Health Management

There's an interesting editorial in the Chicago Tribune today.The authors challenge the candidates solutions for fixing health care, asserting that although they have presented platforms, they haven't addressed real issues, such as why healthcare is so expensive. (excerpt below, full article here)

Some days Mack MacQuarrie defies his Type 2 diabetes and submits to the temptations of a ballgame hot dog. Some days his legs swell, fluid fills his stomach and chokes his breathing, and he finds himself in the emergency room. He knows he should manage his disease better, but very little in America's health-care system encourages him to do so.

(Rebecca's note: I don't think this guy is just eating a hot dog and landing in the hospital. With type 2 diabetes, you can have a hot dog (if you want to...) The carbs are in the hot dog bun and as long as he stayed away from other carbs - soda, fries, ice cream, pretzels, cracker jacks etc. - he can have the dog. OK, back to the story).

MacQuarrie's doctors get paid to drain the 2 gallons of fluid from his purple-bruised legs, but not to call to ask about warning signs. His insurance covers the hospital stays, even when he skips doctor's visits because, as he says, "the co-pays tear you up." And so he often lands here, at Henry Ford Hospital, running up medical bills as high as his blood sugar count.

Polls show voters worry a lot about health care and how much they spend on it. Presidential candidates John McCain and Barack Obama have responded by peddling plans they claim will help more Americans attain and afford care.

But neither candidate has focused publicly on treating the real problem: why American medical care costs too much and isn't as good as it should be.

I agree with the article authors on some points, but I think their arguments would have been strengthened by bringing the importance of chronic disease prevention to the forefront. Their arguments (below) are really costs that occur once a person is already sick. Yes, let's deal with it... but we are missing the boat on huge costs savings if we don't acknowledge the need for prevention to be front and center of health care.

We waste money on tests and visits to specialists that don't make us better. We spend big to add a few weeks or months to the inevitable end of a dying patient's life. We use expensive technology at any cost, even when it exceeds our needs, and we fail to encourage simple, proactive steps that would keep us healthier and save us money. We often don't know which treatments work the best, so we err on the side of too much care, for too much cost, with sometimes damaging consequences.

The reality is that chronic disease management eats up huge dollars, but many chronic diseases can be prevented through weight management - obesity, diabetes, heart disease, hypertension, many cancers... and the list goes on. I know my readers have heard this before from me, but I will say it once again. Health care needs to wake up and pay for disease prevention services - and they should start with visits to a registered dietitian. Bottom line: health behaviors such as diet and exercise are critical for weight management. Preventing further weight gain in overweight people can help prevent weight-related chronic diseases. Establishing healthy eating patterns with families or individuals can make a world of difference. Weight management is one thing, but since you truly are what you eat, people will also feel more energy, and less stress, which contribute to their well-being and overall health. Yet, in order for a "healthy" person to see a dietitian, they have to be prepared to pay a pretty penny because visits to a dietitian are not covered.

This makes no sense. Think about it. We spend most of our lives looking or feeling healthy for the most part. We pay huge amounts each month in "health care", but we don't receive any. Why would someone feel they "should" pay out of pocket for health care services a registered dietitian provides? They already feel like they are paying too much. So many dietitians avoid going in to private practice because they know they will have to struggle with insurance companies and/or fight this battle of convincing people who already pay for health care that they need to pay more out of pocket.

Why can't insurance pay for an annual nutrition checkup - a nutrition assessment and a couple follow up visits with a registered dietitian? If nutrition diagnoses are found, insurance companies can decide what follow ups to pay for based on the diagnoses or they can cover a percentage of follow ups. The point is, something is better than nothing and consumers get nothing when it comes to nutrition services. But by providing these assessments, we can detect problems earlier and deal with them before they become bigger and more expensive issues.

Back to the editorial... I will say this... the authors got Obama wrong. He has presented a case for disease prevention, including paying for registered dietitians for disease management and his plan for obesity goes way beyond advertising to kids (which seems to be the focus). He want to improve the wellness environment by making changes to the schools and communities where people are. Check out a couple past posts for more info.

http://rebeccascritchfield.wordpress.com/2008/09/03/obama-on-obesity/

http://rebeccascritchfield.wordpress.com/2008/02/05/senator-obama-sees-r...

What are your thoughts on health care? Where do we need to go?