Health Care Reform?

I just read an article from the Harvard Business Review titled "The Strategy That Will Fix Health Care." It was a very good read and discussed 6 points needed to move us into a high-value health care delivery system. The first point is to organize into "Integrated Practice Units" or IPUs. This is a team of providers dedicated to caring for an entire condition. Currently a patient with diabetes, for example, may first present to a primary care physician who makes the diagnosis and initiates treatment with medications designed to lower the blood sugar. The patient may end up taking insulin and may eventually be referred to a specialist (Endocrinologist) who may further manage the blood sugar levels with more intense insulin dosing and perhaps even an implantable insulin pump. The patient may also need to see a Nephrologist (kdney specialist) for kidney failure that often accompanies diabetes, or a podiatrist for diabetis foot ulcer, etc. Under an IPU, all of the caregivers are involved at one time in one organized team, providing medical care as needed and education and counseling to help the patient better cope with their condition. The IPU is just one of the 6 pieces of the pie that the authors, Michael Porter and Thomas Lee propose as a cure for the current ailing healthcare system. The other steps include measuring outcomes and costs, moving towards "pay one price" bundled care packages, integrating care delivery across facilities, expanding services geographically and building an effective IT platform. I happen to agree that this approach will indeed go a long way towards improving our current health care system. We will be better poised to care for a larger population of sick patients more effectively and efficiently.

This is what we have come to. Instead of improving our health, we need to improve our ability to deal with more sick people. This is a backwards way of looking at things. We are building a better fire engine when we need to be preventing fires. 

Let's look at diabetes for example. This is a major health problem which in turn becomes a major risk factor for the development of other major health problems such as coronary artery disease leading to heart attacks. In their 2001 article in Diabetes Care, Boyle, et. al. warned that the number of Americans with diabetes is projected to increase 165%, from 11 million in 2000 (prevalence of 4.0%) to 29 million in 2050 (prevalence of 7.2%). (Diabetes Care, 2001: 24(11), 1936-1940). Well, CDC statistics show that the situation is much worse. From 1980 through 2011, the number of Americans with diagnosed diabetes has more than tripled (from 5.6 million to 20.9 million). 

Why is this happening? We often blame this on our aging population. However, the rise in diabetes is seen across all age groups. From 1980 through 2011, the percentage of people with diagnosed diabetes increased 167% (from 0.6% to 1.6%) for those aged 0–44 years. Even more concerning is the rise of type 2 diabetes amongst children. This had previously been termed adult onset diabetes and was rarely seen amongst children. Experts believe that this is linked to the rise in childhood obesity that we have seen throughout our country.

Health care reform is a way of building efficiency into our current health care system which will allow us to provide higher quality care at a lower cost. This is badly needed because of the rise of chronic and possibly preventable illnesses such as diabetes. In my opinion, a more effective form of health care reform would be lifestyle reform aimed at preventing the rise of diabetes in our culture. None of the health care reform measures look at reforming our health. We have been eating poorly for decades and we have seen the effects of it. Our food system is broken, not our health care system. We have been living on processed foods instead of natural foods. We have become an obese nation and now are looking towards the health care system to bear the burden. On the other hand, the food system in this country should be bearing the burden.

Thankfully we are now seeing the quiet rise of the American Farmer and a shift towards a more natural diet. Our local CSA shares have all sold out and the farmers' markets in Connecticut are so crowded that parking is often an issue. Instead of IPUs, what we need is access to more organic whole foods and less access to processed artificial foods. I refer you to Dee McCaffrey's excellent book, "The Science of Skinny" which discusses the health effects of our mass produced foods. If you really want to see what you're eating, by all means watch the documentary "Food, Inc."

So, here is my 6-step solution. Let's shift the focus from health care reform to health reform...

1. Teach the nation to cook. 

2. Support our local farmers by joining CSAs and shopping at local farmers' markets. 

3. Support families that prepare meals at home.

4. Provide healthy, whole food lunches in public schools.

5. Provide subsidies to producers of organic whole foods.

6. Stop buying processed junk foods from the supermarket and shop the organic sections. 

It has taken us 50 years to get this far behind in our health, but it's not too late. We need to reverse the trends that led us here and become a healthier nation.