 billion was spent on direct-to-consumer television, radio, magazine and newspaper advertising, according to Nielsen Media Research.(16) This intense marketing is playing a major role in shaping the healthcare message.

Along with marketing expenditures, insurance companies are spending a substantial amount of money on administration, salaries and bonuses – not on healthcare. And, despite the current recession, they continue to earn billions of dollars in profits. For the five top-earning insurance companies in 2008, average profits were $1.56 billion and executives were compensated salaries, stock options, and fringe benefits ranging from $3 million to $24 million.(17)

Unfortunately, the pharmaceutical and healthcare industries have little vested interest in supporting any dialogue about nutrition and healthy living, and it is difficult to penetrate the mindset in our medical community in order to talk about individualized healthcare and preventative approaches. If we make our country healthier by focusing more on diet and lifestyle, this stands to impact the profits of these companies.

Yet another challenge is that the people who are working on healthcare reform have invited insurance companies, pharmaceutical companies, hospitals, and other traditional healthcare institutions – the same group that has been crafting healthcare policies for years – to work on shaping the plan. This group is too self-contained to allow important new reform, true reform, to take place. We need new thinking, which means new leaders who are shaping healthcare around prevention and healthy living.

A Different Approach – And a Road That Leads to “Wellness”

The current healthcare system is designed, for the most part, around treating symptoms and patients using a one-size-fits-all approach. There is certainly a need for pharmaceuticals at the right time and under the right circumstances. However, in the majority of situations, there is a better way that includes an individualized approach and getting to the root cause of the problem…not just treating symptoms. Every person is a unique individual, with his or her own biochemistry and gene profile. In the long-term, our healthcare system needs to be focused around an individualized approach that truly helps every person live at his or her optimum level of health.

What would a wellness healthcare model look like? It would involve medical institutions and professionals implementing intensive lifestyle treatment programs that could be reimbursed. Treatment plans would be personalized and monitored by a team of healthcare practitioners including physicians, nutritionists, health coaches, behavioral and exercise coaches, etc. Patients would receive comprehensive lab tests that check for such things as nutrient deficiencies, food sensitivities and hormone levels. Based on these tests, plans would be tailored to address root causes of health problems. Patients would also be rewarded for practicing health-promoting behaviors, and there would be incentives and tax credits for employers to implement corporate wellness programs to reduce healthcare costs, minimize absenteeism, and increase productivity.

The Five Keys to Preventative Healthcare

1) Nutrition Education & Healthy Diet

School-based programs can play a bigger role in promoting healthy eating habits and preventing the development of chronic diseases in adulthood. Diet has been shown to be a known risk factor for the development of three leading causes of death: coronary heart disease, cancer, and stroke.(18) Dietary factors also contribute to other chronic diseases such as diabetes, high blood pressure, obesity, and osteoporosis. Over half the number of deaths in women from chronic diseases such as cancer and heart disease could be avoided if they never smoke, keep their weight in check, exercise and eat a healthy diet low in red meat and trans-fats.(19)

It is estimated that if we were able to ban fast food advertisements in the United States, we could reduce the number of overweight children ages 3-11 by 18%, while also lowering the number of overweight adolescents ages 12-18 by 14%, according to a study in the Journal of Law and Economics.(20) With two-thirds of Americans overweight or obese, the United States is spending $147 billion a year, or $1,400 a year more for an obese person than for someone of normal weight.(21)

Healthy eating involves a variety of fresh, whole foods (organic when possible) that give the body nutrients it needs to support vitality, energy levels, and promote physical, mental, and emotional health. A recent study shows that eating a Mediterranean diet, which emphasizes fruits, vegetables, legumes and healthy fats, and increasing physical activity levels can provide substantial protection against major chronic diseases including heart disease, cancer, Parkinson's and Alzheimer's disease.(22)

These numbers continue to tell the story:

