We may be required to buy medical insurance, but what we really need is health insurance

The Affordable Care Act was intended to make insurance coverage more secure and affordable, and insure millions of uninsured Americans. The Supreme Court has now deemed the individual mandate portion – the requirement that everyone purchase health insurance – to be constitutional.

Certainly, some aspects of medical insurance coverage are in need of reform.  But a much greater need exists – the need for Americans to reform their health by reforming their diets.

Of course there will be continued debate on this subject, but when we look at the big picture (the overall health of the American people), the Supreme Court’s decision and even government involvement is irrelevant. Regardless of the government’s involvement, the health of Americans will not improve unless the eating habits of Americans improve.

Money. Flickr: 401K 2012The U.S. per capita health costs are the highest in the world. Health care made up more than 17% of the GDP in 2010. Health care costs rose 5.8% in the year ending February 2012, and costs are predicted to continue rising.  As health care costs rise, so will insurance costs. Overconsumption of medical care (for example, overuse of diagnostic tests) is a significant driver of health care costs.1 

These high costs do not bring about better outcomes than other developed countries. In the U.S. life expectancy is lower than in similarly developed nations whose per capita costs are lower.1  The U.S. is ranked 38th in life expectancy, 37th in infant mortality, and 37th in overall health outcomes, according to the World Health Organization. We cannot expect the Affordable Care Act to significantly improve the health of Americans – its aim is only to increase access to care, which also mean more needless drugs, radiation exposure and surgeries. More medical care does not translate into better health, as much of what doctors do is harmful, such as prescribe antibiotics for viral infections, perform angioplasties and bypass surgeries on stable CAD, or perform CT scans, prostatectomies and other worthless, expensive invasive interventions that serve to protect the doctor, not the patient. Actually interventions that do not extend life are worse than worthless because they create harm. People should not be denied access to care in emergencies, but overall our population (including lower income people) need less medical care, not more.

It is normal in our society to follow a disease-causing diet and sedentary lifestyle. A huge proportion of the health care dollars spent in the U.S. are spent on largely preventable diseases, whose rates are rising.   More medical care supports dependency on medications and the emotional expectation that drugs buy us health, rather than healthy habits and proper dietary choices.  Modern medicine actually weakens personal responsibility. Healthy lifestyle promotion and implementation protect people from medical tragedies, reduces the need for and the side effects and damage from excessive medical care and prescription drugs.

  • Heart disease, cancer, arthritis, hypertension, diabetes, and high cholesterol are all included in the top ten causes of direct health expenditures.2
  • Almost 70% of Americans are overweight or obese, and recent data estimates that obesity adds $2741 to an individual’s annual medical costs – equating to $190 billion/year or 21% of national health expenditures.3,4
  • Cardiovascular disease was estimated to cost over $297 billion in 2008.2
  • The most commonly prescribed drugs are cholesterol-lowering drugs – 20% of middle-aged Americans and about 40% of older Americans take them.

Prescription drugs. Flickr: Charles Williams

It is the number of Americans sick with preventable diseases, not the number of uninsured Americans, or the cost of prescription drugs that is of most concern. More affordable prescription drugs are not what we need – reduced need for prescription drugs is what we need.. More than increasing access to care, we need less requirement for care.  To truly improve the health of the American people and reduce health care spending, Americans must take control of their own health.

We know now that genes are mostly irrelevant – what really counts is gene expression in response to the body’s environment, primarily diet and lifestyle. For example, in people with a certain genetic alteration known to increase heart attack risk, still eliminate risk with  high vegetable and fruit consumption.5

Type 2 diabetes is a lifestyle disease, and it can be reversed, often quite quickly with the appropriate diet. Excess weight is the primary risk factor for developing type 2 diabetes, and conversely weight loss with a low glycemic, nutrient-dense, nutritarian eating style and exercise is effective at reversing the condition. For example, in a recent study, my colleagues and I found that 62% of participants in the study reached normal (non-diabetic) HbA1C levels within seven months on a high-nutrient diet, and the average number of medications dropped from four to one.6 Plus, a recent study confirmed that lifestyle interventions are more cost-effective than metformin for diabetes prevention in high-risk individuals.7

Cardiovascular disease is preventable and reversible with the proper diet and lifestyle modifications, as documented by much medical research.8,9  Medical interventions – cholesterol-lowering drugs, stents and bypass surgery – do not cure heart disease. A large meta-analysis of the data on surgical cardiac interventions demonstrated conclusively that heard disease patients who undergo these interventions do not have fewer heart attacks or longer survival.10,11  Now millions more will have access to be harmed by interventional cardiologists and cardiac surgeons. 

Cancer risk is also largely tied to lifestyle. The American Institute for Cancer Research estimates that about one-third of common cancers could be prevented by following a healthy diet, exercising, and maintaining a healthy weight. I believe that figure could be more than double that protection if Americans were to truly take charge of their health; eat a health-promoting diet based on immune-boosting and cancer-fighting foods, exercise daily and maintain a healthy weight.  Green and cruciferous vegetables, mushrooms, beans, and onions are associated with significantly large risk reductions for common cancers.  After all, look at the cancer rates in other countries in South Asia before the explosion of the fast food revolution; a small fraction of today’s rates of cancer deaths was the norm.12-15

Here is my point:  Regardless of whether we are required to purchase medical insurance, know that we can only buy real health insurance in the produce section of the local supermarket.

