In the great irony of the coming political season (i.e. the upcoming presidential campaign) will be involved in perhaps the most meaningful national discussion on health care we have yet witnessed. Already each candidate has a plan, each is attempting to use the language of universal coverage without actually meaning universal coverage. Each is trying to dance the tricky step of appeasing the public’s growing anger over our health care system and the tremendous power of the insurance companies, pharmaceuticals and the AMA. I don’t envy these politicians; the music is discordant, the beat hard to follow, the crowd raucous and unsympathetic.
In the end, health care reform will most likely be more about economics then medicine. On August 8th in the New York Times there was an article discussing this point. The article questions whether preventative medicine will in the end be cheaper then treating people after they have developed a disease.
It is a good question, it is always good to question assumptions and it has been assumed that prevention is cheaper then treatment. However, the question leaves out the also important question, what is the cost of suffering?
However, Mr. Leonhardt, the article’s author, falls prey to the main pitfall in the current health care discussion - a failure of imagination.
He attempts to answer his good question within the same model, the same mode of thinking that currently exists, and that is itself the source of the problem.
Anything that happens within the current model will be expensive and benefit the industries’ that created the model. He uses the example of diabetes and says that for every one person potentially cured five will have to be “treated,” treatment here being some sort of prevention program. Mr. Leonhardt clearly imagines this all happening within the current model of patient visits to a clinic, the doctor as God, disseminating a 15-minute sermon on whatever, filling a script and see ya later. Next.
Research conducted in communities where diabetes is on the rise indicates that people don’t like these models (See researchers: Dr. Lynn Shinto ND, MPHand Dr. Kimberly Tippens ND, LAc. They do not feel respected by their doctor and are thus less likely to listen to anything they have to say. They do not want drugs; they understand that lifestyle is essential to managing their health and potentially curing their disease. Lifestyle change is complex and requires a completely different approach. It requires doctors to meet people where they are, meet them for example in the grocery store where lifestyle change starts. It goes back to Michael Pollan’s most excellent question; “What should I eat?” For more information, see his NYT article “Unhappy Meals.”
Imagine treating diabetes in the grocery store where people buy food. The patient is looking to change their diet, armed with the American Diabetes recommended diet pamphlet (which may well be a fairly incomplete approach in and of itself) and wondering what to buy and how to make it. Now here is an opportunity for education. In our current system this is beneath the God-like doctor, removed in his or her pulpit of an office, well insulated by the bevy of receptionists, clerks and nurses. Of course, in this model education would be expensive and cumbersome.
The beginnings of this approach can be seen at a health food store chain in Portland, OR – New Seasons Market. There they hire nutritionists or Naturopathic Doctors to be on staff specifically to answer the “now what?” moment that occurs after a doctors visit when someone realizes they must make a change. This model has potential to revolutionize how we conceptualize health care.
Health care will become more cost effective through a tremendous imaginative effort and it is here where Mr. Leonhardt’s answer falls short, but a good question is a good beginning.