The best antidote for a degenerative disease is a regenerative lifestyle
The health care system, what I call the medical-industrial complex, is in reality a disease management system. It does little to promote health and makes money only when people get sick or injured. Doctors only make money when they treat a sick patient. They make nothing for keeping them well. This is the so-called fee for service model and it stinks. It drives up disease care costs. Pharmaceutical corporations create drugs and advertise them on TV in order to get as many people as possible hooked on them. Doctors do little to treat underlying diseases but willingly prescribe drugs to ameliorate symptoms. The big money is in surgery.
Obamacare, aka the Affordable Care Act, while it has placed into law important provisions such as disallowing rescission, disallowing kicking people off of health insurance policies due to preexisting conditions, providing for not quite universal coverage etc, it does little or nothing to actually make health care affordable. Hospitals charge exhorbitant rates according to their Chargemasters. In some cases they won’t accept a patient’s insurance coverage, demanding upfront payment in cash instead. Obamacare does little to keep pharmaceutical costs, health insurance costs or hospital costs down.
I have written a number of critical articles about the health care system. But I don’t want to leave the impression that all I’m doing is to just tear this leviathan down in a critical and negative way and have nothing positive to say regarding the health care system. I do have some positive suggestions about how it could be improved. Since doctors, hospitals and pharmaceutical corporations only make money when you get sick, they have no financial incentives for keeping you well. If you never got sick or injured, they would all go broke. The financial incentives are totally misaligned.
So here is my modest proposal: pay doctors only for keeping you well. This system could be implemented as follows. Put doctors on a base salary plus bonuses and minus penalties. The base salary should be sufficient so that doctors would want to become genaral practitioners or family doctors and not just specialists. Today the opposite is the case. Most doctors want to become specialists, and not family doctors, because that’s where the money is. This situation needs to be reversed.
There should be positive bonuses and negative penalties. On a per patient basis, the cost per average patient for a year’s medical services could be computed. This cost would be adjusted for the age, gender and geographical location of the patient. If a patient consumed less disease management services than average, the doctor would be paid a positive bonus up to the amount of money saved. On the other hand if the patient consumed more than the average amount of disease management services, a negative penalty would be taken away from the doctor’s base salary.
Patients would have to be assigned on a somewhat random basis so that any particular doctor would not wind up with all healthy or all unhealthy patients. The negative penalties are necessary so that a doctor would not just concentrate on his healthier patients and write off the unhealthier ones.
With such a system in place, the financial incentives would be lined up correctly. There would be a tremendous savings in the cost of health care. Doctors would be paid for keeping patients well and not just for taking care of them when they were sick. Of course taking care of the sick in order to restore them to health would still be a significant component of health care. The negative penalties would align the doctor’s incentives to get the patient well as soon as possible in the least costly way.
With such incentives there would be more resources, attention and research devoted to understanding what makes for a healthy lifestyle. Much of this is already known and in fact is common sense. One of the main things a doctor would do is to get his or her patients to stop smoking. The next thing is weight management.
Who knows? -doctors might even be incentivized to hold fitness classes in their offices. Diet, nutrition and exercise are the basic components of a healthy lifestyle. Doctors would see their patients regularly and sit down and talk to them about their lifestyles and what makes for a healthy lifestyle instead of the incentive today to get the patient in and out of the office in six minutes in order to make any money.
Doctors would advise their patients to stay away from processed foods and foods containing a lot of sugar, fat and salt – all the things which food manufacturers put in in order to make food taste better. Instead of drugs to make patients less sick, doctors would advise their patients about vitamins and food supplements.
Doctors would advise their patients to stay away from GMO foods, foods which have been genetically modified so that they can be sprayed with large amounts of pesticides and herbicides with no negative effects to the plant but not necessarily no negative effects to the human who eats the plant. Fruits and vegetables sprayed with pesticides and herbicides contain carcinogens since most chemicals ingested or otherwise taken into the body are carcinogens.