• Lower obesity rates alone could produce productivity gains of $254 billion and avoid $60 billion in treatment expenditures per year.(23)
• 5 % of cancer deaths may be related to dietary factors.(24)
• In 2002, the American Heart Association released a scientific statement linking the benefits of fish consumption, fish oil, and omega-3 fatty acids with a decrease in cardiovascular disease.(25)

2) Nutritional Supplementation

Our bodies need a constant supply of nutrients to support physiologic and metabolic functions. Deficiencies are prevalent in our society and contribute to risk of disease. Supplementing with nutrients such as vitamin D3, omega-3 essential fatty acids, probiotics and CoQ10 could save lives, as well as billions of dollars. According to recent studies conducted by The Lewin Group, dietary supplements not only improve health and quality of life, but also reduce healthcare expenditures.(26) Here are some examples of potential healthcare savings that were found over a 5-year period:

• Daily intake of 1,800 mg of omega-3 fatty acids can reduce the occurrence of coronary heart disease among individuals over 65 years old. Approximately 384,303 hospitalizations and physician fees of $3.1 billion due to coronary heart disease could be avoided.
• Daily intake of 6-10 mg of lutein with zeaxanthin may help reduce the risk of age- related macular degeneration. Approximately 98,000 individuals could avoid the loss of central vision resulting from advanced age-related macular degeneration, and the resulting transition to dependence in the community or a nursing facility – a savings of $2.5 billion.
• Daily intake of 1,200 milligrams of calcium with vitamin D among the over-65 population could prevent approximately 734,000 hip fractures and hospital, nursing facility, and physician costs of $13.9 billion.
• If 10.5 million additional women (of the 64 million American women of child- bearing age) began taking 400 micrograms of folic acid daily before becoming pregnant, approximately 600 babies would be born without neural tube defects and $1.3 billion in lifetime costs could be saved.

In addition, a significant amount of research has emerged showing the importance of vitamin D in health. It plays a critical role in cardiovascular health, bone health, immune health, and cancer prevention. Vitamin D deficiencies are rampant, seen widespread in children, adults, and the elderly. Vitamin D deficiency has been linked to many chronic illnesses. It has been proposed that providing 1,000 IU of vitamin D daily for all adult Americans would cost about $1 billion, and the expected health benefits (including a reduction in cancer) would be in the range of $16 to 25 billion.(27)

3) Exercise

As many as 50 million Americans are living sedentary lives, putting them at increased risk of health problems and even early death. The Aerobics Center Longitudinal Study (ACLS) is an ongoing study that began in 1970 and includes more than 80,000 patients. It has shown that poor fitness levels account for about 16 percent of all deaths in both men and women. ACLS also found that moderately fit men lived 6 years longer than unfit men. And, ACLS found that women who were very fit were 55 percent less likely to die from breast cancer than women who were not in good shape.(28)

Also of note:

• Exercise can cut the risk of colon cancer by up to 24%.(29)
• High-intensity exercise can reduce the risk of stroke by 64%.(30)
• Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.(31)

4) Stress Management

The ability to cope with stress is related to one’s health and vitality. If not properly managed, both acute and chronic stress can negatively affect immune, enzyme, and hormone function. According to some estimates, about 80% of common diseases are related to prolonged stress.(32) The World Health Organization (WHO) Global Burden of Disease Survey estimates that mental disease, including stress-related disorders, will be the second leading cause of disabilities by the year 2020.(33)

The Mayo Clinic reported that psychological stress is the strongest risk factor predictive of future cardiac events, including myocardial infarction and cardiac death, among individuals with existing coronary artery disease. In addition, chronic stress elevates the hormone cortisol, which can contribute to the development of metabolic syndrome, including abdominal obesity and other risk factors for diabetes and cardiovascular disease. Negative emotions and psychological stress also raise the production of pro- inflammatory chemicals, a risk factor for age-related diseases and conditions including cardiovascular disease, diabetes, osteoporosis, arthritis, cancer, and Alzheimer’s. Because stress can dampen immune response, it can increase the risk of infection and delay wound healing.(34)

Researchers have also found that people dramatically increase their use of the medical system during times of job insecurity (stress). Doctor visits increased 150%, episodes of illness increased 70%, and visits to hospital outpatient departments increased 160%.(35) It is estimated that 75-90% of all doctor visits are due to stress related complaints(36); stress management could eliminate a large percentage of these visits.

