Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
1 Apr

Design Your Own Health Care?

healthcare moneyPoliticians of all stripes are discussing it. Millions of Americans are losing sleep over it, particularly those who have lost their health plans in recent layoffs or workplace cutbacks. Every day we read more news about the state and debate of health care in this country. People are delaying recommended tests or important procedures – sometimes with dangerous and/or costly consequences. Because of rising costs, employers are less likely to offer health coverage. All the while, individual plans are out of reach for many working people. For those who find themselves unemployed, COBRA plans can likewise seem unaffordable.

And it isn’t just older Americans impacted by these trends, but also young adults. A recent poll conducted by Medco (pharmaceutical benefit manager – but still…) showed that more than 70% of those 25-34 reported having a harder time paying for health care, fewer than 50% of adults 55+ felt the same. According to research conducted by the Commonwealth Fund, a center for health care policy, young adults (19-29) make up approximately thirty percent of the nation’s uninsured population. (The trend has sparked the label “the young invincibles,” a blanket characterization to be sure. While some in this age group believe their youth renders insurance unnecessary, most go without because of financial limitations.) Still others in this younger age group (and, indeed, in all age groups) are happy in professions that don’t offer group health plans. Many attempt to make a go of it with cheaper “catastrophic” policies for major events and personal savings or health reimbursement accounts for the majority of their health care. The result for many is a very different, more individualized health network and care focus than those who rely on insurance “approved” providers and treatments.

For some with or without health insurance, the bad economy is encouraging a commitment to preventative care and/or an interest in cheaper, alternative treatments for existing health concerns. In the last quarter of 2008, “nationwide retail sales of vitamins and supplements totaled nearly $639 million, up almost 10 percent from the same period in 2007.” And though the bottom line in the family budget may influence this recent rise, the trend toward alternative measures has been growing for some time. A survey conducted by the National Center for Complementary and Alternative Medicine (NIH) and the National Center for Health Statistics (CDC) revealed that some 38% of American adults and 17% of children “use some form of complementary and alternative medicine.” (“Complementary and alternative” medicine for the survey included health related services and products as diverse as non-vitamin/mineral supplements, meditation, massage, chiropractic, naturopathy and acupuncture.)

With the economic upheaval and political focus, we thought it would be an opportune time to step back from how we view health care in this country and envision what we wish it could look like. While the country debates the broader issues of funding and plan structures, we thought we’d zero in on the individual experience.

Insurance, like our health care system in general, addresses health as an absence of symptoms. We wondered what true wellness-based health care – both programming/services and coverage – would look like. What would an annual physical be like? Would there be one? Would there be more than one? What kinds of follow up would exist? How could a health care system/cooperative effectively offer preventative care for the common physical and mental ailments of our society?

If we step outside the box of catastrophic events and serious illness, what can we imagine as true “wellness” care? Does the thought conjure a set of universal principles or perhaps a more individualized design? There’s been debate for years about coverage of “alternative” medical providers, practices and products. What do you think should be covered but isn’t? (On the flip side – a fair question, we think: what is covered that shouldn’t be?) What kinds of health education opportunities do you see as promising, cost-effective possibilities? What kinds of incentives and rebates could/should insurance companies offer to encourage good health in their customers?

Whether your vision focuses more on what could serve the larger common good or what would be an ideal customized plan for you/your family, the questions ultimately get us thinking about what we want from health care. When it comes to our health, for what do we as individuals take responsibility? When do we feel we need to work in partnership with medical/alternative experts and resources? Does our current system work with or against the vision you have for our own care?

We want to know what you think. Tell us your best and boldest ideas, ponderings, rants, raves and solutions.

Further Reading:

Deconstructing Healthcare in America – a Modest Proposal

The Importance of Second Opinions

The High-Tech, High-Risk State of Maternity Care

Should I Get a Flu Shot?

