A Pound of Cure

Newsweek reported last week about the work Senator Tom Harkin is doing to focus the Presidential Transition Team's healthcare portfolio on preventative care and wellness. Bravo to him!

The United States spends $2 trillion (yep, "2" with 12 zeros!) annually on healthcare, more than any other nation on earth (according to the WHO). And yet the US ranks 37th among nations in citizen health, and 20th out of the 21 industrial nations.

Some reasons:

1. Americans are about the unhealthiest people in the world
2. Americans are horribly lazy and believe that pills can cure bad behavior
3. Physicians in this country are paranoid about lawsuits and over-test, over-prescribe, and over-treat
4. Pharmaceutical companies know how good a thing they've got
5. Insurance companies are mind-numbingly stupid
6. The policy and regulatory machine is embarrassingly out of touch

I'm thinking that #2-6 have caused #1.

Senator Harkin is right - something needs to be done. It's a combination of health-conscious behavior with appropriate incentives for the machine. It surprises me that insurance companies won't pay for preventative care, but will happily cover the result of bad behavior. How bizarre!

I'm sure the insurance companies realize that if people are healthy, they will still get premiums but won't in aggregate have to spend as much? Wouldn't it be better to spend a little bit on everyone (assuring preventative healthcare across the population), and then benefit from not having to spend so much on the vast percentage of the population that gets sick because of bad behavior?

It's similar to the drug problem in this country. We spend $billions on the so-called war on drugs in the name of being tough on crime (another ridiculous concept), but don't realize that if we spent those $ on reducing demand by helping and curing drug addiction, we'd end up starving the suppliers. All without having to put people in jail, and instead helping people eliminate their dependencies and lead better lives.

This is classic of a system that is not interested in cause and effect, but simply patching symptoms.

This is an endemic problem, ranging from failing bridges, levees and air traffic control systems, to starting wars without thought to how they'll end, to badly-designed school systems, to borrowing without considering financial capacity, to poor health, to crime, to everything.

Oddly the population of this country seems sanguine about all this. There's no sense of urgency about fixing any of this. Why is that?

I wrote a while ago about how breast cancer can be managed through early detection and about how we're presently governed by a stunningly short-sighted leadership. It feels like this society only lives in the present, and is completely oblivious to anything that might happen tomorrow as a result of indifferent or bad behavior today.

What does it take to open our minds to the reality that you can only paint over the cracks so many times before the walls fall down?

I think the first step is for this entire society to abandon the idea that there is a free lunch for weight-loss. This (yet another) multi-billion dollar industry preys on people that think there's a quick fix.

Let us once and for all recognize the fallacy of fried chicken, pork rinds, french fries with gravy, apple pie and a diet soda?

Comments

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[shafeen]

Hi Andrea,

I've spent a lot of my life living outside the US, and am always astounded by the size of American meals, and even the size of the physical dishes that people use here! The plates in this country are like serving platters (dinner plates in other parts are like salad plates here).

There's been a lot of research showing that people eat less when they use smaller dishes (i.e. the plate still looks like it's full of food).

Food for thought for your next career:)!

[Andrea]

I am old enough to remember when fast food didn't exist. When McDonald's first opened in my city, the servings were small- a single meat patty on a small bun, a small paper envelope of fries and an 8 oz drink. I'm not saying it was healthy food but it was nothing on the massive globs of fat people get these days at the many fast food outlets. Most chain restaurants serve huge portions-the amount of pasta at a Macaroni Grill is 4 times what I would serve at home. And public schools are terrible offenders- the meals are gross and unhealthy(although school food was awful in my day but my mom packed lunch for us)- and schools(where I live) justify vending machines selling soda, candy and chips as making money needed for sports programs(how contradictory is that!!!).
I hope to be more involved with changing the food in our schools(a project for my soon to be retirement) -we are supposed to be one of the best school districts in America- but our food is certainly not.

[shafeen]

Thank you Mrs. Polly!!

I'm so sorry to read about your experience and how you lost your father as a result.

It seems (and your words corroborate this) that we've simply abandoned integrity altogether.

I think we need some oversight, but I also think we need to bring the concept of Phys-Ed and healthcare back into the mandatory curriculum for every K-12 student. Moreover, cafeterias in schools should *only* serve healthy food; there should be no vending machines or pop available; teachers should not give candy out as treats for good work. Etc.

Let us begin creating good habits from birth...

[Mrs. Polly]

Shafeen, the profit motive in both insurance and drug companies seems to me to underlie the entire American approach to healthcare. Sales reps prowl the halls of hospitals, lobbyists the halls of Congress, and patching up unhealthy people with pills is more lucrative than preventive care. Preventive, "eat your vegetables" living is unsexy.

Statin drugs are major earners, and the goals for cholesterol levels have been ratcheted down to where even healthy adults can't achieve them without drugs. This despite serious side effects.

I speak from experience; my father died a year ago from the side effects of a powerful statin, Crestor. Crestor is the only statin on the market that caused a muscle-wasting condition called rhabdomyolysis in trials. Public Citizen filed a complaint about it, but it was ignored; they dealt with it by decreasing the maximum potency of the tablets.

The cardiologist was looking at the cholesterol numbers on my father's chart, but he wasn't looking at my father, who was paler, weaker and more confused by the week. I won't go into the whole nightmare, but the post-marketing reporting for bad results is voluntary---and useless. The Bush-defanged FDA is not a watchdog at all. If Harkin and Obama manage to put some bite back into that organization, it would be worth it to people like my family.

And yes, I came here from Wonkette, and you have a mighty good blog here. Congratulations on whatever good things come from their recommendation, and I'd wish confusion to those poor benighted souls who object, but it would be superfluous.