THE NON-MEDICATED LIFE - Reducing Health Care Costs, Part One
Editor’s Note: This is the 54th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death, while others may reduce certain types of cancer.
In the first 53 installments of The Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost. At a time when health care costs are becoming prohibitive for most Americans, an approach emphasizing diet and lifestyle that has the potential to dramatically lower costs through the actual prevention of disease, deserves fair hearing and consideration. Part One will focus on why such an alternative strategy is needed. Part Two will address the specific disease states which best lend themselves to this approach.
No one will argue that healthcare costs have not become prohibitive. The reasons for the high costs are twofold: first, our population is slowly becoming less healthy, and second, our population is getting older. Quite simply the increasing number of individuals who are less healthy and those who are older require more health care resources and more dollars.
Up until recent times the financial model for ensuring there is enough money to pay for health care resources has been the insurance model. In this model, the cost of caring for the relatively few sick is covered in theory by a modest premium paid by all. When those who are well vastly outnumber those who are sick there is money for all appropriate interventions to save lives and hopefully also improve the quality of life and longevity. However, as the number who are sick increases and the number who are well decreases, at some point there is not enough money to care for all who require it. The only apparent options are to increase the cost in dollars we all pay, to decrease the services offered, or decrease the cost we pay for the services offered either through increased efficiency or decreased reimbursement.
Currently, all three options are employed. All of us note that we are paying much more for healthcare than even a few years ago, and this has given rise to the advent of new insurance products, such as high deductible plans that serve to keep costs more reasonable – as long as we remain healthy. We also note that the services offered including medications, imaging procedures, and surgical procedures are increasing requiring health plan authorization, pre-authorization or approval. And finally, we all may note that doctors and hospitals and ancillary staff have seen reimbursements and salaries drop, with the result that physicians are retiring early and hospitals are closing – and access to care has been compromised.
We have seen strategies to hold down cost by a switch to generic drugs; we have seen the advent of an electronic medical record with the hope that an increase in efficiency will hold down costs, and we have seen the reorganization of medical care to emphasize accountable care organizations, which promise to hold down the cost of care by restructuring incentives to providers of care to support reimbursement for the outcome of care, rather than for processes and procedures.
The problem with the currently promulgated options is simple. All three options completely ignore the fundamental problem that the population is getting progressively less healthy. Instead of focusing on how to get the population more healthy in ways that do not require an increase use of healthcare resources, the current approaches look to strategies that even if fully and successfully implemented would do nothing to stem the tide of progressive need, progressive dependency, and the uncontrolled cost implied. Such strategies ultimately will ensure a nation of the unfit, the unwell, and the unable burdened with financial insolvency.
The alternative is to focus on how to get the population more healthy and thus decrease the number of sick individual and increase the number of healthy individuals. This may be accomplished by the paradigm shift of first establishing in the public consciousness that preventing disease is the primary goal of healthcare and that there are medically acceptable strategies for most individuals to avoid medication, to decrease medication, and to avoid medical procedures. It is important to establish in the public mind that these strategies require the effort of the individual as well as the group and that it is possible to pay with focused and informed effort and behavior change rather than dollars to achieve true robust health.
To this end, an emphasis must not simply be on restructuring incentives for the providers of care but also on restructuring incentives for the consumers of care. Healthcare insurers speak of “pay for performance” regarding providers of care when they also should be speaking of “pay for performance” for the consumers of care. If we continue to treat adults like children where they have no responsibility for their healthcare outcomes we will foster a system of unnecessary need and unnecessary dependence that will not be sustainable going forward. Our health in the final analysis is not primarily dependent on the actions of others as much as it is dependent on the choices and actions we make each day. For the specifics of how we can use diet and lifestyle individually and collectively to prevent disease, make out population healthier, and reduce health care costs stay tuned for Part Two.
Paul E. Lemanski, MD, MS, FACP is a board certified internist with a master’s degree in human nutrition. He is director of the Center for Preventive Medicine of Paul E Lemanski MD PLLC. Paul is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.
**Originally published in Adirondack life magazine