The Heart Scan Blog – Self-Directed Health: At Home Lab Testing

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Mark,

    Another excellent and current blog posting, something that needs to be talked about at length. Your proposition of looking at healthcare from a “wellness” standpoint isn’t new, but something that seems to fall by the wayside during mainstream discussions, and something I rarely hear from our legislatures in Washington. The cost of healthcare is rising and our current system cannot sustain itself now, let alone in the long term. How do we “fix” the system?

    I’m a strong believer that wellness is an active pursuit by the responsible individual. We can’t place our needs in the hands of others and then hope that everything will be ok. There are viable alternative and holistic philosophies that focus on all aspects of health, not sickness alone. The best and most effective “healthcare” must begin from the inside out.

    Phil Mancini wrote on April 1st, 2009
  2. Our system treats the symptoms and not the problems that is for sure! I am glad to hear the trend is headed towards preventative maintenance. I think I would rather eat better now than have a triple bypass later. Some people jst don’t feel that way though. It is more… “I can eat like this now because I CAN have a triple bypass later”. But now if i can’t afford a triple bypass or it is not going to be as easy to get maybe that eating better is a little more appealing. I dunno… just rambling. Car insurance can charge different rates based on your driving record, why can’t health insurance charge based on your health record? I don’t nesecarily pay the same car insurance as Nick Nolte because of his dui’s but I do pay the same price for health insurance as my coworker is on his second bypass. Recently my company started charging smokers more for health insurance. I am ok with that.

    The SoG

    Son of Grok wrote on April 1st, 2009
  3. I’d say a more appropriate name for America’s “health care” would be “disease treatment.” There’s not nearly enough emphasis on prevention and healthy habits… not to mention that most doctors have only a very small body of knowledge on nutrition that is usually outdated and inaccurate. It also doesn’t help that most of the medical studies doctors hear about are funded by pharmaceutical companies whose motivation is to sell drugs, not to keep people healthy.

    Emily
    from the Healthy Eating, Naturally blog

    Emily wrote on April 1st, 2009
  4. I live in Canada, where we do have “universal” health care. All that’s really covered though are hospital trips and visits to your GP. You have to pay for prescriptions or any sort of non-standard health care such as physical/massage therapy or chiropractors or acupuncture. The biggest thing that makes me angry about the system is that we foot the bill for people that knowingly engage in destructive behaviors such as smoking and/or drinking and/or drugs.
    While I realize (and I’m thankful) that we do have this coverage because we don’t need to worry about it the way our American neighbors do, and that I also understand that addictions are addictions, I feel that if a person is making no attempt to stop their destructive behaviors, they should ahve to foot the bills for their care. Much like transplant livers and lungs aren’t given to people that are just going to abuse them.

    Christine Crain wrote on April 1st, 2009
  5. Great idea, but it’ll never happen. The pharmacology lobbies are too powerful, and too many elected officials are in their back pocket for that.
    We live in a country that has a good deal of it’s income based on people being sick. Conventional Medical Wisdom and big pharma want us taking more pills, not less. More evidence of this is the study on the new “polypharmacy” pill, a combination of hypertension, and cholesterol meds that they would like even healthy people to take.
    I think the day might be coming where an insurance company will either not insure you, or give you a discount based on if you are taking certain meds in a “proactive” fashion. I’m not optimistic about health care in America. We need to do what we are all doing here, take control ourselves and eat real food and get a proper workout and be active. Then you won’t have to rely as much on the medical industry. Unfortunately, they’ll still take your taxes for it..

    Dave, RN wrote on April 1st, 2009
  6. christine
    I’m another canadian and I’ll agree with you about being glad to have our system but mad at the people who take advantage of it.
    I’m also a big fan of education and self empowerment. I think a big problem, addressed time and again by Mark here, is the lack of good info on how to live a good lifestyle. The government bowing to the pressures of powerful interests to give us poor health advice.
    Scientists having to frame research in such a way that it fits with the norm and not being able to disagree with “conventional” ideas without losing their funding.
    The media jumping on any story from science, misinterpreting it and selling it to the public whether or not it’s right.
    All these add up to people not knowing how to be “Well”. Wellness care depends on education, open mindedness and literacy on the subject.
    I think this is a major place where we need to do better. I know since I’ve really delved into the primal lifestyle (with the help of people like Mark). I’ve gotten a lot fitter, healthier, more productive and happier.
    Included in this need for education is an actual desire of the people to live better. You can lead a horse to water but you can’t make them drink.

