Make Health Not War

This winter, I have been a contributing blogger for Make Health Not War: Holistic Perspectives on Health Care Policy. Here is a preview of my latest post, which will appear during the week of April 1, 2012.

Dr. Dean Ornish is My (Health) Hero

For 35 years, Dean Ornish, MD, has been advocating a healthy lifestyle to prevent and reverse heart disease. Ornish is a Bay Area cardiologist who, study by scientific study, has amassed a body of evidence that supports the health benefits of a comprehensive approach to wellness. Founder and president of the Preventive Medicine Research Institute, Ornish is a clinical professor of medicine at UCSF, medical editor for The Huffington Post, and a frequent speaker at integrative medicine conferences.

Unlike celebrity doctors who seem as interested in self-promotion as they are in health promotion, Ornish remains dedicated to changing the landscape of health care in America. He wants to “create a new model of medicine that is more caring and compassionate and more cost effective.”(1) That’s why I consider Dean Ornish my hero – my health hero.

Reversing Heart Disease

Ornish’s work first came to my attention in 1998 on a trip east to visit relatives. Following a diagnosis of cardiovascular disease, my godmother’s husband, a vibrant man of 78, had adopted the Ornish program. He and my godmother ate a low-fat, plant-based diet, and played tennis regularly. My husband marveled at the older man’s ability to out-pace and out-distance him on morning walks all over Hilton Head Island. When we returned to California, I bought Ornish’s book and started cooking vegetarian meals a couple of times a week. The recipes were tasty; I continue to use some of them to this day.(1)

More than a Diet Plan

Like many people, I thought Ornish’s prescription for health was simply to eat a low-fat, high fiber, largely vegetarian diet and to get regular exercise. In truth, his Spectrum Lifestyle Program is a holistic approach to health and healing; it addresses the whole person with caring and compassion. Spectrum includes four main aspects: nutrition, stress management, fitness, and love & intimacy. This last piece – human connection and community – is what’s missing in other programs. Ornish writes:

Love and intimacy – our ability to connect with ourselves and others, is at the root of what makes us sick and what makes us well, what causes sadness and what brings happiness, what makes us suffer and what leads to healing.(3)

The healing power of love – what a radical idea for a cardiologist to espouse!

Champion for Change

The seeds Ornish planted decades ago are beginning to bear fruit. In February 2009, Ornish testified before the US Senate Committee on Health, Education, Labor, & Pensions. Reminding Senators that “the mortality rate is still 100%” (i.e., we all will die), he suggested we focus on quality of life not just length of life. Using cardiovascular disease as an example, he explained that instead of spending more than $100 billion on coronary angioplasty and bypass surgeries and $20 billion on cholesterol-lowering drugs each year, as we do now, we could cut costs dramatically by substituting inexpensive preventive care. Not only are high-tech medical interventions very expensive, but in peer-reviewed studies, they were shown to be less effective than lifestyle modification in preventing heart attacks and prolonging life.(4)

It’s hard to argue with outcome improvements and cost reductions. By 2000, 40 insurance companies were reimbursing the cost of the Ornish Program for Reversing Heart Disease.(1) By mid-2010, Medicare Part B was providing coverage for cardiac patients who meet certain criteria to participate in Intensive Cardiac Rehabilitation (the Ornish and Pritikin programs) at certified sites.(5) As of this writing, only a handful of sites are certified.(6) However, if comprehensive programs like Ornish’s were covered by the Patient Protection and Affordable Care Act, access would improve considerably.

Addressing the Root Cause

Those of us who are studying holistic health education are not surprised that a holistic approach works, and works well. We believe that health care goes far beyond disease care. We educators are part of an integrated team approach that empowers individuals to make informed choices about their health.

Using functional medicine’s metaphor of the tree as our model, we understand that Western medicine concerns itself largely with the leaves – symptoms of disease – while holistic, integrative, and functional medicine engages in weeding and fertilizing – addressing the root cause of disease and health.

Integrative Care for All

After studying holistic health education for nearly three years, I support a new paradigm for health care, now more than ever. I believe in a holistic approach that is grounded in caring – one that includes self-care, preventive care, and medical care. Integrative care is the pathway to a healthier nation, as Ornish testified. The challenge today is to provide access to integrative care for all Americans. Fortunately, integrative health care is far more cost effective than disease care. As a nation, we can afford it. In fact, we can afford nothing less. Now we need to convince our lawmakers to rewrite our health care policy accordingly. I plan to ask my representatives to deliver just what the doctor – Dr. Ornish – ordered: caring, compassionate, and cost effective health care. Will you join me?