 

References:

1. Brawley OW. The American Cancer Society and the American Health Care System. Oncologist 2011;16:920-925.
2. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the American Heart Association. Circulation 2012;125:e2-e220.
3. Cawley J, Meyerhoefer C. The medical care costs of obesity: An instrumental variables approach. J Health Econ 2012;31:219-230.
4. Obesity Accounts for 21 Percent of U.S. Health Care Costs, Study Finds. 2012. ScienceDaily. http://www.sciencedaily.com/releases/2012/04/120409103247.htm. Accessed April 20, 2012.
5. Do R, Xie C, Zhang X, et al. The effect of chromosome 9p21 variants on cardiovascular disease may be modified by dietary intake: evidence from a case/control and a prospective study. PLoS Med 2011;8:e1001106.
6. Dunaief D, Gui-shuang Y, Fuhrman J, et al. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density diet. Presented at the 5th IANA (International Academy on Nutrition and Aging) meeting July 26 & 27, 2010 Hyatt Regency Tamaya Resort & Spa 1300 Tuyuna Trail Santa Ana Pueblo, NM, USA J Nutr Health Aging 2010;14:500.
7. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care 2012;35:723-730.
8. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.
9. Esselstyn CB, Jr., Ellis SG, Medendorp SV, et al. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract 1995;41:560-568.
10. Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, et al. Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet 2009;373:911-918.
11. Coylewright M, Blumenthal RS, Post W. Placing COURAGE in context: review of the recent literature on managing stable coronary artery disease. Mayo Clin Proc 2008;83:799-805.
12. Ahn YO, Park BJ, Yoo KY, et al. Incidence estimation of female breast cancer among Koreans. J Korean Med Sci 1994;9:328-334.
13. Jung KW, Park S, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat 2012;44:11-24.
14. Zhang J, Dhakal IB, Zhao Z, et al. Trends in mortality from cancers of the breast, colon, prostate, esophagus, and stomach in East Asia: role of nutrition transition. Eur J Cancer Prev 2012.
15. World Health Organization Mortality Tables. [http://apps.who.int/whosis/database/mort/table1.cfm]


The Truth About Healthcare Reform

 An article by Christina Pirello, an advocate of natural foods nutrition and professor of culinary arts at Drexel University, on Huffington Post states the uncomfortable truth about healthcare reform that the mainstream media consistently fails to report:

“Healthcare reform is irrelevant until Americans improve their lifestyles.”

Money

The fact is, our healthcare costs are out of control because the diet and lifestyle that has become the societal norm in this country causes disease.  As Ms. Pirello mentioned in her article:

“We are willing to tolerate this revolutionized food because it's cheap. But it comes at a high price to our health. We spend less on food today than any other people at any other time in recorded history. And the less we spend on food, the more we spend on health care.”1

 Here are some numbers:

- Overweight and obesity rates are at an all time high – 73% of Americans are either overweight (38.8%) or obese(34.2%).2 In 1980, 15% of adults were obese – over the past 30 years,that number has more than doubled.3

- According to the CDC, U.S. obesity-related health costs totaled $117 billion in 2000, and if current trends continue, that figure is projected to reach $344 billion per year by 2018.3,4

- Coronary heart disease costs are estimated at $177 billion for 2010, costs for stroke at $74 billion, costs for hypertension at $77 billion. 5

- Health insurance premiums have gone up 131% in the last 10 years.6

- Over 50% of insured Americans take prescription drugs for a chronic condition – the majority of these drugs are for blood pressure or cholesterol.7

These costly diseases are caused by poor lifestyle choices, and they are also preventable by positive lifestyle choices.

The problem is not the fact that there are so many uninsured Americans – the problem is that there are so many unhealthy Americans. Do we need a better health care system? Of course. But not as desperately as we need better health. Better health through improved lifestyle choices is also fiscally responsible. Vegetables are cheaper than statin drugs. A gym membership is cheaper than bypass surgery.

Health care costs are the symptom, poor lifestyle choices are the cause. If we want to improve the situation, we need to address the cause. The only way to reduce these costs is to reduce the prevalence of these devastating (but preventable) diseases.

No matter how many confusing messages the American public gets about nutrition, there are some very simple truths. Fruits and vegetables are healthy, processed foods and fast food are not. If you follow a nutritarian diet, it will cost less to keep you healthy. 

Ms. Pirello suggests a healthcare system in which individuals are rewarded for having healthy habits – sounds like a great idea to me. She also mentions Whole Foods Market’s new Health Starts Here program, for which I provide nutritional guidance.

“They are about to implement a program that encourages their employees to get and stay healthy. Beginning with a simple blood test and survey, each employee who chooses to participate will receive a diet plan. Each benchmark they hit (lower cholesterol and blood pressure, healthier BMI, etc., will result in a greater discount on their groceries purchased at Whole Foods Market. Imagine a health care plan that does the same thing.”1

No matter what the outcome of healthcare reform in Washington D.C., if enough of us develop and practice healthy habits, it will be to the benefit of our healthcare system.

 

References:

1. http://www.huffingtonpost.com/christina-pirello/healthcare-reform-is-irre_b_440589.html

2. Ogden CL et al. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008. JAMA. 2010;303(3)

Flegal KM et al. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA. 2010;303(3)

3. http://www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm

http://www.cdc.gov/nccdphp/publications/AAG/pdf/obesity.pdf

4. http://www.americashealthrankings.org/2009/obesity/ECO.aspx#2018

5. http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192667

6. http://money.blogs.time.com/2009/09/30/a-dozen-disturbing-health-care-statistics/

7. http://www.cbsnews.com/stories/2008/05/14/health/main4094632.shtml?source=related_story