Brian Toomey is a resident of Dancing Rabbit, the founder of search engine optimization firm JB Web Analytics, and my partner at sustainablog. On the surface, this may see off-topic, but, as you’ll see, Brian makes a clear connection between the health care debate and environmental issues.
- It may reinforce our cultural denial of death: Ray Kurzweil style futurism not withstanding, we are all acutely mortal. And yet culturally we strive so hard to deny this. In 2008 Medicare paid $50 billion for hospital and doctor bills related to the last 2 months of care, with a large proportion of this spent on unrealistic tests and drastic measures meant to squeeze out several days or weeks of life. My fear is that the quality of life for these extremely costly additional days is quite low, often spent in the ICU where 20% of adults now die. I would love to see us exploring ways to die at home (with hospice support if necessary) saving billions, shifting culture, and increasing dignity in the process.
- Western health care may not be as effective as we think: A World Bank study found that public health spending “explains less than one-seventh of 1% of the observed differences in mortality across countries,” that many developing countries have found ways to avert child mortality at less than 1/100th of the cost, and that “95% of cross-national variation in mortality can be explained by a country’s income per capita, inequality of income distribution, extent of female education, level of ethnic fragmentation, and predominant religion.” The Indian province of Kerela, for instance, has comparatively high income/gender equality and adult literacy (97%+), and has a life expectancy comparable to that of the US (75 vs 77.7 years). This is despite the fact that the GDP per capital for Kerela is well under $1,000 per year.
- It forces me to subsidize treatments I do not support: I spent several years of my life working with adults struggling with chronic psychosis. Most of them were medicated on a class of drugs called neuroleptics, which, after reviewing the evidence carefully, I believe quite often do more harm than good (see Robert Whitaker’s excellent Mad in America for a review). I am uncomfortable having my tax dollars support treatments that I believe are ultimately harmful, and, unfortunately, see this as a sizable portion of current American health care spending.
- It obscures the need for social and lifestyle shifts: In his excellent book Healthy at 100 John Robbins outlines the qualities of societies with a large number of people living healthy, vibrant lives at over 100 years old. The defining factors were access to sanitary living conditions, eating a plant based whole foods diet, regular exercise, avoiding drug abuse, and robust social connection and support. I am much more excited about building culture and choice architecture to support these factors than funding our current health care system as is. Which brings me to the next point…
- I value a cultural balance between rights and responsibilities: When Gandhi was asked what he thought of the Universal Declaration of Human Rights he replied, “all rights to be deserved and preserved come from duty well done.” I agree. If we have rights from other beings, then by extension we have duties toward them. I’ve struggled with weight gain my whole adult life, and when I watched Michael Moore’s Sicko I felt concerned that there was not more emphasis placed on personal responsibility. I would have loved to see him spend some time in the movie empowering himself to take care of his own health through eating fresh local produce and exercising. To my mind the normal progressive narrative is overly focused on social provisions for allopathic care, especially when demography shows that lifestyle changes can often be much more potent in extending life and healthspan.
- Our current practice of medicine is often toxic: Contrasted against lifestyle-based medicine (think walks in the parks, time with family, plenty of rest, and farmer’s markets) current medical practice consumes huge amounts of physical resources, and releases tons of waste into the environment, including dioxins and heavy metals.
- I would rather see the money go to directly support communities and ecosystems: Estimates of what it would cost to provide basic education, nutrition, shelter, and clean drinking water to the entire world run from 20 to 40 billion. Moreover, universal female access to education and decreased income inequality a 40 billion dollar global initiative would provide would almost certainly end population growth within 15 years, which I believe to be the single most important thing we could do to preserve our health as a species and biome.
When I meditate on my personal health, I see it as inextricably linked with that of the biosphere and global population. For me, universal health care is 95% about access to a fresh produce plant based diet, protection of biodiversity and natural capital, and a more just socio-economic world world, and I would love to see progressives steering the debate in this direction.
Do you have any suggestions for how to eat and exercise for health?
Really? So all those people with congenital or environmentally-triggered diseases are just out of luck?
I would love to see progressives who aren’t so self-centered and ideological as to believe that the entire world conforms to their own experiences and attitudes.
Our healthcare system is in bad need of reform – including many of the ideas you’ve suggested here. But poo-pooing the entire process just because you don’t think your opinion will win out is just childish.
