Patients Gone Wild and Healthcare Reform

(I'm blogging from the operating room.  Here's my Saipan Tribune column for this week.)

I recently had the opportunity to read President Barak Obama’s letter on Health Care Reform, dated June 3, 2009.  There is one paragraph in particular that jumped out at me, because it seeks to identify the “root cause” of rising health care costs.  Here it is:

“At this historic juncture, we share the goal of quality, affordable health care for all Americans.  But I want to stress that reform cannot mean focusing on expanded coverage alone.  Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach.  So we must attack the root causes of the inflation in health care.  That means promoting the best practices, not simply the most expensive.… That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”

First, let me say, that I agree with the gist of the statement.  Rising health care costs are killing our economy (well, that and a few other things), and medical care can definitely be improved so that it is more cost effective.

But here’s the truth.  The single best way to reduce the cost of healthcare is to reduce the need for healthcare.  We are a sick bunch of people, and for the most part, it’s because of our own behavior – we’re all “patients gone wild.”  The majority of us are sick, not because we’re out doing healthy things and suddenly get struck down by some horrific disease.  No, we’re sick because we eat too much, sit around too much, eat the wrong foods, smoke, consume alcohol, and generally ignore the things that lead to good health.  We’re sick because of the wild and crazy choices we make.  The vast majority of healthcare costs in America and the CNMI are tied to chronic “lifestyle” diseases.  The top ten causes of death in the US include heart disease, stroke, diabetes, and cancer.  And every single one of these has been incontrovertibly linked to how we live our lives – whether it’s what we eat, what we do, what we drink or what we inhale. 

To a large extent, we’re digging our graves with our spoons and forks.  Last year, we spent over $20 billion dollars on cholesterol lowering drugs.  That’s billion, with a “B”.  If you had $20 billion dollars, and decided to burn a million dollars a day, every single day, it would take you 55 years to spend $20 billion!  Why is our cholesterol high and why does it need to be lowered at a tune of $20 billion a year?  High cholesterol is a major risk factor for heart disease and stroke.  Our bodies produce some cholesterol, but most of the problem comes from what we eat.  Only animals have cholesterol in them.  Vegetables have no cholesterol at all.  We’ve known for decades that the most effective way (and the cheapest way) to lower cholesterol is to lower our consumption of animal products – animal flesh, animal milk, animal cheese, animal crackers, etc.  But you know what? We’d rather not make that kind of change.  We’d rather pop a pill and keep eating whatever we want to eat.  And that’s $20 billion dollars we spend so we can do what we want to do, which is to eat lots of animals. 

The same is true for diabetes, which is devastating our community, and growing at an alarming rate.  We know that for most of us, the adult onset variety can be controlled, or at least hugely improved, with diet and exercise.  Yet we choose not to make these difficult changes.  We choose to eat what we want, and take pills and go on dialysis and lose our vision and our feet and our erections.  And we spend untold billions on the cost of care for diabetes and its related problems. 

A diet high in animal fat is also linked to a slew of cancers.  Pass the processed meat that starts with “S” and ends in “M” and rhymes with “PAM”.  Or just pass a burger or wiener or any other chunk of meat.  Alcohol consumption is linked to many cancers.  Pass a Bud (better make that a Bud Lite).  Tobacco is irrefutably linked to cancer.  But we can’t seem to manage to pass legislation to ban smoking in public spaces.  Pass the votes. 

I admire efforts to improve the cost-effectiveness of the healthcare we deliver, but I know that the “root cause” of the mess includes our culture of indiscretion, of consumption, of sitting around.  Any serious effort to fix the healthcare mess must include a change in our culture – what we eat, what we do, what we drink and what we inhale.  These changes won’t solve all the problems, but they’ll make a huge dent in the demand for and the cost of healthcare.  A major portion of the responsibility to “reform” belongs on our shoulders -- those who end up needing healthcare.  Reduce the need, and you reduce the cost.  It’s simple.  But it’s not easy.  We humans typically don’t like change.  Yet failure to change our behavior will result in more and more people needing healthcare every year, rising costs, and eventually, not enough doctors, hospitals or other resources to take care of so many sick people.  We’re experiencing the fallout right now, right here in the CNMI. 

Addressing our behavior needs move to the front and center in the public policy discussion on healthcare reform.  It’s a nut we must crack.

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David Khorram, MD is the co-founder and medical director of Marianas Eye Institute.  He is the author of the book, World Peace, a Blind Wife, and Gecko Tails, which is available on Amazon.com and at Marianas Eye Institute.  Dr. Khorram can be emailed by visiting www.MarianasEye.com, or by phone at 670-235-9090. © David Khorram, 2009.