What’s your opinion? Please share your comments.

References

(1) Ornish, D. (2000). Health. In M. Williamson, ed. Imagine what America could be in the 21st century: Visions of a better future from leading American thinkers (pp. 44-54). Emmaus, PA: Daybreak/Rodale.

(2) Ornish, D. (1990). Dr. Dean Ornish’s program for reversing heart disease. New York: Ballantine Books.

(3) Ornish, D. (n.d.). Spectrum program (Love & Intimacy tab, ¶ 2). Retrieved from Preventive Medicine Research Institute: http://www.pmri.org/lifestyle_program.html

(4) Ornish, D. (2009). Integrative care: A pathway to a healthier nation (Senate Health Reform Testimony). Washington, DC: U.S. Senate. Retrieved February 1, 2012 from http://www.help.senate.gov/hearings/hearing/?id=03629575-0924-cb2e-13cb-68a8065ababb

(5) Ornish, D. (2010). How to transform your lifestyle and your life, part 1. Retrieved February 20, 2012 from http://www.huffingtonpost.com/dr-dean-ornish/how-to-transform-your-lif_b_577486.html

(6) Ornish, D. (n.d.). Retrieved February 20, 2012 from Preventive Medicine Research Institute: http://www.pmri.org/certified_programs.html

                                                                                                                                                                

Here is a copy of my 2nd post, which appeared originally on March 1, 2012.

Putting Health Back Into Health Care

Consider for a moment your interactions with the American health care system. If you don’t feel well, you may try to self-diagnose and self-medicate in order to feel better. If you’re really sick, you may go to the doctor. Your doctor may examine you and run some tests to learn or confirm what’s wrong. After making a diagnosis, your doctor may prescribe medication, offer instructions for self-care, and send you on your way. If you’re really sick, you may be admitted to the hospital.

Have you noticed that a diagnosis is the key to our health care model? Without a diagnosis, the doctor won’t treat. Without a diagnosis, the insurance company won’t pay for services. That may seem okay on first glance. However, diagnosis implies disease. We are practicing disease care in this country. If Dr. Phil were to ask, “How’s that working for you?” we’d have to admit, “Not very well.”

We’re Losing the War on Disease

Politicians like to declare war on social problems. It rallies the troops to their side, solidifying their power base. It gives the public a false sense of security that the government is doing something to help. Remember the “War on Drugs?” How well did “Just say no” work? What about the “War on Cancer?” Do you remember that one? I’m guessing the answer is no; we lost that war – badly. Today, there’s a “War on Diabetes,” and we’re losing that one, too.[1]  What’s the alternative?

Optimal Well-being

Before we talk about a new approach to health care, let’s take a moment to define what we mean by health. The World Health Organization suggested, “Health is more than the absence of disease. Health is a state of optimal well-being.”[2] The American Holistic Health Association elaborated:

Optimal well-being is a concept of health that goes beyond the curing of illness to one of achieving wellness. Achieving wellness requires balancing the various aspects of the whole person. These aspects are physical, emotional, mental, and spiritual. This broader, (w)holistic approach to health involves the integration of all of these aspects and is an ongoing process.[3]

Described in this way, it’s clear that our health care system is lacking.

Imagine Another Dimension

Imagine, if you will, another dimension, “a dimension not only of sight and sound but of mind.”[4] No, we’re not entering the Twilight Zone, but more of a health zone. We’re talking about an alternate reality that could have been ours if 19th century scientists had adopted Béchamp’s theories along with Pasteur’s. We’ve all heard of Louis Pasteur, the father of microbiology and germ theory. But, who was Béchamp? My point exactly.

Pierre Jacques Antoine Béchamp, courtesy of wikipedia

Today, it’s not easy to find information on Pasteur’s rival, Pierre Jacques Antoine Béchamp.[5] According to Dr. Len Saputo, a leader in the field of integral-health medicine, Béchamp believed that unhealthy lifestyle factors, including stress and a poor diet, create the “terrain” that makes us vulnerable to disease. To be healthy, we need to strengthen “our natural defenses.”1

Saputo suggested we look at health as a continuum, ranging from perfect health at one end to death at the other.