Wellescent Health Blog
This is an interesting read, but in my mind, these 7 reasons are concerns that need to be addressed as the next step after having achieved some form of universal coverage. To the point of Ken above, there are numerous people who become ill through no known fault of their own and without some form of societal protections are left at the mercy of their condition.
That said, we do need to achieve significant efficiencies out of any health care system by promoting healthy lifestyle and individual responsibility, but not in the unsuccessful form of government advertisements. Based on the best research that I have seen, financial incentives and disincentives seem to be the most effective means to attain this. If we make it less costly to eat right and exercise than not to, the investments in such incentives will be more than paid for by the savings in health costs. This directly translates to less resources and use of toxic and generally polluting materials that damage the environment.
Robert Whitaker is about to release an even more comprehensive look at how psychiatric drugs tend to perpetuate and cause chronicity…it’s a darn good book.
He writes a synopsis of it here:
it’s available for preorder now and will be in bookstores on April 13th. Anyone who is interested in psychiatry and mental health needs to read Whitaker’s work.
I was very happy to see this article. I have had great reservations about health care reform as well and as a good liberal I felt stymied and never said a word about my concerns. You’ve stated them very well and I appreciated it. I’ve shared your piece with my networks and will put a link to it on the blog in the next day or two.
nice to find you. I followed you on twitter too.
Most of your thoughts are logically correct and are worthy goals but are irrelevant to universal health care. The system as-is is woeful — both at the public end and the medical end. The new program is also flawed and can do little to correct either problem; and the possibility of a new governmental monstrosity is very real. There is no way to legislate or governmentally guide people to the cultural utopia your ideas represent. If people are incapable of recognizing what is in their best interest and how they can achieve it — their own and the planet’s health and well being — how can the government do it? Would you praise or respect a government that does nothing because it can’t make things perfect? The health-care system needs total reform — from medical education to hospital protocols — but that’s a far more sensitive and intractable issue than regulating financial institutions, and it’s not about to happen. The lifestyle and culture of public health also need total reform, but it’s also inconceivable how that could happen. People cannot be criticized for not wanting to die, even if they are already dying. A government that supports their hopeless wishes may be more compassionate than prudent, but is that not consistent with our supposedly fundamental belief in human rights? The main point is that people should not be excluded from health care, regardless of how stupid they are or how broken the system is. It is indeed regrettable that it hugely increases the windfall for the medical industry and that it does about nothing to prevent the social, economic and lifestyle problems responsible for many of the health conditions. Everything needs to be fixed but not everything can be; paying for it all seems like it can be — could be better, but this will certainly help — so we should take it with gratitude and now focus on making it better. I mean, it’s not like there was any political choice between health care and the things you advocate. If you can figure out what kind of program will achieve all or any of your objectives, good luck. I hope they all come to be. But I’m grateful that I don’t have to wait to get health care until they are all codified.
@Ken, I didn’t say I would not vote for universal health care (if pressed I probably would reluctantly), I just wanted to say that I believe progressives are mistaken in letting the issue be contextualized as it has. I do my best to care deeply about the suffering of all beings. I am saying we should also look to have cleaner communities os that environmentally triggered disease happens more rarely, and any health care debate that leaves this off the table is woefully inadequate.
@BeyondMeds, Yes, I am excited by Whitaker’s coming book, and thanks for the link! I’ve followed your blog as well.
@John, I prefer not to think of it not in black and white terms of intractability.
Expenditures in the United States on health care surpassed $2.3 trillion in 2008, roughly 100x what it would cost to provide for the basic needs of all humans. Lets cut health care 5%, and use that money to get everybody in the world clean drinking water, food, education, vaccines, and get population under control. That is a much healthier world in my book. Then, lets all do our best to take personal responsibility for our health. I would be grateful to see those two steps integrated into the debate.
I’m not pleased with health care reform as passed…
It will only increase the use of drugs as the first course, and often only course of disease management…
In the area of psychiatry, it will mean that we all continue to pay for ineffective “treatments” – drugs that are clinically no better than placebo, drugs that have been illegal researched and marketed, drugs that do not work, and cause much more harm than good in the long-term use.
Duane Sherry, M.S., CRC-R