Wednesday, November 18, 2009

Prevention No Substitute For Health Care

Representative John Adler, Democrat of New Jersey's third congressional district, has an excuse. He barely eked out a victory in November, 2008, an election in which Democrats unseated several Republicans and no congressional seat switched from Democratic to Republican. Perhaps because he is so vulnerable, he voted against the health care bill in the House and recently argued in The Philadelphia Inquirer

We should also give people incentives to live healthier lives. I am a sponsor of a bill that would reduce premiums for Americans who exhibit healthy behaviors or make efforts to achieve normal blood pressure, normal weight, and low cholesterol.

Senate Minority Leader Mitch McConnell, who has expressed a similar view, also has an excuse, coming from a very conservative state and being a Republican officeholder.

But what is Bill Frist's excuse? Tennessean Frist, a thoracic surgeon and specialist in heart and lung transplantation, has served as Senate Majority Leader, and recently appeared (video below) on Bill Maher's show on HBO. Comedian Maher and Republican Frist politely clashed on the value of the H1N1 vaccine but agreed that health care reform should emphasize personal prevention.

Similarly, in a recent guest column in the Manchester (New Hampshire) Union-Leader, Frist wrote

Chronic disease is the No. 1 driver of rising health care
costs, accounting for more than 75 percent of all health care spending. Much of the burden of chronic disease can be prevented or alleviated through sustained behavior change.

And the most important behavior to change is what and how we eat.

Obesity is the root cause of chronic disease, accounting for nearly 10 percent of what the U.S. spends annually on health care.

Actually, Frist does have an excuse, as he suggested upon writing (emphasis mine)

Washington should be looking at wellness solutions like the Vitality progra (full disclosure: I’ve advised Vitality’s board of directors). It’s an outcomes-oriented program that is data-driven, designed to educate and motivate individuals to engage in healthful behavior.

Frist, who is not marching in lockstep with congressional Republicans, may mean well. But while this may be good advice for family and friends, it is at best a diversion from anlysis of the root cause of the failure of the profit-driven health care system.

Aside from avoiding tobacco, three of the leading factors in disease prevention are adequate rest, proper diet, and regular exercise. But for you, what is sufficient sleep? A proper diet? Optimal exercise? Not the same as for me.

No one knows the answers to these questions, including your family doctor (assuming you have one), who likely knows little about diet exercise, or sleep and hasn't had enough time to keep up with the most current research. And no one size fits all: we have been wondrously, and individually, created or made, as reflected in the chapter of the earliest book by the late nutritionist, Carlton Fredericks: the 'u' in menu and the 'i' in diet.

Everyone has heard the story of the 90-year-old woman who has drunk a pint of whiskey daily for decades. It may be apocryphal, but these surely are not: stories of individuals who exercised, ate "properly," slept abundantly, and still suffered a stroke or heart attack or got cancer or diabetes relatively early in life. Exercise, rest, and eat "right," and you'll bolster your odds- but only that.

There is, surely, one way of encouraging the healthy lifestyle that improves one's odds and simultaneously increase revenues, which might cut the national deficit or provide additional revenue for more effective health care programs. That would be imposing an excise tax on products containing above an established percentage of sugar. But are the elite members of society laying responsibility for poor health outcomes in society recommending that? Hardly- not only because it runs counter to the borrow-and-spend mentality, but also because the processed food industry understands the value of campaign contributions.

There is another danger for Democrats (Repubs tend to be immune to this tag) in blaming individual Americans for their health ills and the exorbitant cost of the health care system: being identified as elitists. The average American does not want to be told that it's his or her fault- for the environment, for an inadequate educational system (easier to blame teachers, doncha think?), for increasing poverty in the country, or health care costs far worse than anywhere else and outcomes which fall short.

We on the left don't want to mimic the right, typically reacting impulsively, emotionally, and without adequate reflection. So consider all proposals to improve health care, but be wary of the motives and interests of anyone, especially those who want to divert attention from the forces which have profited so mightily over delivering health care far inferior to that deserved by Americans.

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