Getting To The Heart of Health Care

By Len Saputo MD, with Byron Belitsos

Though we support the "public option" as a possible gateway to universal single-payer insurance, the current debate that has grown up around this discussion often misses much of the point. That's because more advanced reform of the way medicine and health care are practiced is needed; without it, no form of health insurance will tame the beast of rising costs. The core problem is that America's health care system fights the wrong war—it engages in what we call after-the-fact warfare. We devote vastly more resources to treating ill health than to prevention—at least 25 times more. The current House bill, HR 3200, even with the input of the likes of Ted Kennedy and Tom Harkin, only devotes only $10 billion to prevention—leaving this ratio the same. Essentially, America is still not focused on the true causes of our health problems. And our dreadful lack of attention to prevention and health promotion is getting costly in the extreme.

Here's one example among many: Extremely compelling evidence provided by Dr. Dean Ornish and other scientific colleagues to Congress, Medicare, and numerous other government agencies shows that the preventive-medicine approach to heart disease can save several the U.S., and especially Medicare, hundreds of billions of dollars and more. Yet Ornish recently went public to tell a depressing story of fifteen years of official resistance to his well-evidenced solutions.

The bottom line is this: our corporatized health-care system is not really health care—it's "disease care." It's about money and Wall Street profits. And, if we are indeed fighting the wrong war with our disease-care system, if we are wantonly allowing our population to develop diseases before we act, do we really want to pool the health-care insurance premiums of our population so as to better finance this system while leaving its other assumptions unchallenged—especially if these assumptions drive up costs beyond reason and don't deliver wellness, prevention, and healing? And by the same token, do we really want to "automate" disease care with billions of government dollars now being targeted for information technology, when the very foundations of the industry itself need reconfiguring first?

To prevent our health-care system from bankrupting the country, America's health care needs reform that is both paradigmatic and institutional, not just a reform of its financing mechanisms or computer tweaks in the ßow of medical information. Toward this end, we believe the nation needs radical health care reform based on what we call the integral-health medicine model—that is, the cutting edge of integrative medicine that arose from the earlier movement complementary and alternative medicine (CAM). Aside from being informed by an integral or holistic worldview, this emergent health-care model is dominated by a philosophy of prevention and wellness, and is informed by an understanding of the role of consciousness and spirituality in healing, as well as the body's innate self-healing capacity. Its treatment methodology involves four stages:

• Lifestyle strategies such as diet, exercise, adequate sleep, stress reduction, weight control, avoidance of toxic exposures, are the first line of defense.
• Noninvasive complementary and alternative (CAM) services such as acupuncture, herbal medicine, chiropractic, bodywork, homeopathy, and energy medicine are the next line of defense.
• Natural-medicine approaches based on the latest advances in orthomolecular medicine, functional medicine, and bioenergetic research—and inclusive of the more advanced forms of testing—are a further line of defense.
• Very careful and sparing use of pharmaceutical drugs, surgery, and other invasive strategies are the last line of defense.

Integral-health medicine, my name for the new medicine of the future, if it is translated into a renewed delivery system, permits maximal freedom to choose one's therapeutic approach according to personal preferences and the sacred bond between patient and physician. It incorporates integrative or holistic approaches at every juncture, especially for reasons of cost-effectiveness. And it robustly funds truly objective, comparative, and broad-ranging scientific research—in all cases using public money.

Taking health care seriously, according to this worldview, would require far more funding than now designated in Congressional bills for Comparative Effectiveness Research, including an expansion of CER's scope, plus a reconfigurationof of NIH's budget in the direction of the new healing modalities of CAM that now comprise an embarrassing one percent of its budget. Not to sound overly zealous, but I consider it to be an outrage that only about $150 million of the NIH's $30 billion budget is spent on CAM research when it holds so much promise for cutting costs and improving outcomes.

At the level of leadership, the Samueli Institute's recommendations contained in its Wellness Initiative for the Nation ("WIN") are right on target, including its recommendation that the White House or Congress create an executive office or national health board operating at the highest level, overarching numerous government agencies, and focused on developing aggressive lifestyle-based wellness and prevention programs. Some features of this proposal are in a few of the Congressional bills.

But current awareness of such ideas and principles on Capitol Hill is far behind. By all accounts, the public is driving the paradigm shift to this new preventive and wellness medicine and the trend to healthy lifestyle; the Congress is at least a decade behind public sentiment. This macrotrend is evidenced by the way more educated Americans spend their dollars—almost all of them out of pocket—on preventive measures in daily life, on integrative clinics and spas, on scores of alternative and natural treatments, on organic and fresh foods, on food supplements, and on other products and services of the burgeoning wellness market—not to mention the connection between belief and faith and the healing process that those in the spiritual path understand so well. It is far past time for Washington and the health policy establishment to catch up with this huge and growing mass of pioneers—as much as 40 percent of the population—who are mapping the future of health care, and who are often their most afßuent and thoughtful constituents.

But because prevention, healthy lifestyle, and the new healing modalities are usually not covered by insurance under our disease care system, the less affluent or less educated don't get access; and these Americans are among that population that is driving up health care costs.

FEEDBACK: CLICK HERE to email comments and feedback. Please note the title of the article or the author's name. Include your own name or type "name withheld" by request. Thoughtful responses will be published in our next edition.