    John FitzGibbon wrote on April 1st, 2009
  7. How about those of us that never use doctors or medicines don’t have to pay any taxes.

    Mike OD - Life Spotlight wrote on April 1st, 2009
  8. Very timely post from my perspective. I buy my own health insurance and just received my latest premium increase yesterday…+36%. I already have a high deductible, catastrophic plan so there is no option to make it cheaper aside from dropping it, which I will never do.

    As for what to do, I agree that we need to focus on prevention, and that this will be all but impossible as long as big pharma etc is involved (much like the food industry with the agri-lobbies). I would like to see everyone issued an annual health care voucher. Use it as needed, and pocket the remainder at the end of every year. This would promote healthy lifestyles in some people. Maybe offer classes to educate others, payable from their health account. The bottom line is that if people have no financial “skin” in the game they are going to demand all of the most expensive care they can possibly find/use. Also, they will make no effort to live in a healthy way which ends up costing all of us. Just one of many thoughts I have on the subject.

    Rodney wrote on April 1st, 2009
  9. Not a bad post, Mark!

    I agree with Phil. The individual is where it all begins and ends. I’m for elimination of health insurance. Pay for service would lower costs and make health care more realistic.

    Too many people not sufficiently interested in their health, burdening a system with not enough time, or money to pay doctors to counsel patients on lifestyle changes that they won’t make.

    That’s how I see it. People like you and I along with your readers are a huge minority. If we were the majority it would all work a lot better, I think.

    Dr. J wrote on April 1st, 2009
  10. I personally don’t think the system is “broken.” It’s just “abused” and getting more abused. Basically its overtaxed. I totally agree with the prevention thing. The problem, and everyone here should know this, is the “prevention” they recommend. I followed this prevention advice when I was 18 and put on blood pressure and cholesterol meds and told to exercise and follow a low fat/no cholesterol diet. I got worse and worse over the years. The problem is also in the “prevention” they recommend as opposed to the prevention we know actually works (the cure in a lot of cases also).

    Imagine if everyone ate paleo/low carb/etc. No grains/sugars/polyunsaturated oils. Diabetes and related costs (except some costs to Type 1)? Gone. Heart disease, stroke, alzheimer’s? Also mostly gone. Same with cancer. Certainly reduced in costs. Lots of other diseases have been linked to things we didn’t evolve to eat.

    That really takes away a big load. Leaving injuries and others. The other thing I mention is our ability, due to medical advances, is keeping people alive though maybe they shouldn’t. At what point is it decided that the body isn’t meant to live forever? Better yet, who gets to make this decision? Only then will I think that I could support a single (ie government) sponsored health care system. Still not, sure I would want some politician (who won’t be subject to the rules) deciding what procedures I can have and whether I should live or die? Just look at the job they do with everything else…

    Joe

    Joe Matasic wrote on April 1st, 2009
  11. Great post Mark, and many thoughtful replies from my fellow Apples. As an alumni of the Institute for Integrative Nutrition, and a health counselor myself, I have been trying to do my part in lobbying for the spead of more information to the masses (real food is medicine- and access to real food is a right, not a privilige!) At any rate, the April newsletter from my school nicely dovetails with this topic. I’ve included it here (from IIN founder Joshua Rosenthal)

    “I am optimistic about the future of our healthcare system and the powerful role that Health Counselors will play.

    Last month, Integrative Nutrition guest speakers Andrew Weil and Mark Hyman testified in front of the Senate on how to turn our sick-care system into a healthcare system. They pointed out that Americans spend an exorbitant amount of money on medications and operations, and little to none on education and prevention. Their solution is to integrate more alternative therapies such as acupuncture, yoga and meditation into conventional medicine, and to empower Americans to take control over their own health.

