Dr. James Cocores.

A Solution That Pays For Its Self

Healthcare costs continue to reel out of control well after they were first showcased by the Clintons back in the 1990s. Measures taken back then to correct this problem only demonized medical personnel who serve the public and significantly shrunk the profit margins of healthcare insurance companies, hospitals, and physicians. We now have a glut of overworked and underpaid healthcare workers. Those of us in the field have a tough time encouraging young people to hop on board this sinking ship. Even after many parts of the healthcare system (pharmaceutical industry excluded) have tightened their belts, the revenue vice continues to cripple it. Medicare and Social Security are struggling to pay their bills and those receiving the best healthcare in the world continue to scream "no fair" each time they pay a co-payment or a new fee is added. What happened to: "Ask not what your country can do for you; ask what you can do for your country"?

Even non Freudian psychiatrists would agree with the father of psychoanalysis when he proposed that patients need to pay in order to get well. Most substance dependence treatment centers and self-help groups would add: "No pain, no gain." Although it has never been proven, a national study of medical specialties would find much better treatment outcome results in private practices that enjoy a majority of self-paying patients, than in practices relying almost exclusively on an insured population. The main flaw of such a study would be that people who can afford to pay out of pocket medical costs also are more likely to have healthier lifestyles and not tax the healthcare mill for every scrape and ache.

Many ideas were bandied about in the early 1990s in an effort to curb skyrocketing healthcare costs. One suggestion was to hold cigarette and cigar smokers more accountable for their personal choice to smoke. I recall this aspect of the controversy as the editor of the newly published medical textbook, The Clinical Management of Nicotine Dependence (Springer-Verlag). Almost everyone on the front lines trying to cut healthcare costs back then knew that cardiovascular disease and cancers were among the most costly. Only an almost inaudible minority knew that these two groups of diseases were actually caused by a phantom disease, nicotine dependence, lurking behind the cardiovascular/cancer façade. 

I can still hear the tobacco lobby, the precursor of today's processed foods, oils, grains, beverages and sugar substitutes lobbies, shouting "these are nothing but poorly designed studies leading to inconclusive links between cigarette smoking and disease." Politicians were afraid to speak up in a country that literally gained its independence on the back of the tobacco trade, a little business our ancestors learned from Native Americans, where gold tobacco leaves adorn the columns of Congress and tobacco stimulated not only their minds but also commerce and the economy. Nonsmokers cried, "No fair! Why should we pay for coronary bypasses, cancers, emphysema and other diseases because people chose to take up a disgusting habit?" Smokers yelled the loudest: "It's a free country. You can't tell us what to do," and "I am not paying more for insurance; that's discrimination." There was neither a peep nor a helping hand from the rich pharmaceutical industry that quietly walked away without a stain on its lab coat.

The side stage debates, however, may have been fruitful because today there is a two-tier system regarding price tags on private healthcare and life insurance; one price for smokers and a lower one for people who were treated, stopped or choose not to smoke in the first place. Much more could have been and can be done, however, to have smokers pay for their freedom to choose. For example, cigarette or cigar smokers, and tobacco chewers or dippers receiving Social Security, who are also on Medicare, should have their monthly check reduced by a certain percentage to give them an incentive to stop, while taxing the healthcare system less.

Be that as it may, in today's political arena we have much bigger fish to fry. And although the pre-primary debates present a virtual buffet of very hot issues, healthcare seems to be over on yesterday's hors d'oeuvre table. Who knows, with healthcare costs continuing to tax the national deficit to the tune of hundreds of billions of dollars, maybe soon it will become a special on the political debate menu. Regardless, it would be a good strategy for both Democratic and Republican candidates to keep voter attention away from this steaming topic and on the war, where at least each team is confident that it can win; time will tell. The problem with this strategy, however, is our nation has attention deficit disorder and is not likely to stay focused on the geographically distant issues from now until the very distant Election Day. The fact remains, that healthcare is likely to become an important issue just before we vote because last minute deciders, perhaps the majority of Americans, often vote on pocketbook and living room issues. Candidates will know when to broach the topic of healthcare when their strategists give the green light, which they will get from skewed polls. By skewed I mean biased and inaccurate because participants in a  FOX TV (for example) poll may view issues more off to the right than perhaps participants in a New York Times poll. In any case, poll participants, as a group, are not necessarily reflective of national views as the majority of Americans are too busy to be bothered answering pollsters' questions. In any case, let's begin formulating our own perspectives and solutions to the healthcare crisis before we get bamboozled by agenda driven politico-babble.

