Fantasyland – are we living in it?

Having just returned from Disney with kids and grandkids, it clearly is a fantasyland for the little ones.  It also seemed to be a Mecca for the obese who motored around in scooters designed for the handicapped. We see that reality, an enlarging population, everywhere. I wonder when our government is going to figure out that what they are seeing is a marker for high blood pressure, high cholesterol, heart disease, diabetes, kidney disease, orthopedic problems and stroke.  Those are the things that drive health care costs and are bankrupting our economy.

But our federal government must live in fantasyland also.  They think health care reform is merely to provide health care coverage to those who do not have it. That is called insurance; not reform.  And since covering those un-insured will increase health care costs, and the president insists any plan they devise be budget neutral, they will achieve that goal by a variety of NON-reform measures: further discounting of providers, tax on the wealthy, and an excise (actually sounds more like a luxury) tax on those employers who provide too expensive an insurance plan. Interestingly, the unions are opposed to this as many of their members have the highest cost plans in the country.

Everyone agrees that there is waste and over-utilization in health care. No one wishes to address it.  The more and more insurance coverage we offer our citizens, the less responsible they feel for their own health status.  “If I have a heart attack, I can get an angioplasty or a bypass and be cured” is a common comment I hear.  Nothing could be further from the truth. But it is easier for us to live in fantasyland than take better care of ourselves.

Fantasy:  An angioplasty prolongs life.  With few exceptions (during an acute heart attack), that is false. 

Fantasy: Coronary artery surgery prolongs life.  Again, with few exceptions, that is false.

Fantasy: Hospitals and doctors can now do wonderful things if a have a heart attack.  Since close to one-third of all heart attacks result in sudden death (before you get to a hospital), I would not bank on the quality of care at the hospital.

Fantasy: Taking cholesterol lowering medicine and blood pressure medicine and diabetes medicine will prevent the problem.  There certainly is some truth to that statement, but in the relative scheme of things, I would not count on that either.  Cholesterol reduction results in about a 25% reduction in heart attack risk.  Most individuals with high blood pressure do not take enough medication to normalize their blood pressure.  It is rarely achieved with one med and many need three different meds to achieve control.  Controlling blood sugars is helpful to the diabetic, but the disease in the blood vessels is not stopped and heart attacks and other vascular disease are common.

Back to reality – we are the problem, not the health care system. With our personal behaviors, we are developing the diseases that have us flooding doctors’ offices and hospitals demanding everything possible be done to deal with the consequences.  Doctors have less time to spend with you due to the volume and the government wants to: a) increase the number of insured and b) pay the doctor less for each visit.  This will not work.

The solution to this problem lies not in the health care system, but in the much larger community. I often ask people what they would do differently if they did not have health insurance and had to pay the exorbitant costs for all they care they currently demand because someone else is paying for it.  That is like asking how much you would drink at a cocktail party if you were paying for it versus someone else paying for it.  (The answer to that turns out to be you drink twice as much when someone else is paying for it.)

Time for the community at large to recognize that living an unhealthy lifestyle and getting bailed out by a very sophisticated and expense health care system when you get into trouble is not in its best interest.  Everyone acknowledges that PREVENTION is better than treatment, but we don’t all agree as to what prevention is.  To me it is simple and straightforward. It is all of us eating healthy and aerobically exercising every day for at least 30 minutes without stopping.  It is NOT dieting.  Weight loss is not the focus of prevention.  Major sustained weight loss is very difficult to achieve.  Eating healthy foods (avoiding saturated and trans-fats) and exercise is very doable by virtually everyone except those with severe musculoskeletal problems in the lower extremities.   And unlike the 25% reduction in risk with medications, you get 75-85% reduction of those same risks with proper lifestyle change.  The impact of behavioral changes on health care costs would be dramatic; far greater than we will achieve with medications and procedures.

Let’s spend our health care budget on teaching people how to do this properly.  It is far cheaper than how we now spend our money and far more effective.  And let’s not support a near trillion dollar health care reform bill until it has major plans and funding in it to achieve these goals. We seem to be rushing to pass a bill that does not do what we need it to do.  The Senate version is being released now – several thousand pages – and Mr. Reid is looking for a vote on it in the next 72 hours.  Do we really want our senators to vote on something they have never seen or read that will have a huge economic impact on all our futures?

Gerald L. Evans, M.D.