    There will always be a need for highly trained doctors, but there is a new tier of Health Counselors that aren’t as expensive to train, and who can motivate people to eat better, exercise more and do stress-reducing activities. That would be us.

    Andrew Weil called our current healthcare system a “nutritionally illiterate system.” Wouldn’t it be a lot easier to eat whole grains, fruits and vegetables than go in for quadruple bypass surgery?

    This is where Health Counselors step in. We can be health activists in our communities, advising others to incorporate healthy foods into their diet and teaching the importance of primary food. We can help reform the healthcare system so people are spending less money on medications and operations, and investing more money in nutrient-rich food and alternative therapies. Let’s empower people with knowledge and tools to achieve high level wellness”.

    ok, so maybe the whole grains part is not Primal, but I think we can all agree that even getting 1% of Americans off of the SAD & into a quasi-primal way of eating would have tremendous, positive reprecussions!

    marci wrote on April 1st, 2009
  12. I’ll admit, I honestly don’t care about the system and how it applies to the 95% of (unhealthy) Americans. I am so primal in that I really only care about me and my family, and then friends after that.

    I think we should just worry about what we healthy people should do to not get shafted by this system (which is obviously not designed for us!)

    Since switching to a primal blueprint style life, I haven’t had a single sniffle. The only time I feel crappy is when I cheat on the diet. This isn’t to say that I’ll ever get sick, but I get sick rarely enough that I don’t need extensive insurance.

    If I were to lose my job, which has great benefits, I would need to research the best insurance for myself. It sounds like it’d be a catastrophic style insurance with high deductible.

    We should worry about ourselves first, as we’re the ones getting screwed the most, and then fix the rest later.

    Berto wrote on April 1st, 2009
  13. I am also a Canadian. IMO both our healthcare systems are a reflection of our society. We get what we have created. We consider ourselves advanced but in reality we are quite primitive in our understanding of the human condition and what makes a healthy individual. For the most part people will not put in the commitment and hard work that it takes to be well. Eating well and being reasonably fit and active are a good start but the big leap is to have a better understanding how we actually function.

    Rod wrote on April 1st, 2009
  14. Tax processed food and food additives like we tax liquor and tobacco and use that to pay for health insurance. That way the people eating the *rap would be paying for their own problems and may be encouraged to choose more healthy foods. Think how much a .01 HFCS tax on every can of soda would raise. (Yes, I know I’m dreaming.)

    Frank wrote on April 1st, 2009
  15. By far the best approach would be to get government completely out of health care.

    EVERYTHING the government touches becomes a politicized, fetid fever swamp.

    For example:

    Rge government must pay social security retirees who reach the ” to Government’s goals are frequently at cross purposes.

    Terry wrote on April 1st, 2009
  16. Last post got a bit jaberwockied. Let me finish.

    As I was saying, Government’s goals are frequently at cross purposes.

    Example:
    They must pay social security retirees, who when they reach retirement age, a monthly stipend is paid until death. The shorter the lifespan the less they must pay. How motivated do you think the gov’t is to extend lifespan – I say not very since every additional month a person live costs them money.

    Also, politicians, being the slimy Cretins they are, will promote, via law, whatever “health policies” their biggest contributors tell them to. Examples include the corn growers (think Iowa caucuses), The AMA (think statins), etc., etc.

    Terry wrote on April 1st, 2009
  17. And one more thing, I tremble to think what gov’t health care will be for us aging baby boomers. We’ll be be getting old & decrepit & sickly so the gov’t will want us all DEAD ASAP to keep their health costs down not to mention keeping their social security costs down.

    Terry wrote on April 1st, 2009
  18. Until people take personal responsibility for their health, wellness is a pipe dream. People have the right to live like crap and have the government take care of them and no matter how many people you teach to fish, only so many will go fishing.

    George wrote on April 1st, 2009
  19. The best health, most personalized, most respectful and thorough health provider I have ever had was the lay midwife who attended the birth of my second child.