The Wellness Buffer (Saputo, 2009, p. 141)

As he pointed out, Western medicine focuses on disease care – the part of the spectrum where symptoms are present. The other end of the spectrum – “the wellness buffer” – is largely ignored. Therefore, to change our approach to one of true health care, we need to promote health along the entire functional spectrum of wellness and disease.1

Changing Our Paradigm

Our forebears missed an opportunity when they favored Pasteur over Béchamp, ignoring the wellness buffer and the importance of a healthy lifestyle. However, it’s not too late for us. We can start by practicing good self-care. Dr. Jim Gordon, head of the Center for Mind-Body Medicine (CMBM), preaches “Self-care is primary care.” Gordon promotes an integrated approach to health and healing, one that includes self-awareness along with diet and exercise. CMBM trains health professionals so they can, in turn, teach their clients and patients a comprehensive set of “life skills,” including stress management techniques.[6]

Today’s mind-body medicine addresses the whole person – body, mind, and spirit. By providing a range of tools for self-care, this health-based model empowers each of us, as individuals, to take responsibility for our own health and well-being. Unfortunately, most health insurance policies do not cover many complementary and alternative therapies much less training in self-care techniques. Today, we pay out-of-pocket for health promotion, while politicians continue to debate the details of health care reform. Stuck in an outdated paradigm, our representatives and candidates for president don’t realize that they are missing the point. They are attempting to find solutions to the wrong problems; they are waging war on disease instead of creating health for Americans.

It’s time for Congress to go beyond disease care; it’s time for them to embrace – and fund – holistic health care that promotes optimal well-being. How would that work? If self-care is part of the solution – and I believe it is – then we need coverage for self-care. We can start by teaching Americans how to be and stay healthy. We don’t have to reinvent the wheel on this one. Many high quality educational programs exist. We just need to get the information out there – in a big way – for very little or no cost to the consumer. In the short term, that means getting insurance companies and employers to foot the bill for nationwide implementation.

In the long term, when we enact comprehensive national health care policy, health education and health promotion need to be among the major components. By synthesizing the best practices in holistic health education to strengthen our natural defenses, we can deliver a fully integrated model of health care to our citizens.

What’s your opinion? Please share your comments.


[1] Saputo, L. (2009). A return to healing: Radical health care reform and the future of medicine. San Rafael, CA: Origin Press.

[2] World Health Organization. (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Retrieved from http://www.who.int/suggestions/faq/en/

[3] American Holistic Health Association. (2007). Wellness from within: The first step. Retrieved from http://ahha.org/WellnessBooklet.pdf

[6] Gordon, J.S. (2009). Manifesto for a new medicine: Your guide to healing partnerships and the wise use of alternative therapies (p. 17). Reading, MA: Perseus Books.

                                                                                                                                                                      

Here is a copy of my first post, which appeared originally on February 6, 2012.

Kaiser for Everyone: A Single-Payer Solution

Americans agree that our health care system is broken. We don’t agree on what to do about it. I have the solution: Put all Americans on the Kaiser Permanente system. Yes, that constitutes a single-payer system. And, guess what? Along with better access, it also means better quality care for an affordable price.

I Speak from Experience

When I write about quality care and affordability, I speak from experience. For a woman my age (52), I have been hospitalized more times than most. I had five surgeries in the five years before I turned 50. My experience with medical care and hospitalization while privately insured – even with a “Cadillac” company-paid plan – stands in stark contrast to my experience in the Kaiser system.

Private Insurance Woes

I drove myself to the E.R. of my local community hospital one Sunday night when a nagging pain in my lower abdomen wouldn’t go away. I suspected diverticulitis; my sister, the nurse, suspected an ulcer. The E.R. physicians put me through a battery of tests, including a costly CT scan. Their findings? Appendicitis. They admitted me. I was pronounced stable, and the chief of surgery was scheduled to operate on me in the morning (mistake #1). More than 18 hours after I arrived at the E.R., I was finally prepped for surgery (mistake #2). By the time the surgeon started laparoscopic surgery (mistake #3), my gangrenous appendix had ruptured. My abdominal cavity had turned into the embodied equivalent of a Superfund site – a toxic mess that was difficult to clean up.

