don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

I don't know what's so complicated about reforming the health, or sickness care system. Every politician, policy expert and commentator who has studied the issues agrees that the medical system costs far too much, that access is insufficient across different economic groups and that too many medical mistakes occur--and that's just for starters. 

The most important fact to remember when assessing what masquerades for a health system is that the people of this country are not very healthy! This despite the unprecedented costs, higher by far than other large, Western countries. (We spend 14 percent of gross domestic product on health care, while other advanced nations spend an average of 8 percent.) Jeff Madrick, in an article entitled "Studies Look at Health Care in the U.S.," NY Times, July 8, 2004, suggests costs will rise to 18 percent by 2013. The only good news is that we have slightly fewer doctors and hospital beds as a percentage of population than many European countries.Many think there is a correlation between more doctors and hospitals and better outcomes. The opposite is more likely, in my opinion. 

We are probably the fattest of all nations (the US Surgeon General puts the economic cost of obesity at $117 billion a year and estimates it kills 300,000 annually), and our life span and infant mortality levels are below most developed nations that spend far less than we do for medical coverage. (The US is at the bottom of five countries in a study recently published by the Commonwealth Fund for kidney transplant survival rates and in the middle rank in other areas measured.) Americans pay a great deal more for drugs than other nations, administration expenses for all medical care giving are exorbitant and financial incentives encourage unnecessary procedures with too few incentives to reward medical managers for improving quality of life. There are other terrible problems, but I'll mention just one more before moving on to a sketch of what's needed, the dangers of medical care. Medical errors in U.S. hospitals are estimated to have contributed to almost 600,000 patient deaths over the past three years (The study was done by the Institute of Medicine--see "Fatal Medical Errors Said To Be More Widespread," The Wall Street Journal, July 27, 2004; Page D5.)

The medical system includes doctors and all other providers, plus all the hospitals, nursing homes and drug companies. All are involved in caregiving and treatment. Healthcare is a $1.2 trillion business. It is the largest industry in the US, accounting for 14 percent of the GDP. It is organized and run to make money in a highly competitive environment marked by the trading of medical goods, services and facilities to sick people. If we had a health industry (which the US does not have at present), it would be organized and managed so that goods and services, facilities and all the rest were focused on assisting people to become and stay well. For the more ambitious, it would support efforts for reaching the highest levels of well-being possible.
 
A sensible reform program, therefore, would move the nation away from a medical care toward a health system model. A wellness take on this fragmented non-system, such as sketched above, leads to the conclusion that the existing mess cannot be fixed. It has to be redesigned--along wellness lines. If I were nominated by Democrats, Republicans or some fringe party lunatic enough to have me as their standard bearer for president, I would make the CREATION of a health system, not the reform of the sickness system, a high priority.

Health insurance, which, of course, is nothing but a medical payment plan, not a program that in any conceivable way "insures health," should NOT be deductible on corporate or individual income taxes, as it is now. What SHOULD be deductible are expenses associated with becoming healthier, such as exercise costs and a host of well-being investments to be determined. (Some kind of Congressional Wellness Board would have to be established. This Congressional body would identify eligible deductions that are truly health related and craft the enabling legislation required for the mindset change to promote health and reinforce healthy behaviors, not pay for sickness care.

In the past, reform proposals have overlooked the single most important factor that contributes to these high costs and other crises, namely, too many people become sick in the first place! If the system were designed and run to encourage and support wellness, Americans would not require so much care. With a wellness orientation, we would be healthier and we would save gazillions! 

Be well, and know that you have to do it yourself--being well can never result from a medical or even a health system, without your leadership and daily involvement.  Always look on the bright side.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of lifestyle habits. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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