Sunday, January 28, 2007

modern healthcare

I'm having to read quite a bit on healthcare for my current job. "Having to" is an exaggeration, as the truth is that I've been tossed into reading endless documents and trying to pluck out relevant information for clients that I hardly know about and have never actually met. Thus in order to make sense of what I'm doing, I read as much as I can in my spare time in the office.

I've often thought of picking up the equivalent of "healthcare for dummies" to read over, but I'm not sure such a tome exists, nor am I sure it exists outside of the 100$+ world of largely unreadable textbooks. Instead I've turned to the second easiest outlet: blogs. There are a surprising number of healtcare blogs out there, with many written by hospital management, healthcare consultants, and individuals in the insurance industry. It's interesting reading the back and forth between them, especially given the current initiatives in Massachusetts, California, and in the Federal government.

In my own mind I've continually compared the healthcare crisis to the problems facing the modern American school system, namely, there's lots of snake oil and frequent shameful comparisons to the rest of the industrialized civilization. Unlike education though, healthcare has the added problem of being an inconcievably large industry with many players that all have their own lobby. Despite the gap in money being involved, there is one overarching nuance that I believe the two have in common: you could throw every single economist in the world at each and you would not come out with a solution to their problems. Why? Well, until today I couldn't really tell you. It just seemed like whatever problems they had weren't rooted in concepts that economics is suited to solve, and keep in mind this is coming from someone who would sincerely like to go back in time and replace at least his undergraduate degree with one in economics. These are not problems that are solved via transactions but via a perspective behind the transactions that can't really be quantified, at least not by the traditional economic thought that goes into policymaking. (To that end, I suppose the problem is more that of any science, namely that the wrong people use it the wrong way. But I digress.)

Today I stumbled across something that encapsulated much of my recent thinking. The article was not directly about healthcare, but it touched on related issues. The article, "Unhappy Meals" by Michael Pollan, was published recently in the New York Times and essentially argues that "Nutritionism" is to blame for America's dietary failings. That is, focusing on components instead of the whole, the vitamin and not the food, is harmful and is largely to blame for recent diabetes and cardiovascular disease epidemics. It struck a chord with me not only because it mentioned issues severely effecting the healthcare industry, but also because permeating the article was an argument against reductionism. Pondering all this tonight, I wonder now if the current American belief in our ability to micromanage everything, from our calcium intake to our children's education to a land war on another continent, has really been the thought on the tip of my toungue.

The real money quote from the article is the following:
"It might be argued that, at this point in history, we should simply accept that fast food is our food culture. Over time, people will get used to eating this way and our health will improve. But for natural selection to help populations adapt to the Western diet, we’d have to be prepared to let those whom it sickens die. That’s not what we’re doing. Rather, we’re turning to the health-care industry to help us “adapt.” Medicine is learning how to keep alive the people whom the Western diet is making sick. It’s gotten good at extending the lives of people with heart disease, and now it’s working on obesity and diabetes. Capitalism is itself marvelously adaptive, able to turn the problems it creates into lucrative business opportunities: diet pills, heart-bypass operations, insulin pumps, bariatric surgery. But while fast food may be good business for the health-care industry, surely the cost to society — estimated at more than $200 billion a year in diet-related health-care costs — is unsustainable."

Joe Paduda, a principal in the consulting group Health Strategy Associates, recently asked in a blog entry where the starting point for healthcare reform should be. I'm now going to go out on a limb and propose my own snake oil: lets start with healthier people that need less care in the first place, rather than continuing down this circuitous path we've made for ourselves. Obviously this isn't meant as a single cure all for every issue and is in fact a comprehensive perspective shift on behalf of our entire culture. Furthermore having healthier people that eat less (for lack of a better word) crap means less money flowing through a large sector of our economy, and we simply can't have that overnight. What we can have is a gradual shift towards a healthier society, and not with softball "eat more of ____" tactics that have been the official standpoint of the Feds for the past 20 years.

Perhaps I have a bit of a bias, as I am 90% vegetarian (or as I found out tonight, a "Flexitarian") and eat meat essentially once every two weeks. I had been making it my goal to consume as much raw food as possible when I had an unfortunate brush with the Florida Bar Exam and essentially lived off of coffee and anything microwaveable for several months. In closing, I'm taking this opportunity to get back on the wagon and I'd like to invite anyone out there to join me.


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