What the candidates are missing on health policy
| By Dr. Ronald Hoffman
Amid the frenzy of the current election, both sides are sidestepping the big issues that impact American’s health. It’s a missed opportunity.
COVID-19 provided a shocking wake-up call about our vulnerabilities. Of all the world’s countries, the U.S. bore the brunt of serious illness and death. I tackled some of the reasons for this in a previous article: “Why did the US get hit so hard with COVID-19”
The current dumbed-down political debate boils down to an argument over which party could have better managed the contagion. There are real issues of policy and preparedness, but no clear answers.
Additionally, there’s a big fight about whether to expand our current health care system, the Affordable Care Act (aka “Obamacare”), or dismantle it in favor of other solutions emphasizing freedom of choice and competition.
Then there’s a lot of clamor over how to bring down the cost of drugs—a laudable goal.
What gets missed amid these controversies is that access to health care or more Pharma fixes don’t necessarily equate to better health.
It’s clear from international statistics that we aren’t getting enough bang for our health care bucks. The Harvard Gazette heralds, “U.S. pays more for health care with worse population health outcomes”.
“In 2016, the U.S. spent 17.8 percent of its gross domestic product on health care, while other countries ranged from 9.6 percent (Australia) to 12.4 percent (Switzerland). Life expectancy in the U.S. was the lowest of all 11 countries in the study, at 78.8 years; the range for other countries was 80.7 to 83.9 years.”
Higher health care spending doesn’t equal better results according to a 2018 survey. And a study from the National Bureau of Economic Research entitled “The Effect of Health Insurance on Mortality: Power Analysis and What We Can Learn from the Affordable Care Act Coverage Expansions” found that, while expanding insurance coverage saved people money, they could find no “statistically significant pattern of results consistent with . . . mortality changes.”
What about addressing the fundamental causes of American’s poor health? The current candidates are silent on that issue amid the din of the political campaign.
I’m old enough to remember when a President set an example, urging Americans to embark on 50-mile hikes. That was John F. Kennedy, who in 1960 embodied youthful “vigah”.
He penned a piece for Sports Illustrated touting the importance of “physical soundness” for Americans:
“A single look at the packed parking lot of the average high school will tell us what has happened to the traditional hike to school that helped to build young bodies. The television set, the movies and the myriad conveniences and distractions of modern life all lure our young people away from the strenuous physical activity that is the basis of fitness in youth and in later life,” wrote Kennedy.
Kennedy harkened back to the “bully pulpit” of Theodore Roosevelt, himself an inveterate exerciser, who as early as 1901 inveighed against Americans’ descent into indolence and ease.
A white paper recently published in The American Journal of Clinical Nutrition further highlights the problem:
“More Americans are sick than are healthy, largely from rising diet-related illnesses. These conditions create tremendous strains on productivity, health care costs, health disparities, government budgets, US economic competitiveness, and military readiness. The coronavirus disease 2019 (COVID-19) outbreak has further laid bare these strains, including food insecurity, major diet-related comorbidities for poor outcomes from COVID-19 such as diabetes, hypertension, and obesity . . .”
The problem is compounded by food industry complicity: “COVID Puts a Spotlight on the Food Industry’s Role in Obesity” according to Bloomberg News. They write:
“Industrially processed convenience food, usually loaded with salt, fat, sugar, and additives, makes up more than half of consumed calories in the U.S. and U.K. Foods such as cookies, potato chips, breakfast cereals, and even packaged sliced bread are ubiquitous and make up the core business of many consumer staple companies. For the poorest people, it’s typically what they can afford, and that’s only grown more acute during the pandemic.”
Government subsidies encourage obesity: “ . . . what U.S. farmers are most efficient at producing . . . are just a few highly subsidized crops—wheat, soybeans, and especially corn. Support for these few crops, critics say, has compelled farmers to ignore other crops such as fruits, vegetables, and other grains. The market is flooded with products made from the highly subsidized crops, including sweeteners in the form of high-fructose corn syrup (HFCS), fats in the form of hydrogenated fats made from soybeans, and feed for cattle and pigs. This flood, in turn, drives down the prices of fattening fare such as prepackaged snacks, ready-to-eat meals, fast food, corn-fed beef and pork, and soft drinks. Worse yet, some scientists say, paltry support for foods other than these staples increases the contrast between prices of fat-laden, oversweetened foods and those of healthier alternatives, offering poor folks little choice but to stock their pantries with less nutritious foods.”
No politician has dared to challenge this paradigm, which overwhelms the capacity of our health care system to stem the tide of avoidable disease with expensive high-tech fixes. Oh wait, there was one . . . now relegated to obscurity.
That candidate was Marianne Williamson. Her idealistic proposals on foreign policy and defense and her “New Age” persona doomed her campaign, and I’m by no means aligned with most of her proposals. But reading her platform on health care, I’m impressed with its boldness.
She prefaces it by saying: “Today’s health care system puts an unbalanced focus on treating the symptoms of illness at the expense of treating their cause. Until we ask why so many of us experience chronic illness to begin with – far more than do the citizens of comparably wealthy countries – then we will continue to experience unsatisfactory results in health care.”
Among other things, she calls for:
- Addressing environmental toxicity from pollutants like lead and chemical contaminants
- Eliminating dependency on antibiotics and glyphosate in agriculture
- Promoting access to healthy food
- Encouraging exercise
- Reducing waste by supporting “food recovery”, the distribution of unused fresh healthy food to underserved communities
- Providing more public education around good nutrition and supports for integrating optimal nutrition into our lives
- Increasing research funding related to nutrition so that people stay healthier longer
- Preventing and even reversing many diseases through lifestyle changes
- Constraining the influence of BigPharma on medical education and practice
These are proposals I can get behind!
I would hasten to append:
- Declare a moratorium on the FDA’s and FTC’s assaults on the dissemination of truthful information about the proven benefits of nutritional supplements
- Overhaul our current punitive malpractice system, which inordinately penalizes and demoralizes doctors, and encourages expensive “defensive medicine”, while offering scant protection to patients who suffer harm
- Expand the scope of practice for nutritionally-oriented health professionals who can form a large cadre of “lifestyle practitioners” at the vanguard of Americans’ health restoration
Whatever the outcome of the election, it’s likely these big issues won’t be addressed. But we have to remain steadfastly dedicated to the fulfillment of our goals, despite the political impediments. Intelligent Medicine will be there to advocate for you.