Therefore, doctors would advise their patients to consume organic foods as much as possible and to limit “eating out” since the aim of most restaurants is to make food taste as good as possible while at the same time adding preservatives to lengthen the shelf life. Even expensive restaurants are using highly sprayed and chemically altered foods unless the menu specifically says that the foods are organic.
In particular fast food restaurants are to be avoided because all foods served there are ones that have been acquired from industrial farmers who use pesticides, herbicides, preservatives, antibiotics and hormones because these foods are the cheapest to produce and the cheapest to consume.
Meat and farmed fish, unless they are organic, contain large amounts of hormones and antibiotics and are raised and killed under ghastly conditions for the animal’s health and well-being not to mention the health and well-being of the humans who consume them. Only wild caught fish should be eaten and beef, pork and chicken that have not been fed GMO or pesticide and herbicide sprayed foods. Doctors would have to become experts in nutrition something they do not even have a course in in medical school today.
Exercise and lifestyle are important components of a healthy life. Aerobic exercise such as swimming and running are probably the most important forms, but weight training to develop muscle mass in also important especially for older people who tend to lose it. An exercise program appropriate to a patient’s age will be developed by caring doctors. There should be emphasis on non-competitive sports since how fast or strong or agile a patient is is not important.
What is important is keeping a patients’s body operating at a highly functional level. A lot of people who are not athletic have never been encouraged to exercise for the sake of the health benefits it brings. Even competitive athletes often become sedentary once their competitive careers are over. The point isn’t to win a contest; it’s to improve one’s health and stay alive.
People need to exercise on a daily basis and try to stay “in shape.” There is a difference between random exercise and exercise that keeps the cardiovascular system operating at a high level. Any athlete knows the difference between being “in shape” and just tossing a football or a basketball around occasionally. Generally, if one gets winded with moderate exercise, one is not “in shape.” If you can run or swim continuously for a half hour or more, and do this on a daily basis, you are probably in pretty good shape.
There needs to be more research done on the benefits of exercise in disease prevention, but most of the reserach goes into developing drugs for disease treatment rather than into creating the preconditions for preventing disease in the first place. The best antidote for a degenerative disease is a regenerative lifestyle. The body will regenerate itself if given a chance through diet and exercise. High levels of blood oxygenation which come about from exercise can probably flush away the precursors of disease and stagnation in the body just as a free flowing stream is healthier than a stagnant pond. Why is nobody studying this? Because there’s no money or Nobel prize in it?
A nonsedentary lifestyle should be encouraged. Sitting behind a desk for 30 years in a professional career is not good for maintaining a healthy body. Mild exercise during one’s work hours combined with aerobic and weight training in a patients’s recreational time should lead to the best results. The American lifestyle of sedentary work combined with hours spent watching TV while consuming junk food is the worst possible lifestyle.
Our bodies were designed as hunter gatherers. Instead the American Way of Life promotes sedentaryness at an early age. Kids are taught to sit and be quiet from preschool on. For those who rebel against this lifestyle, they are diagnosed as ADHD, Attention Deficit Hyperactivity syndrome and, of course, prescribed a drug at an early age – Ritalin. This gets them on the treadmill that, for every problem they face in life in not conforming to the American system, there exists a drug to take off the rough edges and make them perfectly docile and compliant. The goal is to make them docile and compliant workers and consumers.
Doctors need to get involved in advising their patients about lifestyle. A low stress lifestyle will lead to a more mentally and physically healthful life. Avoiding high stress occupations is an important part of choosing a career. Although the workstyles of those who do physical work is looked down upon in many quarters, those occupations may be the least stressfull and have the most beneficial results compared to sedentary workstyles and lives.
An article in a recent issue of Time magazine was entitled “How to Cure Cancer” which was emblazoned in large type across the cover. In all due respect, they are missing the point. The point is not how to cure cancer but how to prevent cancer in the first place. Cancer in many but not all cases can be prevented by lifetyle choices. The main and obvious one is not to smoke. But also to stay away from chemicals in the environment as much as possible.
