Health Care Reform and the Real Bottom Line

I just hung up the phone a little over an hour ago–I was on the line with President Obama! What an honor to be included in a conference call about health care reform. One of the questions was about an older couple who were doing fine, until he got sick, and she had a stroke–and then it was the same sad story of hard won life savings swept away by the unbelievable costs of health care. I really should not use the term health care in this case, it should be disease management, which increasingly has been the focus of our system of hospital and office medicine since (believe it or not!) the early 1920’s. We have had almost 100 years of medicine that puts profit of individual doctors and medical insitutions, and sales of pharmaceuticals and related medical goods above every other consideration.

And now, the American people are paying for it. We are paying with childhood obesity, with our own tax money that is allocated for “Cadillac” health insurance policies for members of Congress and other branches of government, while we struggle with high deductibles, medical expense-related bankruptcies, and death because we are not covered by insurance that would pay for our deadly illnesses. Meanwhile, the United States is a poor performer on the list of developed countries regarding important issues like maternal and fetal death in childbirth. The false bottom line–a narrow view of the profit margin of health care providers and institutions, has been the overriding goal of our system for nearly the last century, and has served us poorly.

How to change this? Rather than looking at the false bottom line, let’s look at the real one. We must examine the real costs of illness, and change our goals. Our main goal for health care must be the highest state of health, for the greatest number of people, at the lowest cost. This goal should then be our standard for reducing health care costs.

We need have the tenacity to do the real work of preventive health care as our main effort at achieving that goal. In order to do real prevention, we need to be advocates for healthy diets, exercise, stress reduction, and other healthy choices, and to look for the real causes of illness. Too many of our so-called diagnoses are just descriptions of groups of symptoms, and the possibility of looking for a cause of these diseases is shrugged off. A few examples of these are “Irritable Bowel Syndrome” or “GERD”, “IBD” (inflammatory bowel disease) and “chronic sinusitis.

I just received a message from a woman I saw as a patient more than 20 years ago. This is what she said:

I wanted to let you know I have gotten rid of my Crohn’s Disease! All the things you helped me with–digestive enzymes, vitamins, probiotics, staying away from the foods I was allergic to, and not eating too much meatdoing all this over the years made it go away completely. The last colonoscopy showed NO trace of Crohn’s! Thank you for giving me an open mind to alternative medicine. When my doctor recommended me to you over 20 years ago little did I know how it would change my life. Thank you!

As a result of some persistent investigative work, and some real prevention, this woman just spent the last 20 years as a healthy person instead of a Crohn’s patient. Now imagine the difference in the cost of treating a person with active Crohn’s Disease for the last 20 years, as opposed to the cost of a few vitamins, probiotics, and digestive enzymes over that same period of time. In a 1990 study, it was estimated that the average expenditure per year was $6,561 on every Crohn’s disease patient. Allowing for only a 3% annual rate of inflation, it was $10,221 by 2005. (figures from http://crohns.ie.com) At an average of $8,391 per year for my patient, that’s $167,820 saved for her alone. With an estimated number of Crohn’s patients in the USA in 2005 at 600,000, that’s a staggering annual cost of just over 6 billion dollars a year for all patients. Now, let’s say that the origin of Crohn’s is undiagnosed food allergies, as it was in my patient, for half of the Crohn’s population. That is an annual savings in direct medical costs of 3 billion dollars per year, as well as uncounted costs in loss of work days or full disability.

Here’s another example in which keeping the goal in mind–the greatest health, for the lowest cost–insisting on looking for the cause of illness, and doing the real work of prevention pays off. I saw a 7 year old girl who had been, in her mother’s words, in “medical hell” for five years, since the age of 2. She had eczema so severe that she woke herself up scratching at night, and her arms and legs were covered with sores, she had asthma, ADD, recurrent ear infections and gum disease. Her mother said she had been to the doctor almost every week with her over the previous five years, and she had had countless courses of antibiotics. We found she was allergic to gluten, dairy, corn products and cane sugar. I only saw her for two visits, but her mother called me a year later and told me that she was free of all her illnesses, including the asthma and ADD, and that in the year following her visits to our office, had been to see a doctor only once, when she hurt her hand on the playground. I haven’t done cost estimates for her, but it’s easy to see the difference between more than 40 doctor visits a year, and medications, versus one visit and no medications. In addition, what is the cost of a child missing important early years of education because of ADD?

The point of all this is that each individual act of prevention is important, and that in health care reform, it’s not just a matter of who pays and who is covered. It’s having the motivation to examine what we are really doing. What is our concept of health care and what are our goals? We need to stop following the false bottom line, looking narrowly at the profit margins of health care providers and insurance companies, and instead broadly examine the true financial, social and emotional costs of illness. We need to start at the base, and educate doctors in real preventive practices by requiring comprehensive courses in nutrition, exercise physiology, and psychoneuroimmunology at all medical schools. We need to look for real diagnoses and do real prevention.

The health care industry has just said that it is projecting 20 years of “self-regulated” cost reduction. If we accept this, then we have learned nothing from our recent economic crash, brought to us by the “self-regulated” financial industry. We can no longer afford the insanity of doing the same thing and expecting different results.