Without boring you with the details, let me just say that the next nine months were hell. I was in and out of the hospital multiple times for recurring peritoneal infections. Finally, I had another surgery (with a different surgeon in a tertiary care center) to remove scar tissue and a suspected abscess. I missed a lot of work – and a lot of life. Six weeks after I returned to work for good, my job was eliminated. Not only did I lose my primary source of income, but altogether, I spent $10,000 out-of-pocket for this experience. That was my share – the 20% that my top-of-the-line insurance didn’t cover.

Kaiser Care

After I lost my job, I went on COBRA and switched into the Kaiser system. Within a year’s time, a routine mammogram spotted something abnormal. A biopsy revealed early-stage breast cancer. A team of doctors met to review my case. They recommended a mastectomy with reconstruction. I did my own research before making my decision. My Kaiser surgeon – the head of the Breast Care Center – trained at UCSF where the recommended state-of-the-art treatment for my condition originated. I felt confident that I would get world-class care, and I did. I breezed through two surgeries and was pronounced cured. The cost to me? Less than $500. Even factoring in monthly COBRA premiums over six months, I spent about $2,500 in total.

Night and Day

The difference between the two experiences – private insurance and Kaiser – was night and day. In the first, a series of mistakes, lack of coordinated care, sub-standard hospital conditions, and perhaps a little bad luck contributed to a very unpleasant and very expensive ordeal. In the second, a team of physicians delivered excellent care at a fair price. It was as positive an experience as breast cancer could be. Now you may understand why I’m a huge advocate for Kaiser. I do not stand alone.

Don’t Take My Word for It

If you have read this far, you may be thinking, “I doubt that every Kaiser patient is that positive about her experience.” You may be right. So, don’t take my word for it. Look at the facts:

  • 18 Kaiser Permanente Hospitals were named “2011 Top Hospitals” by the Leapfrog Group, an organization whose standards are consistent with measures used by The Joint Commission, National Quality Forum and Centers of Medicare & Medicaid Services.
  • Kaiser Permanente received No. 1 rankings for 2011 in 11 effectiveness-of-care measures, more than any other health plan in the nation.
  • Kaiser Permanente’s Medicare health plans received a 5-star rating from the Centers for Medicare & Medicaid Services, the highest ranking possible, in five of its regions.
  • Kaiser Permanente was rated by the National Committee for Quality Assurance as having the four highest-ranked Medicare health plans in the nation and four of the top 25 Private (Commercial) health plans.

Kaiser management credits their success to their “commitment to high quality care and service,” and to “continuous improvement.”[1]

Thus, by several measures, Kaiser ranks high in quality. This begs the question, how does Kaiser deliver quality care for an affordable price?

How Kaiser Works

Kaiser Permanente is one of the largest, not-for profit health care organizations in the country. It is both an integrated delivery system and an insurance provider. Considered a “closed” system, Kaiser doctors and facilities serve only those patients who are members. In other words, to be treated by Kaiser, you must have insurance coverage with Kaiser – through an individual, group (employer) or government (e.g., Medicare) plan. The insurance arm collects premiums from members and makes capitated payments (set payments per member per month) to the medical group arm, which pays salaries to physicians and staff.[2]

What’s the benefit? According to Kaiser:

Physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.[3]

The beauty of the system is that it removes any financial incentive for doctors to overtreat patients. In fact, doctors are rewarded for keeping costs low while keeping quality high.

What’s Next?

Unfortunately, given the partisan politics in Washington – especially during an election year – I don’t hold high hopes for a national solution to the health care debacle any time soon. However, if Kaiser Permanente were inclined to expand their operations, we could solve the problems of access, quality and affordability without any help from the politicians.

What’s your opinion? Please share your comments.


[1] J. Weissberg, MD, Kaiser Permanente press release, December 6, 2011. Retrieved from Kaiser Permanente News Center on January 26, 2012: http://xnet.kp.org/newscenter/clinicalexcellence/2011

[2] McCarthy, D. (2011). Chpt. 10, Integrative models and performance, pp. 205-231. In A.R. Kovner & J.R. Knickman, Eds. Jonas & Kovner’s health care delivery in the United States. (10th Ed.) New York: Springer Publishing.

[3] Fast Facts about Kaiser Permanente. Retrieved from Kaiser Permanente News Center on January 26, 2012: http://xnet.kp.org/newscenter/aboutkp/fastfacts.html

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