Recently a Marine former drill sergeant traced the dealth of his six year old daughter to cancer to the contamination of well water at Camp Lejeune by a local dry cleaning company which dumped toxic dry cleaning chemicals on the ground instead of disposing of them properly. He was recently acknowledged at the White House for his work on tracking down the problem and probably preventing many other cancer deaths.
There may be no Nobel prize involved for a doctor who keeps his patients healthy as there might be for a doctor who studies molecular biology and discovers a cure for cancer. All the prestige and the money and the interesting work is in the frontiers of science, but the true doctor heroes are the ones who care enough about their patients to get them to stop smoking, eat healthy foods, drive cautiously, keep their weight down and exercise.
Even if there is a cure for cancer in terms of developing drugs which can shrink tumors, there is no guarantee that new tumors won’t eventually grow as long as the preconditions for cancer continue to exist. The important thing is to live a healthy lifestyle so that most cancers cannot get a toehold in the first place.
So there is my modest proposal for improving the health care system and keeping health care costs down. The important thing is to align financial incentives as much as possible with keeping patients well instead of charging them for instances of disease management when they get sick.
John Lawrence
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I dunno John. I’ve written in many times with high celebrations of your earlier articles because I found them (or you) to be the hottest brightest light on that day’s particular illness care subject I’d read. This time I’m wobbly.
I can’t understand how your idea to reward doctors higher pay for providing fewer services is any more than a replication of poverty-based care, in which more people die because they don’t have access to meds and surgical corrections. A lot of people whose bodies require more interventions recover completely and lead productive lives, and doctors should have incentives to provide care, not deny it.
When you say, “Patients would have to be assigned on a somewhat random basis so that any particular doctor would not wind up with all healthy or all unhealthy patients,” you’re encouraging a further erosion of personal, intimate understanding between patient and doctor. There’s no denying that some people become “professional patients” who confuse illness with achievement; you can hear a lot of “Have I told you about my preventive appendectomy?” and “My doctor consults with the Mayo Clinic” from lots of people. Medical consumerism indicates a life failed.
But our problems don’t start with the doctors. I’m convinced of that. They tend to be higher functioning mammals with genuine curiosity about what is causing a person’s illness. Big Pharma and Big Medicine in most cases punishes their curiosity by insisting that a prescription issued in 5 minutes is the best way to gain maximum profits from medical care. And if there are professional patients overusing their benefits the patients should be advised by professional counselors, medical and psychological, who can lessen the expense of constant dramatic interventions.
The doctors, not capital investors, must be restored to running the system.
Thanks, Bob, for your comment. I was fortunate enough for about 20 years to have a doctor who worked outside the system. He sat you down and talked to you about your life for a half hour, 45 minutes. He would stress that you should wear your seat belt and stop smoking if you were a smoker. He also got you involved in whatever problems you were having by asking you to research the disease or problem yourself. I spent some hours in the medical research library at UCSD going over scholarly papers at his suggestion.
When I moved down to San Diego in 2000, I felt I had to have a new doctor since he was located in San Marcos, but I remember Dr. Sutton with fondness since he was never in any rush to get you in and out of his office and he didn’t tolerate any bullshit. He was old in those days, a WWII veteran, and I don’t know if he’s still around, but I remember that he cared about his patients and took time with them.
That’s not happening to any great degree today.
I’m with Bob on this one. John, I respect and value your reportage on health care and I am wobbly on this one. We are often born into and live in compromised environments filled with a stew of chemical toxins that corporations deny knowledge of, responsibility for, and are willing to pay fines & continue to pollute because it remains profitable. Moving from those environments may be the only choice, but that doesn’t address the issue of why those environments exist in the first place.
The foods that are ubiquitous and packaged to catch our eye and satisfy our desire for sweetness and salt are a testimony to corporate power and governmental support of that power- think corn syrup sweetners and agricultural subsidies. We can be encouraged to avoid those foods, but why do they exist in the first place?
Our workplaces are seldom ergonomic (five star hotels won’t provide fitted sheets to lessen the impact of changing kingsize beds on housekeeping staff, generally women) and many don’t even pay for sick leave. Women in many work environments don’t get pee breaks and end up with urinary tract infections. A doctor can prescribe medicine for the infection; the patient can scrupulously follow the regimen– and return to the same workplace, because there are few or no other work options.