    Paid for her services largely out of pocket. Worth every penny, in my opinion.

    All the rest of my family’s health care comes from the military hospital. I’m glad it’s there, don’t get me wrong.

    But it’s chaotic, impersonal, and highly strained, despite the fact that it serves a very young and healthy population.

    Anyway, the idea of “health counselors” sounds pretty bad to me; they’d probably be no better than WIC counselors, who are a lumpy and unwell looking bunch, reminding you to make sure your kids drink their juice.

    Mama B wrote on April 1st, 2009
  20. Have you seen Michael Moore’s “Sicko” movie about U.S. healthcare compared to other countries? It really made me mad. I don’t know if the U.S. is capable of massive healthcare reform.

    Yum Yucky wrote on April 2nd, 2009
  21. I wouldn’t believe anything Michael Moore’s name on it. I’m sure there are grains (even those are bad here on MDA, get it…grains? It’s early.) of truth in it however. I’m absolutely sure its extremely biased and distorted just like his other “movies.” He only tell you the view he wants you to believe and portrays it the way he wants, which in my opinion is the same as lying.

    Joe Matasic wrote on April 2nd, 2009
  22. I think personal responsibility is the number one solution for the health problems facing Americans, and prevention-based care is a good next step. But I’m with Josie on this one – I don’t think the US is ever going to reform its health care system to a point where it actually helps the majority of Americans stay dis-ease free. We’re a little too far down the creek.

    “If the doctors of today do not become the nutritionists of tomorrow, then the nutritionists of today will become the doctors of tomorrow.”
    -Rockefeller Institute of Medicine research

  23. Here in the UK we have the National Health Service, and now its offshoot NICE (The National Institute for Clinical Excellence, which is basically newspeak for rationing treatment). The whole thing is rapidly becoming a sea of accountants and Deputy Chief Assistant Undermanagers, none of whom would last five minutes in industry (and in fact whose presence has already decimated manufacturing), all requiring healthy salaries and now outnumbering the actual medical professionals.

    In order to afford them many aspects of healthcare are being rationed. What I need are glucose test strips – not available, regular Full Lipid Panels – not available, and to be left the hell alone to manage my own conditions myself. Not acceptable

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    http://www.fsascience.net/2009/02/10/the_appliance_of_science

    http://barrygroves.blogspot.com/2009/01/nanny-state-at-its-worst.html

    Then when we suffer from Type 2 diabetes and other cardiovascular conditions, or obesity, we will be told it was our own fault for not eating enough carbs.

    We seem to be adopting the worst of your system – PCTs which take government money and act like your HMOs – while you are adopting the worst aspects of ours.

    Personally I’ve started watching my medical professionals, and especially dieticians, closely for lizard tongues, knees that bend the other way and other signs that they are space aliens come among us to decimate the population. The only other possible explanation is that they have decided to eliminate from the gene pool everyone who cannot live by grains alone.

    Terry above has some equally plausible explanations.

    Trinkwasser wrote on April 5th, 2009
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    Jonathan wrote on January 8th, 2010
  25. I haven’t read much of this site. Just two articles. So I don’t know what your demographic is. Instead, I’ll just take this article at face value. My answer is more interesting that way.

    I’m going to consider medicine primitive until it can replace the majority of the human body. Whether the answer is hardware or wetware doesn’t matter to me. Whether the revolution is bioprinting or cybernetics doesn’t matter to me. The key thing is that the basic design has flaws. We need to acknowledge those flaws and start trying to improve the design.

    Yes, things are far too focused on disease treatment, and not focused enough on prevention. I can agree with that. I take my conclusion somewhere most people don’t. How can you have a better preventative for the failure of Heart 1.0, than the installation of Heart 2.0? I consider the same to be true for every other organ.

    Right now, artificial hearts aren’t as good as the natural thing. Let’s fix that. Let’s make them better than the natural thing. It can be done. It should be done. It will be done. Why leave that to the distant future? Every day we can bring that future forward means less death and suffering for people with heart problems.

    Esther wrote on October 19th, 2010

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