The recent collapse of the Trump-Ryan healthcare bill in Congress has left an expectant nation in a state of confusion. While some on the right and on the left have exulted in the demise of the AHCA, moderates are dismayed; and virtually everyone agrees that the status quo can't remain without the prospect of fiscal disaster and a threat to the health status of Americans.
The fact is, we spend more per capita on healthcare than any other country in the world, and our health outcomes rank behind those of many developed countries.
Without devolving into a partisan political debate, it's my opinion that Obamacare, and its aborted successor the AHCA, are merely re-arranging the deck chairs on the Titanic. What is needed is a very fundamental re-ordering of our healthcare priorities, and elimination of the perverse incentives which lead to more people undergoing costly sick-care. Only then can our healthcare system be saved from implosion, and the costly toll of degenerative diseases on our society and our economy be alleviated.
1. Eliminate inequity by offering health coverage for all Americans based on means-tested eligibility. No one should die from lack of rudimentary medical care; nor should they suffer medical bankruptcy.
2. Create competition and diversity in health insurance. Plans should be available ranging from bare-bones/high deductible to "platinum" coverage. Innovative companies should be allowed to compete for health-conscious applicants by offering a wide range of integrative medicine benefits.
3. Foster a return to direct-pay of doctors which eliminates pricey insurance and government bureaucrats as arbiters of "correct" medical care.
4. HSAs (tax-incentivized health savings accounts) should be encouraged, and expanded to cover supplements, gym memberships, yoga, and treatment by alternative practitioners).
5. Medical education needs to be completely reformed. While pharmacology and surgery now dominate curricula, reflecting the priorities of BigPharma and device makers, young doctors need to be mobilized to become the vanguard for prevention via diet and lifestyle.
6. Expand post-graduate education opportunities for doctors in integrative medicine and nutrition. Most doctors pursuing these careers must do so outside of traditional residency programs, at great cost to them.
7. Put an end to state medical boards' prosecution of doctors merely for providing integrative services.
8. Create an entirely new medical speciality called "iatrinology". Iatrogenic means medicine-caused: By various estimates, harm due to (even correctly-applied) medicines and surgery is among the major causes of death, injury and disability in the US. Medical overkill is tanking our healthcare economy and undermining the well-being of Americans, so doctors need to cultivate the skill of identifying side effects, and how to wean patients off complex drug regimens. In part, this can be accomplished by skillful deployment of diet, lifestyle and scientifically-validated supplements.
9. Take supplement regulation out of the FDA. It seems these days, the orientation of the FDA is to green-light the approval of ever more expensive drugs with toxic side effects, while impeding innovation in the supplement sector. It makes little sense for an agency dominated by cronyism with the drug industry to be the arbiter of what supplements Americans can or can't take.
10. Allow for truthful claims about the efficacy of supplements to be communicated to the US public. Under the current system-an extraordinary abridgment of free speech rights-supplement companies are enjoined from claiming that their products do anything to prevent or ameliorate disease, even when conclusive scientific evidence exists to back their claims! Recently even walnuts, cherries and pomegranate juice were threatened with ruinous government law suits for publicizing true health benefits. How can Americans make informed health choices when purveyors of low-cost natural solutions are muzzled?
11. Lift the burden of malpractice claims for US doctors. It won't make the lawyers' lobby happy, but our current system of medical liability demoralizes doctors and makes them run tests and administer treatments that are entirely unnecessary, adding immeasurably to the cost of healthcare and exposing consumers to the risks of excessive medical intervention. Instead, why not have cases of alleged negligence or malfeasance reviewed by professional arbitration panels, who can fairly assess culpability and assign reasonable compensation?
12. Establish centers of excellence for research on lifestyle interventions to curb our epidemic of degenerative diseases: diabetes, Alzheimer's, coronary artery disease. While high-tech cure efforts like the "Cancer Moonshot" are laudable, they need to incorporate substantial preventive components.
13.Leverage technology to provide widespread health education and outreach programs. While the wealthy elite can afford costly individualized natural medicine care, it's the poor that are most prey to lifestyle diseases. Technology has enormous potential to extend the benefits of structured diet and exercise interventions to stem the tide of costly metabolic disorders like Type 2 diabetes.
14. Expand research on vaccine harms and work to improve vaccine safety. While some uphold vaccines as the immutable cornerstone of community preventive medicine, we can't afford to smugly assert that vaccine safety is "settled science" amid the inexplicable rise in childhood developmental disorders that put an enormous strain on our healthcare resources.
15. Incentivize healthy lifestyle choices by providing insurance discounts, not just for non-smoking, but assign points for diet, exercise, optimal fat-lean ratio, blood sugar and blood pressure control.
16. Expand education, credentialing and licensing of non-MD/DO health practitioners. Create a national cadre of lay health promoters who can organize community programs.
17. Re-prioritize exercise for Americans. Redesign communities to make them walk- and bike-friendly. Reinstitute severely curtailed programs of physical education in schools and universities. Leverage technology like trackers to reinforce compliance.
18. Reduce environmental hazards. It doesn't make sense to unleash industry to goose the economy when unregulated expansion will result in pollution that will undermine the health and productivity of Americans-think China, whose growth has been unprecedented, but may soon be catastrophically threatened by the deadly toll of environmental ills unleashed by rampant commerce.
19. Eliminate current farm subsidies that encourage production of cheap, unhealthy processed foods like refined flour and high fructose corn syrup. Why not, instead, incentivize raising broccoli? Arugula? Avocados?
20.Promote and support organic, GMO-free agriculture. The resulting products reduce the burden of pesticide and herbicide pollution, and deliver higher levels of protective nutrients than conventional produce.
21. Align the Dietary Guidelines for Americans (DGA) with the latest nutritional science which implicates excess carbohydrates and refined vegetable oils, not animal protein, cholesterol and saturated fats, as instigators of obesity and diet-related health conditions.
22. Empower a federal task force to combat America's epidemic of opiate dependency. Drug deaths are at an all-time high, and addiction is a major drain on worker productivity. On the FDA's watch, the country has been flooded with powerful painkillers that lure our youth and ordinary citizens into dependency; many prescription meds have been diverted into the illicit drug trade.
23. Raise awareness about "digital heroin"-the pernicious effects of screen addiction that hooks young people, promotes social isolation, encourages sedentary lifestyle, and stokes our epidemic of childhood ADHD.
24.Eliminate "Direct-to-Consumer" (DTC) drug ads. They encourage unnecessary demand for expensive medications with unpredictable side effects. The US is one of only 3 nations that permit DTC ads (along with Brazil and New Zealand).
Will an Administration and Congress of the future ever have the courage and will to buck the special interests that stand in the way of these reforms? Or will the US healthcare system have to "bottom out" or tank our economy before we are stirred out of inaction? Whatever the resolution, this will be the decisive political issue of the coming decade.
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