You cannot separate out individual health and health care, talk about a patient’s individual responsibility for his or her own health, and incentivize positive health care provider outcomes in a political and economic vacuum. The deck is frankly stacked against a healthy environment and healthy lifestyles and healthy human beings.
My decision to buy a more costly organic tomato might make me feel good for a variety of reasons and even have a limited salubrious effect. But I think the emphasis on individual choice gives a free pass to corporate practices and their less than salubrious effects. Emphasizing individual responsibility, which always makes good sense on a basic level, can also became a dangerous diversion from an analysis of which entities wield a preponderance of power and how that power is used.
What you are describing as a sound relationship between health care provider and patient is hauntingly similar to the relationship being promoted between K-12 educators and students. Teachers teach to the test- outcomes- and there is little if any meaningful discussion about the social/economic/political context in which education occurs. We have been recently informed how that pressure for outcomes has translated into cheating, erasing the wrong answers. I don’t think you would agree with a recent attempt in Tennessee to reduce aid to families if their children perform poorly in school, yet that is touted as a way to incentivize certain outcomes–improved school performance– of the poor.
John– you have consistently pointed out the abuses that result so often from unregulated profit driven corporate power. Individual doctors and patients are at the bottom of a pretty savage food chain at the moment which has become even more fraught by the incentives and dis-incentives being proposed for employer provided health insurance. Since we don’t have universal health care, employer provided health insurance is the only option for most people under medicare age. Some employers are responding to higher health costs by charging employees more if they are overweight, have high blood pressure, are diabetic, smoke and do not show an improvement in their health through counseling, etc. Interestingly, there is little push back against the insurance company decisions to maximize their profits by increasing premiums any time they can. For the health insurance companies, there is nothing but carrots.
I am unwilling to see the only stick in all of this applied at the physician – patient level.
Anna, thanks for your comment. Sorry for the delay, but the other day right in the middle of my response, the computer died. I picked up a new laptop at Fry’s today.
Anyway, a doctor can give individual advice to a patient without precluding an analysis of the corporate and societal forces that create the “toxic stew” of chemicals that poison our environment in the first place. I envision doctors who will provide that kind of information to their patients, but it depends on the patient’s choice of doctor.
I was fortunate to read an article about Dr. Sutton which stated his political as well as medical philosophy. That’s why I chose him in the first place. I knew he was a left winger to begin with. So I felt a sense of sympatico with him from the start.
I would hope that doctors participating in a system to help prevent disease such as I’ve suggested would not be dispensing “medical advice in a vacuum.”
No, I wouldn’t “agree with a recent attempt in Tennessee to reduce aid to families if their children perform poorly in school” because I don’t believe that test scores should determine how either the student or teacher is doing or that teachers should be evaluated solely on that. By the way nowhere in the article did I suggest that there should be financial consequences to the patient based on his or her medical or health well-being or lack thereof.
But this brings up an interesting point about both teachers and doctors that is relevant. Should a teacher or a doctor receive no evaluation of how they are doing in your mind? My father was a school principal and part of his job was to give teachers an annual (I’m assuming) evaluation. He would sit quietly in the back of the class and take in the proceedings. Of course, his evaluation of a teacher’s performance was based on more than that. He knew each of the teachers very well and had feedback from parents and other sources.
So his evaluation was based on a totally human interaction with the teacher and not some metric based on test scores. This was in the 1940s, 50s and 60s. I think this kind of evaluation is completely appropriate. When I worked in industry I had to have an annual review by my supervisor as well. If I had performed well, I got a raise. If I hadn’t, I didn’t.
With the system I’m suggesting, doctors would be evaluated on how few medical services his or her patients consumed, but that need not be the entirety of the evaluation. I’m not laying out every detail of how such a system would work, just making a few generalization.