5) Environmental Issues

We are exposed to numerous chemicals, including heavy metals, pesticides, and drug residues in the air, water, food supply, and our home and work environments. Studies have shown that environmental toxins can significantly affect major organ systems, such as the immune, neurological, and endocrine systems. Toxicity that affects the immune system may be a major factor in the increasing rates of asthma, allergies, autoimmune conditions, and cancers. Neurological toxicity affects cognition, mood, and causes chronic neurological illnesses. Endocrine toxicity can affect reproduction, menses, libido, metabolism, stress-handling ability, glucose regulation, and other important functions.(37)

Illnesses and disabilities associated with toxic exposures produce both direct costs (hospital care, drugs, physician visits, medical treatments) and indirect costs (special education, institutional and special care at home). A national study estimated the direct and indirect costs of selected illnesses and disabilities in American children at nearly $55 billion in 2002.(38) The estimated U.S. healthcare cost of diseases affecting women that have a "strong environmental association" totaled $12.2 billion, according to a report by the Women's Foundation of California. These diseases include breast cancer, birth defects, autoimmune disease and infertility. The costs to women beyond health care include lost wages and diminished quality of life.(39)

Becoming aware of common toxins in the environment, reducing toxin exposure to harmful substances and improving the body’s detoxification processes are required to maintain good health. Some ways to reduce toxin load include using a high quality air purifier and water filter for your home and work environment, cutting down on all plastic use, eating organic foods, using non-toxic household cleaners and yard care products, and choosing natural, chemical free body care products.

Seven Action Steps for True Healthcare Reform

Below are some key changes that should be considered in order to significantly transform our healthcare system.

• Provide insurance reimbursements to health practitioners who advise their patients on healthy lifestyle practices that contribute to prevention and treatment of chronic disease.
• Fund more research that looks at benefits from improved nutrition, diet and lifestyle, alongside benefits – and risks – from drugs and medical procedures.
• Develop improved nutrition, diet, lifestyle and environmental health curriculum required for all K-12 public and private schools in the U.S.
• Completely revamp food policy in schools (lunch programs, vending machines, etc.) by making healthy foods accessible to children and eliminating items that contribute to obesity and disease.
• Incorporate nutrition, diet, lifestyle, and environmental health as core curriculum in all primary health care personnel training and continuing education for all types of physicians (MD’s, DO’s, ND’s, DC’s, etc.), nurses, physician assistants and pharmacists.
• Have a Presidential-appointed position (a “champion”) that is responsible for shifting the focus of healthcare to a system of healthy lifestyle and disease prevention.
• Jump-start the practices of healthy living and disease prevention by providing incentives and tax breaks for corporate wellness programs.

The REAL Bottom Line

Because chronic diseases are often the direct result of unhealthy lifestyle behaviors, if we corrected these lifestyle factors, it is estimated that by 2023, we could avoid 40 million cases of chronic disease and reduce the economic impact by 27% ($1.1 trillion annually).(40) We need to restructure the system so that doctors identify and reduce disease risks and provide education and motivation to improve patient health. Greater incentives, education and reward systems need to be put in place for all lifestyle components, including diet, exercise, smoking cessation, stress management, reducing environmental toxin exposure, and the use of nutrients. The creation of a new healthcare model that focuses on healthy living is the only long-term solution to the healthcare crisis. Not only would it ease the enormous economic burden of chronic disease, but it would also enhance quality of life and create a healthier nation.

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