Politics aside, I see deja vu all over again, because cardiovascular disease and cancers are still among the largest financial burdens imposed upon our government, economy, commerce, and people. Don't forget type two diabetes, stroke, Alzheimer's, and many other lifestyle-dependent medical disorders draining hundreds of billions of dollars from the increasingly inaccessible American dream pool. Once again the powers that govern purse strings are missing a primary cause for these diseases. What is the common denominator? It's malnutrition, even as it relates to Alzheimer's, in the form of being overweight and obese; the direct result of eating an inordinate amount of over-processed convenience foods. As an expert in the treatment of addictions for over 25 years, I once again am trying to point out that people who are dependent on addictive, over processed foods and additives, the cause of the brain disease popularly known as obesity, need to be held accountable for their choice to over indulge; the best way to persuade them to reconsider their food and lifestyle choices is to charge an Abnormal BMI (Body Mass Index) Fare for those who exercise their right to bulge.

I can hear them now: objections from special interest groups and food and additive lobbyists confidently parroting an intimidating "These comments are from irresponsible scientists who base their comments on poorly designed studies and inconclusive findings" (never mind that there is a squadron of data to support the link between processed foods and additives, and obesity, cardiovascular disease and cancers). Politicians skirt the issue until they know what their flock would graciously accept besides free healthcare and because food and beverage manufacturers stimulate the economy and create jobs; inactive overweight and obese people will be screaming bloody murder. The same ones that typically spout "We all have to die some day!" in response to recommendations made to change their self destructive behaviors, might shout "No Fair! Are you out of your mind? It's a free country. You can't tell me what to eat and what not to eat. I am not paying more for healthcare, that's discrimination." Then there is the eye rolling minority, less than forty percent of the population, who are within their ideal weight range (as determined by the BMI) and whose mantra could be "no good deed will go unpunished" might be heard complaining "Why should we have to help pick up the tab for treating obesity driven diseases in people who have unnecessarily inflicted harm upon themselves by choosing an unhealthy lifestyle?" The pharmaceutical industry might be too busy formulating the next diet pill (a futile effort given that food cravings are stifled only by wholesome nutraceuticals) to weigh in on this issue; where are the candidates that closed many quality hospitals in the 1990s after gripes of $1000 dollar a day hospital stays, to point out that it is not uncommon for prescription medicines to cost more than $30 per pill? Come on guys, can't we pull in that 42 inch belt a notch?

Peanut gallery aside, people who treat addictive food dependence, popularly known as obesity, know that optimal treatment results are achieved by having patients change their eating choices and behaviors and some of the best motivational fuel includes consequences in the form of continuing to pay a fare to stay obese and give financial rewards for those who reach and maintain an ideal weight. Applying this incentive-driven treatment model to the current healthcare system could conceivably cut costs and defeat the nation's biggest terrorist. Let's take a brief look at how a nutritional neuropsychiatrist might take the healthcare crisis and turn it into an opportunity to prevent and treat the most costly diseases facing our nation and simultaneously cut costs:

1. Private health and life insurance companies should be permitted to charge higher rates for the underweight, overweight, obese and morbidly obese accordingly; rates would be adjusted after the patient's insurance company receives,  directly from a treating physician, documentation of a healthier weight sustained for at least six months.

2. The cost of employer-sponsored health or life insurance should be offset by having employees who are outside their ideal weight range have a percentage of their check go towards helping their employer/employer's carrier pay for their healthcare.

3. Elementary, middle and high schools should clean up their lunchrooms and vending machines; get graded lifestyle classes and workshops with homework.

4. Overweight people receiving social security benefits, Medicare, Medicaid and service connected veterans should have a percentage taken off their monthly checks and increased co-payments to offset their higher healthcare costs and more importantly motivate them to reach and maintain an ideal weight.

5. Overweight people receiving food stamps should receive itemized percentages of medicinal foods instead of the current food stamp system that allow overweight people to continue feeding their addictive foods habit with bagged, boxed, bottled, canned, jarred, frozen, and other heavily salted and over processed nutritionally depleted foods. For example, 50% of the stamps each beneficiary is awarded would be green and could only be used to purchase fresh fruits and vegetables, 20% would be white for old fashioned oats, uncooked wild rice, barley, legumes, a small bottle of first press olive oil, multigrain pasta and multigrain bread, and 30% would be colored yellow for minimally processed proteins including unprocessed chicken, flounder, talapia, turkey, Cornish hen, eggs, peas, beans, nuts and seeds.

6. Junk food should follow the same excise tax hike route as cigarettes in an effort to help offset healthcare costs and begin making headway in the obesity epidemic

This thumbnail sketch illustrates how an incentive-driven healthcare system can be both therapeutic and cost-efficient. There are many additional ways to cut healthcare costs and limit self-destructive behavior. For more information, contact James Cocores, M.D., Director of Research, Psyche Nutrition Sciences at PNSI-Inc.com.

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