Kaiser Permanente already pays doctor’s a set salary, and I imagine that they do or easily could evaluate doctors based on the improvements in health of a particular doctor’s patients. So I don’t think what I’m suggesting here is totally off the wall. I’m not a Kaiser Permanent patient, but they might very well be giving doctors bonuses based partially on how well they are motivating patients to live healthier lifestyles.
Finally, obesity and obesity related diseases and degenerative diseases are epidemic in this country. I think doctors should do more to educate their patients not only about changing their lifestyles to avoid those disease but also to educate their patients about the societal factors responsible for helping to create them.
Again, we can all agree that the current system is badly broken, but a real, workable solution for the obvious problems is not nearly as obvious . . . until you look at the unthinkable: the inherent value distortions of the monetary system itself driven by the profit motive over the basic needs of humanity. But how do you take on something so huge and to which we’ve grown so attached for thousands of years? We’re currently like the addict who knows their addiction is killing them, still cannot bring themselves to change. Until we as a species come to terms with that root problem, we’re just arranging the deck chairs on the Titanic or engaging in hypothetical discussions about how many angels can dance on the head of a pin.
Question: “How is an individual’s health different from the importance of Public Health (about which we’ve learned some important lessons over the last hundred years or so)?” Are we so willing to sacrifice the limb (person) thinking we can still save the life (species)? Have we truly learned nothing since the 19th Century? There is a far better theory which addresses our core values in an elegant way, but it will take much more intestinal fortitude than I think enough of us have yet: Video
Hi John, I have been anxiously awaiting the bill from Sharp for the over-night stay when I had my TIA on March 4th. It came today, and although my insurance covered all but $150 of it, I was a little surprised at the total of $25,535.30. (Thanks goodness for Medicare and my AARP supplement!)
In looking at the breakdown I thought that Radiology would have been more – CAT Scan; MRI; MRA; EKG; carotid artery;
echo-gram – but it came in at $5410. I was charged $1012 for therapy services, but, in actuality, did not have any therapy. I was evaluated but it was deemed unnecessary. The lab bill was high – $4414 and for the life of me I do not know just what that entailed. It took 7 tries to get the vein for blood tests; didn’t have any IV’s, so maybe each poke was $630.57! And am not sure about the “Special Services” of $5140. The Intermediate Care Room was a whopping $6424; Emergency Care Services was $2749. Supplies were $245 – could that have been the little plastic bag of toothpaste and brush? – and the pharmacy was $141.30. Let’s see, I had 2 Plavix; and 2 thyroid tablets. Wow! Couldn’t do it without insurance. Judi
Thank God, Judi, for Medicare. Otherwise, you would have had quite a bill similar to the one I reported about the lady who went to the hospital for a false alarm. Now we see why Medicare is going broke! Judi, you should inquire what some of those charges that you don’t understand are.
I have traditional Medicare, but no supplementary insurance. I inquired about that the other day and found out that the cheapest available would cost me $150. a month. Traditional Medicare itself costs about $100. a month and that covers 100% of the hospital bill and 80% of the doctor’s bill. So I would be paying $150. for about 10% or less of the total bill! I won’t get it and take my chances.
Thanks for your comments, John. I have a call in to Sharp for some clarification. BTW – my supplemental insurance with United Health Care (AARP) is $69 a month. It covers just about everything, including RX. I have the highest coverage because I never changed it after Bob died, and it paid for almost all of his medical expenses. I don’t think I will change it now. Judi
I checked with AARP, and they are the ones who quoted me $150. It’s age related. If I would have gotten it at 65 when I got on Medicare, it would have been cheaper.
Judi, your medical bill for $25,000. was higher than the lady’s bill who was profiled in the Time article. Her bill for a false alarm heart attack was $21,000. and she had an ambulance ride to boot! However, she wasn’t on Medicare so she had to pay it herself.
These kind of bills are the reason that Medicare is in trouble. There’s nothing wrong with Medicare in and of itself except for the fact that they have to pay bills like this.
We should demand that our government should crack down on these exhorbitant hospital charges. They are the cause of Medicare’s problems and are the cause of runaway health care costs outside of Medicare.
I’m glad that you came out of it unscathed though.