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.